|
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
|
Professional
|
Both
|
$9,305.00
|
|
|
Service Code
|
CPT 52240
|
| Hospital Charge Code |
9605224001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$360.62 |
| Max. Negotiated Rate |
$8,746.70 |
| Rate for Payer: Aetna of VT Commercial |
$8,746.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$8,336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$371.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$8,336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$504.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$922.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$414.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$922.45
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cash Price |
$4,652.50
|
| Rate for Payer: Cigna Commercial |
$628.37
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$596.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$596.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$360.62
|
| Rate for Payer: Multiplan Commercial |
$8,653.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$512.08
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare Commercial |
$554.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.62
|
| Rate for Payer: United Healthcare VA CCN |
$360.62
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9825231001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna of VT Commercial |
$415.15
|
| 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 |
$193.55
|
| 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 |
$263.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$371.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$353.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$196.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$347.42
|
| Rate for Payer: Cash Price |
$218.50
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$349.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$349.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$196.65
|
| Rate for Payer: Multiplan Commercial |
$406.41
|
| Rate for Payer: MVP Health Care of NY Commercial |
$371.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$415.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.65
|
| Rate for Payer: United Healthcare VA CCN |
$196.65
|
|
|
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
|
$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
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
5105228501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.76 |
| Max. Negotiated Rate |
$574.75 |
| Rate for Payer: Aetna of VT Commercial |
$574.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$447.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$447.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$514.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$508.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$484.00
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$484.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$484.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$484.00
|
| Rate for Payer: Multiplan Commercial |
$562.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$514.25
|
| Rate for Payer: United Healthcare Commercial |
$574.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$692.73 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna of VT Commercial |
$889.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$692.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$748.80
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$748.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$748.80
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$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
|
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
|
$6,744.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
5105221401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$6,339.36 |
| Rate for Payer: Aetna of VT Commercial |
$6,339.36
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,041.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$166.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,041.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$225.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,829.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$185.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,829.05
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cash Price |
$3,372.00
|
| Rate for Payer: Cigna Commercial |
$279.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,090.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,090.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$675.45
|
| Rate for Payer: Multiplan Commercial |
$6,271.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$228.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.21
|
| Rate for Payer: United Healthcare Commercial |
$247.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.21
|
| Rate for Payer: United Healthcare VA CCN |
$161.21
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 52276
|
| Hospital Charge Code |
9825227601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$872.58 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,120.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$872.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,002.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$990.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$943.20
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$943.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$1,096.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,002.15
|
| Rate for Payer: United Healthcare Commercial |
$1,120.05
|
|
|
CYSTOSCOPY 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
|
$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
|
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
|
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
|
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
|
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
|
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
|
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
|
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
|
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 REMOVAL OF CLOTS
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Aetna of VT Commercial |
$736.25
|
| 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 |
$343.25
|
| 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 |
$466.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$658.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$627.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$348.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$616.12
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$620.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$620.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$620.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$348.75
|
| Rate for Payer: Multiplan Commercial |
$720.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$658.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$348.75
|
| Rate for Payer: United Healthcare Commercial |
$736.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$348.75
|
| Rate for Payer: United Healthcare VA CCN |
$348.75
|
|
|
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
|
|
