|
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
|
OP
|
$3,570.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
9825233201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,581.15 |
| 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 |
$3,198.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,581.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,198.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,149.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,034.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,606.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,838.15
|
| 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: Martins Point Health Care Commercial |
$1,606.50
|
| Rate for Payer: Multiplan Commercial |
$3,320.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,034.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,606.50
|
| Rate for Payer: United Healthcare Commercial |
$3,391.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,606.50
|
| Rate for Payer: United Healthcare VA CCN |
$1,606.50
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$3,558.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
5105222401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,633.28 |
| Max. Negotiated Rate |
$3,380.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,380.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,633.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,633.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,988.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,846.40
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,846.40
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,024.30
|
| Rate for Payer: United Healthcare Commercial |
$3,380.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 52265
|
| Hospital Charge Code |
9825226501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$924.38 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,186.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$924.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,061.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,049.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$999.20
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cigna Commercial |
$999.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$999.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$999.20
|
| Rate for Payer: Multiplan Commercial |
$1,161.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,061.65
|
| Rate for Payer: United Healthcare Commercial |
$1,186.55
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,779.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
5105231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,316.64 |
| Max. Negotiated Rate |
$1,690.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,690.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,512.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,494.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,423.20
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$1,423.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,423.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,423.20
|
| Rate for Payer: Multiplan Commercial |
$1,654.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,512.15
|
| Rate for Payer: United Healthcare Commercial |
$1,690.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$3,558.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
5105222401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,575.84 |
| Max. Negotiated Rate |
$3,380.10 |
| Rate for Payer: Aetna of VT Commercial |
$3,380.10
|
| 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 |
$1,575.84
|
| 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 |
$2,141.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,024.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,881.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,601.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,828.61
|
| Rate for Payer: Cash Price |
$1,779.00
|
| Rate for Payer: Cigna Commercial |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,846.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,846.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,601.10
|
| Rate for Payer: Multiplan Commercial |
$3,308.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,024.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,601.10
|
| Rate for Payer: United Healthcare Commercial |
$3,380.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,601.10
|
| Rate for Payer: United Healthcare VA CCN |
$1,601.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9825228101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$369.82 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Aetna of VT Commercial |
$793.25
|
| 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 |
$369.82
|
| 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 |
$502.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$709.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$676.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$375.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$663.83
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$668.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$668.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$668.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$776.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$709.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$375.75
|
| Rate for Payer: United Healthcare Commercial |
$793.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.75
|
| Rate for Payer: United Healthcare VA CCN |
$375.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$414.55 |
| 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 |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$414.55
|
| 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 |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.12
|
| 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: Martins Point Health Care Commercial |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.20
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.20
|
| Rate for Payer: United Healthcare VA CCN |
$421.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 52265
|
| Hospital Charge Code |
9825226501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$553.18 |
| Max. Negotiated Rate |
$1,186.55 |
| Rate for Payer: Aetna of VT Commercial |
$1,186.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,118.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$553.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,118.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$751.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,061.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,011.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$562.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$992.96
|
| Rate for Payer: Cash Price |
$624.50
|
| Rate for Payer: Cigna Commercial |
$999.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$999.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$999.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$562.05
|
| Rate for Payer: Multiplan Commercial |
$1,161.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,061.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$562.05
|
| Rate for Payer: United Healthcare Commercial |
$1,186.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$562.05
|
| Rate for Payer: United Healthcare VA CCN |
$562.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna of VT Commercial |
$676.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$645.05
|
| 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 |
$645.05
|
| 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 |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| 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 |
$669.60
|
| 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
|
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
|
$1,386.00
|
|
|
Service Code
|
CPT 52300
|
| Hospital Charge Code |
9825230001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,025.78 |
| Max. Negotiated Rate |
$1,316.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,316.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,025.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,025.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,178.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,164.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,108.80
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$1,108.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,108.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,108.80
|
| Rate for Payer: Multiplan Commercial |
$1,288.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,178.10
|
| Rate for Payer: United Healthcare Commercial |
$1,316.70
|
|
|
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
|
$538.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$531.16 |
| Rate for Payer: Aetna of VT Commercial |
$505.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$481.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$233.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$481.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$317.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$531.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$260.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$531.16
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cigna Commercial |
$394.87
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$375.44
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$375.44
|
| Rate for Payer: Martins Point Health Care Commercial |
$226.92
|
| Rate for Payer: Multiplan Commercial |
$500.34
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.23
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare Commercial |
$349.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.92
|
| Rate for Payer: United Healthcare VA CCN |
$226.92
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$8,746.70 |
| Rate for Payer: Aetna of VT Commercial |
$8,746.70
|
| 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 |
$371.44
|
| 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 |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$922.45
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cigna Commercial |
$628.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$8,653.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
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
|
Professional
|
Both
|
$6,657.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$6,257.58 |
| Rate for Payer: Aetna of VT Commercial |
$6,257.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,964.01
|
| 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 |
$5,964.01
|
| 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 |
$3,328.50
|
| Rate for Payer: Cash Price |
$3,328.50
|
| 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 |
$6,191.01
|
| 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
|
$1,032.00
|
|
|
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
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$618.52 |
| Rate for Payer: Aetna of VT Commercial |
$618.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$574.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$574.95
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$394.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$227.27
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$227.27
|
| Rate for Payer: United Healthcare Commercial |
$349.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.27
|
| Rate for Payer: United Healthcare VA CCN |
$227.27
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$6,933.44 |
| Rate for Payer: Aetna of VT Commercial |
$6,933.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,608.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,608.16
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$922.45
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cigna Commercial |
$628.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$4,695.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
9605222401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$4,413.30 |
| Rate for Payer: Aetna of VT Commercial |
$4,413.30
|
| 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 |
$191.87
|
| 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 |
$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 |
$2,347.50
|
| Rate for Payer: Cash Price |
$2,347.50
|
| 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 |
$4,366.35
|
| 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
|
$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
|
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
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$646.85 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Aetna of VT Commercial |
$830.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$646.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$646.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$742.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$699.20
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$742.90
|
| Rate for Payer: United Healthcare Commercial |
$830.30
|
|
|
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
|
|
