|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9825223401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$457.07 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Aetna of VT Commercial |
$980.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$924.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$457.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$924.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$621.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$835.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$820.44
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$825.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$825.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$825.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$464.40
|
| Rate for Payer: Multiplan Commercial |
$959.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$877.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$464.40
|
| Rate for Payer: United Healthcare Commercial |
$980.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.40
|
| Rate for Payer: United Healthcare VA CCN |
$464.40
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9825223401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$763.78 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Aetna of VT Commercial |
$980.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$763.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$763.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$825.60
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cigna Commercial |
$825.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$825.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$825.60
|
| Rate for Payer: Multiplan Commercial |
$959.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$877.20
|
| Rate for Payer: United Healthcare Commercial |
$980.40
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$2,011.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,069.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,019.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,011.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,011.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,011.26
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Cash Price |
$569.00
|
| Rate for Payer: Cigna Commercial |
$323.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,141.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,141.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.30
|
| Rate for Payer: Multiplan Commercial |
$1,058.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.28
|
| Rate for Payer: United Healthcare Commercial |
$286.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.28
|
| Rate for Payer: United Healthcare VA CCN |
$186.28
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$2,082.10 |
| Rate for Payer: Aetna of VT Commercial |
$2,082.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,984.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$144.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,984.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$196.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$590.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$590.30
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$243.88
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$464.93
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$464.93
|
| Rate for Payer: Martins Point Health Care Commercial |
$285.62
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$199.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare Commercial |
$216.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.44
|
| Rate for Payer: United Healthcare VA CCN |
$140.44
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$368.94 |
| Max. Negotiated Rate |
$791.35 |
| Rate for Payer: Aetna of VT Commercial |
$791.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$368.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$746.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$501.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$674.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$374.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$662.24
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: Cigna Commercial |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$666.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$666.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$374.85
|
| Rate for Payer: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.05
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$374.85
|
| Rate for Payer: United Healthcare Commercial |
$791.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$374.85
|
| Rate for Payer: United Healthcare VA CCN |
$374.85
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,474.77 |
| Max. Negotiated Rate |
$4,460.25 |
| Rate for Payer: Aetna of VT Commercial |
$4,460.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,474.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,474.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,990.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,943.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,756.00
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,756.00
|
| Rate for Payer: Multiplan Commercial |
$4,366.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,990.75
|
| Rate for Payer: United Healthcare Commercial |
$4,460.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,079.42 |
| Max. Negotiated Rate |
$4,460.25 |
| Rate for Payer: Aetna of VT Commercial |
$4,460.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,079.42
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,826.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,990.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,802.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,112.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,732.53
|
| Rate for Payer: Cash Price |
$2,347.50
|
| Rate for Payer: Cigna Commercial |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,756.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,756.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,112.75
|
| Rate for Payer: Multiplan Commercial |
$4,366.35
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,990.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,112.75
|
| Rate for Payer: United Healthcare Commercial |
$4,460.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,112.75
|
| Rate for Payer: United Healthcare VA CCN |
$2,112.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$4,741.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
5105223401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,508.81 |
| Max. Negotiated Rate |
$4,503.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,503.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,508.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,508.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,029.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,982.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,792.80
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cigna Commercial |
$3,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,792.80
|
| Rate for Payer: Multiplan Commercial |
$4,409.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,029.85
|
| Rate for Payer: United Healthcare Commercial |
$4,503.95
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,121.18 |
| Max. Negotiated Rate |
$8,839.75 |
| Rate for Payer: Aetna of VT Commercial |
$8,839.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4,121.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5,601.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,909.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,537.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4,187.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,397.48
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cigna Commercial |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,444.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$4,187.25
|
| Rate for Payer: Multiplan Commercial |
$8,653.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,909.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4,187.25
|
| Rate for Payer: United Healthcare Commercial |
$8,839.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,187.25
|
| Rate for Payer: United Healthcare VA CCN |
$4,187.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$5,721.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
5105223501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$5,377.74 |
| Rate for Payer: Aetna of VT Commercial |
$5,377.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,125.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,125.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$372.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.93
|
| Rate for Payer: Cash Price |
$2,860.50
|
| Rate for Payer: Cash Price |
$2,860.50
|
| Rate for Payer: Cigna Commercial |
$463.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$439.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$439.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.87
|
| Rate for Payer: Multiplan Commercial |
$5,320.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare Commercial |
$408.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare VA CCN |
$265.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$522.18 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$522.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,056.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$709.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$954.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$530.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$937.30
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$943.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$530.55
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$530.55
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$530.55
|
| Rate for Payer: United Healthcare VA CCN |
$530.55
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$872.58 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$943.20
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$692.73 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna of VT Commercial |
$889.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$748.80
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$3,570.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
9825233201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$2,642.16 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Aetna of VT Commercial |
$3,391.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,642.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,642.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,034.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,998.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,856.00
|
| Rate for Payer: Cash Price |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$2,856.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,856.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$3,320.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,034.50
|
| Rate for Payer: United Healthcare Commercial |
$3,391.50
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
5105222401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$3,344.52 |
| Rate for Payer: Aetna of VT Commercial |
$3,344.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$191.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,187.61
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$260.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,011.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,011.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$214.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,011.26
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$323.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,141.76
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,141.76
|
| Rate for Payer: Martins Point Health Care Commercial |
$706.30
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$264.52
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$186.28
|
| Rate for Payer: United Healthcare Commercial |
$286.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.28
|
| Rate for Payer: United Healthcare VA CCN |
$186.28
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$879.84 |
| Rate for Payer: Aetna of VT Commercial |
$879.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$372.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.93
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$463.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$439.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$439.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.87
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare Commercial |
$408.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare VA CCN |
$265.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$586.84 |
| Max. Negotiated Rate |
$1,258.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,187.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$586.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,187.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$797.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,126.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,073.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,053.38
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,060.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$596.25
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,126.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$596.25
|
| Rate for Payer: United Healthcare Commercial |
$1,258.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$596.25
|
| Rate for Payer: United Healthcare VA CCN |
$596.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$7,577.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,355.85 |
| Max. Negotiated Rate |
$7,198.15 |
| Rate for Payer: Aetna of VT Commercial |
$7,198.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,355.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,788.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,561.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,440.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,137.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,409.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,023.72
|
| Rate for Payer: Cash Price |
$3,788.50
|
| Rate for Payer: Cigna Commercial |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,061.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,061.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,409.65
|
| Rate for Payer: Multiplan Commercial |
$7,046.61
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,440.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare Commercial |
$7,198.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,409.65
|
| Rate for Payer: United Healthcare VA CCN |
$3,409.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9825228101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$784.90 |
| Rate for Payer: Aetna of VT Commercial |
$784.90
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$748.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$145.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$748.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$197.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$750.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$750.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$162.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$750.13
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$245.25
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$472.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$472.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$290.26
|
| Rate for Payer: Multiplan Commercial |
$776.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$200.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$141.22
|
| Rate for Payer: United Healthcare Commercial |
$217.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.22
|
| Rate for Payer: United Healthcare VA CCN |
$141.22
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
9825226001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$194.27 |
| Max. Negotiated Rate |
$608.18 |
| Rate for Payer: Aetna of VT Commercial |
$608.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$579.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$200.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$579.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$271.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$364.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$364.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$223.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$364.48
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$338.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$321.96
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$321.96
|
| Rate for Payer: Martins Point Health Care Commercial |
$194.28
|
| Rate for Payer: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$275.86
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$194.27
|
| Rate for Payer: United Healthcare Commercial |
$298.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.27
|
| Rate for Payer: United Healthcare VA CCN |
$194.27
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,338.07 |
| Max. Negotiated Rate |
$5,015.05 |
| Rate for Payer: Aetna of VT Commercial |
$5,015.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,729.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,338.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,729.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,177.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,487.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,275.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,375.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,196.81
|
| Rate for Payer: Cash Price |
$2,639.50
|
| Rate for Payer: Cigna Commercial |
$4,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,223.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,375.55
|
| Rate for Payer: Multiplan Commercial |
$4,909.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,487.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,375.55
|
| Rate for Payer: United Healthcare Commercial |
$5,015.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,375.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,375.55
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$6,744.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
5105221401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$6,339.36 |
| Rate for Payer: Aetna of VT Commercial |
$6,339.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,041.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,041.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$225.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,829.05
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cigna Commercial |
$279.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,090.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,090.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$675.45
|
| Rate for Payer: Multiplan Commercial |
$6,271.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.21
|
| Rate for Payer: United Healthcare Commercial |
$247.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.21
|
| Rate for Payer: United Healthcare VA CCN |
$161.21
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
5105228501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$576.29 |
| Rate for Payer: Aetna of VT Commercial |
$568.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$542.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$187.13
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$542.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$254.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$576.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$576.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$208.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$576.29
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$315.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$512.25
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$512.25
|
| Rate for Payer: Martins Point Health Care Commercial |
$313.05
|
| Rate for Payer: Multiplan Commercial |
$562.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$257.99
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$181.68
|
| Rate for Payer: United Healthcare Commercial |
$279.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.68
|
| Rate for Payer: United Healthcare VA CCN |
$181.68
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$980.63 |
| Max. Negotiated Rate |
$1,258.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$980.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$980.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,126.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,113.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,060.00
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,060.00
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,126.25
|
| Rate for Payer: United Healthcare Commercial |
$1,258.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$6,744.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
5105221401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,991.23 |
| Max. Negotiated Rate |
$6,406.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,406.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,991.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,991.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,732.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,664.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,395.20
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cigna Commercial |
$5,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,395.20
|
| Rate for Payer: Multiplan Commercial |
$6,271.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,732.40
|
| Rate for Payer: United Healthcare Commercial |
$6,406.80
|
|
