|
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
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$586.84 |
| Max. Negotiated Rate |
$1,258.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,258.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,187.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$586.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,187.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$797.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,126.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,073.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$596.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,053.38
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,060.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,060.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$596.25
|
| Rate for Payer: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,126.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$596.25
|
| Rate for Payer: United Healthcare Commercial |
$1,258.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$596.25
|
| Rate for Payer: United Healthcare VA CCN |
$596.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$6,886.63 |
| Max. Negotiated Rate |
$8,839.75 |
| Rate for Payer: Aetna of VT Commercial |
$8,839.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,886.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,886.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$7,909.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$7,816.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$7,444.00
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cigna Commercial |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$7,444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$7,444.00
|
| Rate for Payer: Multiplan Commercial |
$8,653.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7,909.25
|
| Rate for Payer: United Healthcare Commercial |
$8,839.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$6,744.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
5105221401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,991.23 |
| Max. Negotiated Rate |
$6,406.80 |
| Rate for Payer: Aetna of VT Commercial |
$6,406.80
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,991.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,991.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,732.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,664.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,395.20
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cigna Commercial |
$5,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,395.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,395.20
|
| Rate for Payer: Multiplan Commercial |
$6,271.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,732.40
|
| Rate for Payer: United Healthcare Commercial |
$6,406.80
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$7,376.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
5105224001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,458.98 |
| 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 |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,458.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,269.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,195.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,900.80
|
| 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: Multiplan Commercial |
$6,859.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,269.60
|
| Rate for Payer: United Healthcare Commercial |
$7,007.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$6,657.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,926.85 |
| 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 |
$4,926.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,926.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,658.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,591.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,325.60
|
| 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: Multiplan Commercial |
$6,191.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,658.45
|
| Rate for Payer: United Healthcare Commercial |
$6,324.15
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9825228101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$617.98 |
| 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 |
$617.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$617.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$709.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$701.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$668.00
|
| 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: Multiplan Commercial |
$776.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$709.75
|
| Rate for Payer: United Healthcare Commercial |
$793.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$244.05 |
| Max. Negotiated Rate |
$1,108.26 |
| Rate for Payer: Aetna of VT Commercial |
$1,108.26
|
| 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 |
$251.37
|
| 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 |
$341.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$622.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$280.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$622.93
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$424.34
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$403.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$403.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$244.05
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$346.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare Commercial |
$375.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.05
|
| Rate for Payer: United Healthcare VA CCN |
$244.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
9605223401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,338.07 |
| Max. Negotiated Rate |
$5,015.05 |
| Rate for Payer: Aetna of VT Commercial |
$5,015.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,729.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,338.07
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,729.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,177.96
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,487.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,275.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,375.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,196.81
|
| Rate for Payer: Cash Price |
$2,639.50
|
| Rate for Payer: Cigna Commercial |
$4,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,223.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,223.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,375.55
|
| Rate for Payer: Multiplan Commercial |
$4,909.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,487.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,375.55
|
| Rate for Payer: United Healthcare Commercial |
$5,015.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,375.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,375.55
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$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
|
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 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
|
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
|
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
|
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
|
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
|
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
|
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 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
|
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
|
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
|
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
|
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 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
|
$775.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$264.59 |
| Max. Negotiated Rate |
$732.83 |
| Rate for Payer: Aetna of VT Commercial |
$728.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$694.32
|
| 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 |
$694.32
|
| 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 |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| 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 |
$720.75
|
| 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
|
|
