|
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
|
$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
|
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
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$486.99 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna of VT Commercial |
$625.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$526.40
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$526.40
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
|
|
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
|
$6,657.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,948.39 |
| Max. Negotiated Rate |
$6,324.15 |
| Rate for Payer: Aetna of VT Commercial |
$6,324.15
|
| 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 |
$2,948.39
|
| 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 |
$4,007.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,658.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,392.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,995.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,292.31
|
| Rate for Payer: Cash Price |
$3,328.50
|
| Rate for Payer: Cigna Commercial |
$5,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,325.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,325.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,995.65
|
| Rate for Payer: Multiplan Commercial |
$6,191.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,658.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,995.65
|
| Rate for Payer: United Healthcare Commercial |
$6,324.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,995.65
|
| Rate for Payer: United Healthcare VA CCN |
$2,995.65
|
|
|
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
|
Facility
|
OP
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,266.83 |
| Max. Negotiated Rate |
$7,007.20 |
| Rate for Payer: Aetna of VT Commercial |
$7,007.20
|
| 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 |
$3,266.83
|
| 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 |
$4,440.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,269.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,974.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,319.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,863.92
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cigna Commercial |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,900.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,900.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,319.20
|
| Rate for Payer: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,269.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,319.20
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,319.20
|
| Rate for Payer: United Healthcare VA CCN |
$3,319.20
|
|
|
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
|
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
|
OP
|
$720.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$318.89 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna of VT Commercial |
$684.00
|
| 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 |
$318.89
|
| 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 |
$433.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$612.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$583.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$572.40
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$576.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$576.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$669.60
|
| Rate for Payer: MVP Health Care of NY Commercial |
$612.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$324.00
|
| Rate for Payer: United Healthcare Commercial |
$684.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.00
|
| Rate for Payer: United Healthcare VA CCN |
$324.00
|
|
|
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
|
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
|
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
|
$1,386.00
|
|
|
Service Code
|
CPT 52300
|
| Hospital Charge Code |
9825230001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$258.12 |
| Max. Negotiated Rate |
$1,302.84 |
| Rate for Payer: Aetna of VT Commercial |
$1,302.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,241.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$265.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,241.72
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$361.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.47
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna Commercial |
$449.28
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$426.87
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$426.87
|
| Rate for Payer: Martins Point Health Care Commercial |
$258.12
|
| Rate for Payer: Multiplan Commercial |
$1,288.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$366.53
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$258.12
|
| Rate for Payer: United Healthcare Commercial |
$397.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$258.12
|
| Rate for Payer: United Healthcare VA CCN |
$258.12
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$821.56 |
| Rate for Payer: Aetna of VT Commercial |
$821.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$783.02
|
| 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 |
$783.02
|
| 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 |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| 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 |
$812.82
|
| 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
|
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
|
$833.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$1,829.05 |
| Rate for Payer: Aetna of VT Commercial |
$783.02
|
| 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 |
$166.05
|
| 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 |
$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 |
$416.50
|
| Rate for Payer: Cash Price |
$416.50
|
| 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 |
$774.69
|
| 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
|
Facility
|
OP
|
$5,721.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
5105223501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,533.83 |
| Max. Negotiated Rate |
$5,434.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,434.95
|
| 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 |
$2,533.83
|
| 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 |
$3,444.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,862.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,574.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,548.19
|
| Rate for Payer: Cash Price |
$2,860.50
|
| Rate for Payer: Cigna Commercial |
$4,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,576.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,574.45
|
| Rate for Payer: Multiplan Commercial |
$5,320.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,862.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,574.45
|
| Rate for Payer: United Healthcare Commercial |
$5,434.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,574.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,574.45
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
9605221402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$616.50 |
| 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 |
$616.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$616.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$708.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$666.40
|
| 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: Multiplan Commercial |
$774.69
|
| Rate for Payer: MVP Health Care of NY Commercial |
$708.05
|
| Rate for Payer: United Healthcare Commercial |
$791.35
|
|
|
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
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$590.30 |
| Rate for Payer: Aetna of VT Commercial |
$410.78
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$391.51
|
| 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 |
$391.51
|
| 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 |
$218.50
|
| Rate for Payer: Cash Price |
$218.50
|
| 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 |
$406.41
|
| 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
|
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
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$291.43 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna of VT Commercial |
$625.10
|
| 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 |
$291.43
|
| 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 |
$396.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$532.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$523.11
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$526.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$296.10
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$296.10
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$296.10
|
| Rate for Payer: United Healthcare VA CCN |
$296.10
|
|
|
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
|
|
