|
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
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
OP
|
$6,792.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
5105200101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,008.18 |
| 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 |
$6,084.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,008.18
|
| 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 |
$4,088.78
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,773.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,501.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,056.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$5,399.64
|
| 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: Martins Point Health Care Commercial |
$3,056.40
|
| Rate for Payer: Multiplan Commercial |
$6,316.56
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,773.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,056.40
|
| Rate for Payer: United Healthcare Commercial |
$6,452.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.40
|
| Rate for Payer: United Healthcare VA CCN |
$3,056.40
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,350.98 |
| Max. Negotiated Rate |
$7,187.70 |
| Rate for Payer: Aetna of VT Commercial |
$7,187.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3,350.98
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4,554.73
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6,431.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6,128.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$3,404.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6,014.97
|
| Rate for Payer: Cash Price |
$3,783.00
|
| Rate for Payer: Cigna Commercial |
$6,052.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$6,052.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$6,052.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$3,404.70
|
| Rate for Payer: Multiplan Commercial |
$7,036.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6,431.10
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3,404.70
|
| Rate for Payer: United Healthcare Commercial |
$7,187.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,404.70
|
| Rate for Payer: United Healthcare VA CCN |
$3,404.70
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200102
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$573.58 |
| 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 |
$573.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$573.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$658.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$651.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$620.00
|
| 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: Multiplan Commercial |
$720.75
|
| Rate for Payer: MVP Health Care of NY Commercial |
$658.75
|
| Rate for Payer: United Healthcare Commercial |
$736.25
|
|
|
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
|
|
|
CYSTOSCOPY REMOVAL OF CLOTS
|
Professional
|
Both
|
$7,566.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
9605200101
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$264.59 |
| Max. Negotiated Rate |
$7,112.04 |
| Rate for Payer: Aetna of VT Commercial |
$7,112.04
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$272.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$6,778.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$370.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$732.83
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$304.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$732.83
|
| Rate for Payer: Cash Price |
$3,783.00
|
| Rate for Payer: Cash Price |
$3,783.00
|
| Rate for Payer: Cigna Commercial |
$460.91
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$647.51
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$647.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$395.63
|
| Rate for Payer: Multiplan Commercial |
$7,036.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$375.72
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$264.59
|
| Rate for Payer: United Healthcare Commercial |
$407.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.59
|
| Rate for Payer: United Healthcare VA CCN |
$264.59
|
|
|
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 & REVISE URETHRA
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
9605227502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$549.64 |
| Max. Negotiated Rate |
$1,178.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,178.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,111.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$549.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,111.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$747.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,054.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,005.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$558.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$986.60
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$992.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$992.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$992.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$558.45
|
| Rate for Payer: Multiplan Commercial |
$1,154.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,054.85
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$558.45
|
| Rate for Payer: United Healthcare Commercial |
$1,178.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$558.45
|
| Rate for Payer: United Healthcare VA CCN |
$558.45
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
5105227501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,605.77 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Aetna of VT Commercial |
$4,628.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,605.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,605.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,141.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,092.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,897.60
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,897.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,897.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,897.60
|
| Rate for Payer: Multiplan Commercial |
$4,530.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,141.20
|
| Rate for Payer: United Healthcare Commercial |
$4,628.40
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Professional
|
Both
|
$1,241.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
9605227502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$229.52 |
| Max. Negotiated Rate |
$1,285.29 |
| Rate for Payer: Aetna of VT Commercial |
$1,166.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,111.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$236.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,111.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$321.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,285.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,285.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$263.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.29
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$398.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$792.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$792.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$487.12
|
| Rate for Payer: Multiplan Commercial |
$1,154.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$229.52
|
| Rate for Payer: United Healthcare Commercial |
$353.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Healthcare VA CCN |
$229.52
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
9605227502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$918.46 |
| Max. Negotiated Rate |
$1,178.95 |
| Rate for Payer: Aetna of VT Commercial |
$1,178.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$918.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$918.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,054.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,042.44
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$992.80
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$992.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$992.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$992.80
|
| Rate for Payer: Multiplan Commercial |
$1,154.13
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,054.85
|
| Rate for Payer: United Healthcare Commercial |
$1,178.95
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
OP
|
$6,112.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
9605227501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,707.00 |
| Max. Negotiated Rate |
$5,806.40 |
| Rate for Payer: Aetna of VT Commercial |
$5,806.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,475.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,707.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,475.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$3,679.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4,950.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,750.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,859.04
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cigna Commercial |
$4,889.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,889.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,889.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,750.40
|
| Rate for Payer: Multiplan Commercial |
$5,684.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,195.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,750.40
|
| Rate for Payer: United Healthcare Commercial |
$5,806.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,750.40
|
| Rate for Payer: United Healthcare VA CCN |
$2,750.40
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
IP
|
$6,112.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
9605227501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$4,523.49 |
| Max. Negotiated Rate |
$5,806.40 |
| Rate for Payer: Aetna of VT Commercial |
$5,806.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,523.49
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,523.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$5,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$5,134.08
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4,889.60
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cigna Commercial |
$4,889.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4,889.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4,889.60
|
| Rate for Payer: Multiplan Commercial |
$5,684.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5,195.20
|
| Rate for Payer: United Healthcare Commercial |
$5,806.40
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
5105227501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,157.81 |
| Max. Negotiated Rate |
$4,628.40 |
| Rate for Payer: Aetna of VT Commercial |
$4,628.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,364.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,157.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,364.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,932.94
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4,141.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,946.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,192.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,873.24
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$3,897.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,897.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,897.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,192.40
|
| Rate for Payer: Multiplan Commercial |
$4,530.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4,141.20
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,192.40
|
| Rate for Payer: United Healthcare Commercial |
$4,628.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,192.40
|
| Rate for Payer: United Healthcare VA CCN |
$2,192.40
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Professional
|
Both
|
$4,872.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
5105227501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.52 |
| Max. Negotiated Rate |
$4,579.68 |
| Rate for Payer: Aetna of VT Commercial |
$4,579.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,364.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$236.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,364.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$321.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,285.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,285.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$263.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.29
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$398.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$792.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$792.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$487.12
|
| Rate for Payer: Multiplan Commercial |
$4,530.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$229.52
|
| Rate for Payer: United Healthcare Commercial |
$353.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Healthcare VA CCN |
$229.52
|
|
|
CYSTOSCOPY & REVISE URETHRA
|
Professional
|
Both
|
$6,112.00
|
|
|
Service Code
|
CPT 52275
|
| Hospital Charge Code |
9605227501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$229.52 |
| Max. Negotiated Rate |
$5,745.28 |
| Rate for Payer: Aetna of VT Commercial |
$5,745.28
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$5,475.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$236.41
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$5,475.74
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$321.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,285.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,285.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$263.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,285.29
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cigna Commercial |
$398.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$792.54
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$792.54
|
| Rate for Payer: Martins Point Health Care Commercial |
$487.12
|
| Rate for Payer: Multiplan Commercial |
$5,684.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$325.92
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$229.52
|
| Rate for Payer: United Healthcare Commercial |
$353.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.52
|
| Rate for Payer: United Healthcare VA CCN |
$229.52
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9605200501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.92 |
| Max. Negotiated Rate |
$4,398.26 |
| Rate for Payer: Aetna of VT Commercial |
$4,398.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,191.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,191.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.47
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$215.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.42
|
| Rate for Payer: Multiplan Commercial |
$4,351.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare Commercial |
$190.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare VA CCN |
$123.92
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
IP
|
$4,051.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
5105200501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,998.15 |
| Max. Negotiated Rate |
$3,848.45 |
| Rate for Payer: Aetna of VT Commercial |
$3,848.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,998.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,998.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,443.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,402.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,240.80
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cigna Commercial |
$3,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,240.80
|
| Rate for Payer: Multiplan Commercial |
$3,767.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,443.35
|
| Rate for Payer: United Healthcare Commercial |
$3,848.45
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
OP
|
$4,679.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9605200501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,072.33 |
| Max. Negotiated Rate |
$4,445.05 |
| Rate for Payer: Aetna of VT Commercial |
$4,445.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$4,191.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$2,072.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$4,191.92
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,816.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,789.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$2,105.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,719.80
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$3,743.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,743.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,743.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$2,105.55
|
| Rate for Payer: Multiplan Commercial |
$4,351.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$2,105.55
|
| Rate for Payer: United Healthcare Commercial |
$4,445.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,105.55
|
| Rate for Payer: United Healthcare VA CCN |
$2,105.55
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
IP
|
$4,679.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9605200501
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$3,462.93 |
| Max. Negotiated Rate |
$4,445.05 |
| Rate for Payer: Aetna of VT Commercial |
$4,445.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,462.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,462.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,977.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,930.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,743.20
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$3,743.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,743.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,743.20
|
| Rate for Payer: Multiplan Commercial |
$4,351.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,977.15
|
| Rate for Payer: United Healthcare Commercial |
$4,445.05
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Professional
|
Both
|
$4,051.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
5105200501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.92 |
| Max. Negotiated Rate |
$3,807.94 |
| Rate for Payer: Aetna of VT Commercial |
$3,807.94
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,629.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,629.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.47
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cigna Commercial |
$215.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.42
|
| Rate for Payer: Multiplan Commercial |
$3,767.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare Commercial |
$190.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare VA CCN |
$123.92
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
OP
|
$4,051.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
5105200501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,794.19 |
| Max. Negotiated Rate |
$3,848.45 |
| Rate for Payer: Aetna of VT Commercial |
$3,848.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,629.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,794.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,629.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,438.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,443.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,281.31
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,822.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,220.55
|
| Rate for Payer: Cash Price |
$2,025.50
|
| Rate for Payer: Cigna Commercial |
$3,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,240.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,240.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,822.95
|
| Rate for Payer: Multiplan Commercial |
$3,767.43
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,443.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,822.95
|
| Rate for Payer: United Healthcare Commercial |
$3,848.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,822.95
|
| Rate for Payer: United Healthcare VA CCN |
$1,822.95
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9825200501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$123.92 |
| Max. Negotiated Rate |
$528.47 |
| Rate for Payer: Aetna of VT Commercial |
$336.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.47
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$215.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.42
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare Commercial |
$190.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare VA CCN |
$123.92
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9825200501
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna of VT Commercial |
$340.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$158.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$320.73
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$304.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$289.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$284.61
|
| Rate for Payer: Cash Price |
$179.00
|
| Rate for Payer: Cigna Commercial |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$286.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$286.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$161.10
|
| Rate for Payer: Multiplan Commercial |
$332.94
|
| Rate for Payer: MVP Health Care of NY Commercial |
$304.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare Commercial |
$340.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.10
|
| Rate for Payer: United Healthcare VA CCN |
$161.10
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9605200502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$123.92 |
| Max. Negotiated Rate |
$591.26 |
| Rate for Payer: Aetna of VT Commercial |
$591.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$563.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$127.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$563.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$173.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$142.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$528.47
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$215.48
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$437.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$437.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$269.42
|
| Rate for Payer: Multiplan Commercial |
$584.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$175.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare Commercial |
$190.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.92
|
| Rate for Payer: United Healthcare VA CCN |
$123.92
|
|
