|
CYSTOSCOPY AND TREATMENT
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
9605231001
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,639.32 |
| Max. Negotiated Rate |
$2,104.25 |
| Rate for Payer: Aetna of VT Commercial |
$2,104.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,639.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,882.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,860.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,772.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,772.00
|
| Rate for Payer: Multiplan Commercial |
$2,059.95
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare Commercial |
$2,104.25
|
|
|
CYSTOSCOPY AND TREATMENT
|
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
|
IP
|
$1,325.00
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
9605228501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$980.63 |
| 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 |
$980.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$980.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,126.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,113.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,060.00
|
| 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: Multiplan Commercial |
$1,232.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,126.25
|
| Rate for Payer: United Healthcare Commercial |
$1,258.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
9825228101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$369.82 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Aetna of VT Commercial |
$793.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$748.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$369.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$748.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$502.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$709.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$676.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$375.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$663.83
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$668.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$668.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$668.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$776.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$709.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$375.75
|
| Rate for Payer: United Healthcare Commercial |
$793.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.75
|
| Rate for Payer: United Healthcare VA CCN |
$375.75
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$5,721.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
5105223501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,533.83 |
| Max. Negotiated Rate |
$5,434.95 |
| Rate for Payer: Aetna of VT Commercial |
$5,434.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,125.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,533.83
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,125.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,444.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,862.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,574.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,548.19
|
| Rate for Payer: Cash Price |
$2,860.50
|
| Rate for Payer: Cigna Commercial |
$4,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,576.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,576.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,574.45
|
| Rate for Payer: Multiplan Commercial |
$5,320.53
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,862.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,574.45
|
| Rate for Payer: United Healthcare Commercial |
$5,434.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,574.45
|
| Rate for Payer: United Healthcare VA CCN |
$2,574.45
|
|
|
CYSTOSCOPY AND TREATMENT
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 52235
|
| Hospital Charge Code |
9605223502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$414.55 |
| 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 |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$414.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$795.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$758.16
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$744.12
|
| 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: Martins Point Health Care Commercial |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$870.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$795.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$421.20
|
| Rate for Payer: United Healthcare Commercial |
$889.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.20
|
| Rate for Payer: United Healthcare VA CCN |
$421.20
|
|
|
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
|
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
|
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
|
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
|
$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 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
|
$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
|
$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
|
$890.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9825228701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$394.18 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of VT Commercial |
$845.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$394.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$535.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$756.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$720.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$400.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$707.55
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$712.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$712.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$400.50
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$756.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$400.50
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.50
|
| Rate for Payer: United Healthcare VA CCN |
$400.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$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
|
$5,330.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,360.66 |
| Max. Negotiated Rate |
$5,063.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,063.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,775.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,360.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,775.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,208.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,530.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,317.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,398.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,237.35
|
| Rate for Payer: Cash Price |
$2,665.00
|
| Rate for Payer: Cigna Commercial |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,264.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,398.50
|
| Rate for Payer: Multiplan Commercial |
$4,956.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,530.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,398.50
|
| Rate for Payer: United Healthcare Commercial |
$5,063.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,398.50
|
| Rate for Payer: United Healthcare VA CCN |
$2,398.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$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
|
$723.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228702
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$320.22 |
| Max. Negotiated Rate |
$686.85 |
| Rate for Payer: Aetna of VT Commercial |
$686.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$320.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$647.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$435.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$614.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$585.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$325.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$574.78
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$578.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$578.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$578.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$325.35
|
| Rate for Payer: Multiplan Commercial |
$672.39
|
| Rate for Payer: MVP Health Care of NY Commercial |
$614.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$325.35
|
| Rate for Payer: United Healthcare Commercial |
$686.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.35
|
| Rate for Payer: United Healthcare VA CCN |
$325.35
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9825228701
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$836.60 |
| Rate for Payer: Aetna of VT Commercial |
$836.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$160.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$797.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$218.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$483.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$179.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$483.46
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$271.13
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$564.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$564.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$346.63
|
| Rate for Payer: Multiplan Commercial |
$827.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare Commercial |
$240.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.16
|
| Rate for Payer: United Healthcare VA CCN |
$156.16
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
IP
|
$5,330.00
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
9605228701
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,944.73 |
| Max. Negotiated Rate |
$5,063.50 |
| Rate for Payer: Aetna of VT Commercial |
$5,063.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,944.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,944.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,530.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,477.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,264.00
|
| Rate for Payer: Cash Price |
$2,665.00
|
| Rate for Payer: Cigna Commercial |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,264.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,264.00
|
| Rate for Payer: Multiplan Commercial |
$4,956.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,530.50
|
| Rate for Payer: United Healthcare Commercial |
$5,063.50
|
|
|
CYSTOSCOPY CHEMODENERVATION
|
Facility
|
OP
|
$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
|
Professional
|
Both
|
$6,792.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
5105200101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$264.59 |
| Max. Negotiated Rate |
$6,384.48 |
| Rate for Payer: Aetna of VT Commercial |
$6,384.48
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,084.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$272.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,084.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$370.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$304.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$732.83
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cigna Commercial |
$460.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$647.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$647.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$395.63
|
| Rate for Payer: Multiplan Commercial |
$6,316.56
|
| 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
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
IP
|
$6,792.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
5105200101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,026.76 |
| Max. Negotiated Rate |
$6,452.40 |
| Rate for Payer: Aetna of VT Commercial |
$6,452.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,026.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,026.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,773.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,705.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,433.60
|
| Rate for Payer: Cash Price |
$3,396.00
|
| Rate for Payer: Cigna Commercial |
$5,433.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$5,433.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$5,433.60
|
| Rate for Payer: Multiplan Commercial |
$6,316.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,773.20
|
| Rate for Payer: United Healthcare Commercial |
$6,452.40
|
|
