|
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
|
$1,032.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9825223401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$970.08 |
| Rate for Payer: Aetna of VT Commercial |
$970.08
|
| 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 |
$233.73
|
| 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 |
$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 |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| 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 |
$959.76
|
| 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
|
$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
|
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
|
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
|
$1,929.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224002
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$1,813.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,813.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,728.19
|
| 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 |
$1,728.19
|
| 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 |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| 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 |
$1,793.97
|
| 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
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,639.32 |
| Max. Negotiated Rate |
$2,104.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$2,104.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
9825226001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$614.65 |
| Rate for Payer: Aetna of VT Commercial |
$614.65
|
| 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 |
$286.56
|
| 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 |
$389.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$291.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$514.37
|
| Rate for Payer: Cash Price |
$323.50
|
| Rate for Payer: Cigna Commercial |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$517.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$517.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$291.15
|
| Rate for Payer: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$291.15
|
| Rate for Payer: United Healthcare Commercial |
$614.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.15
|
| Rate for Payer: United Healthcare VA CCN |
$291.15
|
|
|
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
|
Professional
|
Both
|
$5,279.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$4,962.26 |
| Rate for Payer: Aetna of VT Commercial |
$4,962.26
|
| 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 |
$233.73
|
| 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 |
$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 |
$2,639.50
|
| Rate for Payer: Cash Price |
$2,639.50
|
| 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 |
$4,909.47
|
| 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
|
$1,779.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
5105231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.44 |
| Max. Negotiated Rate |
$1,672.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,672.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,593.81
|
| 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 |
$1,593.81
|
| 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 |
$889.50
|
| Rate for Payer: Cash Price |
$889.50
|
| 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 |
$1,654.47
|
| 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 CHEMODENERVATION
|
Facility
|
IP
|
$723.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$535.09 |
| Max. Negotiated Rate |
$686.85 |
| Rate for Payer: Aetna of VT Commercial |
$686.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$535.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$535.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$614.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$607.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$578.40
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$578.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$578.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$578.40
|
| Rate for Payer: Multiplan Commercial |
$672.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$614.55
|
| Rate for Payer: United Healthcare Commercial |
$686.85
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$679.62 |
| Rate for Payer: Aetna of VT Commercial |
$679.62
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.46
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$271.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.63
|
| Rate for Payer: Multiplan Commercial |
$672.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare Commercial |
$240.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare VA CCN |
$156.16
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$4,607.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
5105228701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,040.44 |
| Max. Negotiated Rate |
$4,376.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,376.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,127.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,040.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,127.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,773.41
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,915.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,731.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,073.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,662.57
|
| Rate for Payer: Cash Price |
$2,303.50
|
| Rate for Payer: Cigna Commercial |
$3,685.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,685.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,685.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,073.15
|
| Rate for Payer: Multiplan Commercial |
$4,284.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,915.95
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,073.15
|
| Rate for Payer: United Healthcare Commercial |
$4,376.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,073.15
|
| Rate for Payer: United Healthcare VA CCN |
$2,073.15
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9825228701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$658.69 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of VT Commercial |
$845.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$658.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$658.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$756.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$747.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$712.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$712.00
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$756.50
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$723.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.22 |
| Max. Negotiated Rate |
$686.85 |
| Rate for Payer: Aetna of VT Commercial |
$686.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$320.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$435.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$614.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$585.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$325.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$574.78
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$578.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$578.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$578.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$325.35
|
| Rate for Payer: Multiplan Commercial |
$672.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$614.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$325.35
|
| Rate for Payer: United Healthcare Commercial |
$686.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.35
|
| Rate for Payer: United Healthcare VA CCN |
$325.35
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9825228701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$836.60 |
| Rate for Payer: Aetna of VT Commercial |
$836.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.46
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$271.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.63
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare Commercial |
$240.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare VA CCN |
$156.16
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$4,607.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
5105228701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$4,330.58 |
| Rate for Payer: Aetna of VT Commercial |
$4,330.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,127.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,127.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.46
|
| Rate for Payer: Cash Price |
$2,303.50
|
| Rate for Payer: Cash Price |
$2,303.50
|
| Rate for Payer: Cigna Commercial |
$271.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.63
|
| Rate for Payer: Multiplan Commercial |
$4,284.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare Commercial |
$240.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare VA CCN |
$156.16
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$5,330.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,944.73 |
| Max. Negotiated Rate |
$5,063.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,063.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,944.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,944.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,530.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,477.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,264.00
|
| Rate for Payer: Cash Price |
$2,665.00
|
| Rate for Payer: Cigna Commercial |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,264.00
|
| Rate for Payer: Multiplan Commercial |
$4,956.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,530.50
|
| Rate for Payer: United Healthcare Commercial |
$5,063.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9825228701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$394.18 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of VT Commercial |
$845.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$394.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$535.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$756.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$400.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.55
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$712.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$400.50
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$756.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$400.50
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.50
|
| Rate for Payer: United Healthcare VA CCN |
$400.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$5,330.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$5,010.20 |
| Rate for Payer: Aetna of VT Commercial |
$5,010.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,775.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,775.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.46
|
| Rate for Payer: Cash Price |
$2,665.00
|
| Rate for Payer: Cash Price |
$2,665.00
|
| Rate for Payer: Cigna Commercial |
$271.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.63
|
| Rate for Payer: Multiplan Commercial |
$4,956.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare Commercial |
$240.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare VA CCN |
$156.16
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$5,330.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,360.66 |
| Max. Negotiated Rate |
$5,063.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,063.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,775.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,360.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,775.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,208.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,530.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,317.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,398.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,237.35
|
| Rate for Payer: Cash Price |
$2,665.00
|
| Rate for Payer: Cigna Commercial |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,264.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,398.50
|
| Rate for Payer: Multiplan Commercial |
$4,956.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,530.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,398.50
|
| Rate for Payer: United Healthcare Commercial |
$5,063.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,398.50
|
| Rate for Payer: United Healthcare VA CCN |
$2,398.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$4,607.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
5105228701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,409.64 |
| Max. Negotiated Rate |
$4,376.65 |
| Rate for Payer: Aetna of VT Commercial |
$4,376.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,409.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,409.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,915.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,869.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,685.60
|
| Rate for Payer: Cash Price |
$2,303.50
|
| Rate for Payer: Cigna Commercial |
$3,685.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,685.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,685.60
|
| Rate for Payer: Multiplan Commercial |
$4,284.51
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,915.95
|
| Rate for Payer: United Healthcare Commercial |
$4,376.65
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,350.98 |
| Max. Negotiated Rate |
$7,187.70 |
| Rate for Payer: Aetna of VT Commercial |
$7,187.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,350.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,554.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,431.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,128.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,404.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,014.97
|
| Rate for Payer: Cash Price |
$3,783.00
|
| Rate for Payer: Cigna Commercial |
$6,052.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,052.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,052.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,404.70
|
| Rate for Payer: Multiplan Commercial |
$7,036.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,431.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,404.70
|
| Rate for Payer: United Healthcare Commercial |
$7,187.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,404.70
|
| Rate for Payer: United Healthcare VA CCN |
$3,404.70
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Professional
|
Both
|
$7,566.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$264.59 |
| Max. Negotiated Rate |
$7,112.04 |
| Rate for Payer: Aetna of VT Commercial |
$7,112.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$272.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$370.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$304.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$732.83
|
| Rate for Payer: Cash Price |
$3,783.00
|
| Rate for Payer: Cash Price |
$3,783.00
|
| Rate for Payer: Cigna Commercial |
$460.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$647.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$647.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$395.63
|
| Rate for Payer: Multiplan Commercial |
$7,036.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$375.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$264.59
|
| Rate for Payer: United Healthcare Commercial |
$407.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.59
|
| Rate for Payer: United Healthcare VA CCN |
$264.59
|
|
