|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$4,741.00
|
|
|
Service Code
|
CPT 52234
|
| Hospital Charge Code |
5105223401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,099.79 |
| Max. Negotiated Rate |
$4,503.95 |
| Rate for Payer: Aetna of VT Commercial |
$4,503.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,247.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,099.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,247.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,854.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,029.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,840.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,133.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,769.09
|
| Rate for Payer: Cash Price |
$2,370.50
|
| Rate for Payer: Cigna Commercial |
$3,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,792.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,792.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,133.45
|
| Rate for Payer: Multiplan Commercial |
$4,409.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,029.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,133.45
|
| Rate for Payer: United Healthcare Commercial |
$4,503.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,133.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,133.45
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$1,779.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
5105231001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,316.64 |
| Max. Negotiated Rate |
$1,690.05 |
| Rate for Payer: Aetna of VT Commercial |
$1,690.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,316.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,512.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,494.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,423.20
|
| Rate for Payer: Cash Price |
$889.50
|
| Rate for Payer: Cigna Commercial |
$1,423.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,423.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,423.20
|
| Rate for Payer: Multiplan Commercial |
$1,654.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,512.15
|
| Rate for Payer: United Healthcare Commercial |
$1,690.05
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$486.99 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Aetna of VT Commercial |
$625.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$486.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$559.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$552.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$526.40
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$526.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$526.40
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$559.30
|
| Rate for Payer: United Healthcare Commercial |
$625.10
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$6,657.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$265.87 |
| Max. Negotiated Rate |
$6,257.58 |
| Rate for Payer: Aetna of VT Commercial |
$6,257.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,964.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$273.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,964.01
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$372.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$679.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$305.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$679.93
|
| Rate for Payer: Cash Price |
$3,328.50
|
| Rate for Payer: Cash Price |
$3,328.50
|
| Rate for Payer: Cigna Commercial |
$463.16
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$439.73
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$439.73
|
| Rate for Payer: Martins Point Health Care Commercial |
$265.87
|
| Rate for Payer: Multiplan Commercial |
$6,191.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$377.54
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare Commercial |
$408.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.87
|
| Rate for Payer: United Healthcare VA CCN |
$265.87
|
|
|
CYSTOSCOPY AND TREATMENT
|
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
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 52260
|
| Hospital Charge Code |
9825226001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$478.84 |
| 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 |
$478.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$478.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$549.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$543.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$517.60
|
| 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: Multiplan Commercial |
$601.71
|
| Rate for Payer: MVP Health Care of NY Commercial |
$549.95
|
| Rate for Payer: United Healthcare Commercial |
$614.65
|
|
|
CYSTOSCOPY AND TREATMENT
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
CPT 52320
|
| Hospital Charge Code |
9825232001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$227.27 |
| Max. Negotiated Rate |
$618.52 |
| Rate for Payer: Aetna of VT Commercial |
$618.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$234.09
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$589.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$318.18
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$574.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$574.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$261.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$574.95
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cigna Commercial |
$394.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$376.47
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$376.47
|
| Rate for Payer: Martins Point Health Care Commercial |
$227.27
|
| Rate for Payer: Multiplan Commercial |
$611.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$322.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$227.27
|
| Rate for Payer: United Healthcare Commercial |
$349.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.27
|
| Rate for Payer: United Healthcare VA CCN |
$227.27
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9825223501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$646.85 |
| Max. Negotiated Rate |
$830.30 |
| Rate for Payer: Aetna of VT Commercial |
$830.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$646.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$646.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$742.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$734.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$699.20
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$699.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$812.82
|
| Rate for Payer: MVP Health Care of NY Commercial |
$742.90
|
| Rate for Payer: United Healthcare Commercial |
$830.30
|
|
|
CYSTOSCOPY AND TREATMENT
|
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
|
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 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 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
|
$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
|
$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
|
$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
|
$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
|
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
|
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
|
$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
|
$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 REMOVAL OF CLOTS
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$5,599.60 |
| 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 |
$5,599.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,599.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,431.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,355.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,052.80
|
| 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: Multiplan Commercial |
$7,036.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,431.10
|
| Rate for Payer: United Healthcare Commercial |
$7,187.70
|
|
|
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
|
|
