|
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
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9605200502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$278.58 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Aetna of VT Commercial |
$597.55
|
| 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 |
$278.58
|
| 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 |
$378.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$534.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$509.49
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$283.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$500.06
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$503.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$503.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$283.05
|
| Rate for Payer: Multiplan Commercial |
$584.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$534.65
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$283.05
|
| Rate for Payer: United Healthcare Commercial |
$597.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.05
|
| Rate for Payer: United Healthcare VA CCN |
$283.05
|
|
|
CYSTOSCOPY & URETER CATHETER
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
9605200502
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$465.52 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Aetna of VT Commercial |
$597.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$465.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$465.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$534.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$528.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$503.20
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$503.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$503.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$503.20
|
| Rate for Payer: Multiplan Commercial |
$584.97
|
| Rate for Payer: MVP Health Care of NY Commercial |
$534.65
|
| Rate for Payer: United Healthcare Commercial |
$597.55
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9825220401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$245.81 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Aetna of VT Commercial |
$527.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$245.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$334.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$449.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$249.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$441.23
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$249.75
|
| Rate for Payer: Multiplan Commercial |
$516.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.75
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$527.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.75
|
| Rate for Payer: United Healthcare VA CCN |
$249.75
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Professional
|
Both
|
$3,979.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9605220401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$3,740.26 |
| Rate for Payer: Aetna of VT Commercial |
$3,740.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,564.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,564.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$923.48
|
| Rate for Payer: Cash Price |
$1,989.50
|
| Rate for Payer: Cash Price |
$1,989.50
|
| Rate for Payer: Cigna Commercial |
$228.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$336.77
|
| Rate for Payer: Multiplan Commercial |
$3,700.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare Commercial |
$201.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare VA CCN |
$131.20
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
OP
|
$3,979.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9605220401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,762.30 |
| Max. Negotiated Rate |
$3,780.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,780.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$3,564.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,762.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$3,564.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,395.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,382.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,222.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,790.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,163.30
|
| Rate for Payer: Cash Price |
$1,989.50
|
| Rate for Payer: Cigna Commercial |
$3,183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,183.20
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,790.55
|
| Rate for Payer: Multiplan Commercial |
$3,700.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,382.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,790.55
|
| Rate for Payer: United Healthcare Commercial |
$3,780.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,790.55
|
| Rate for Payer: United Healthcare VA CCN |
$1,790.55
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9605220402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$479.66 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,028.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$479.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$651.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$877.23
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$487.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$860.99
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$866.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$487.35
|
| Rate for Payer: Multiplan Commercial |
$1,007.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$920.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$487.35
|
| Rate for Payer: United Healthcare Commercial |
$1,028.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$487.35
|
| Rate for Payer: United Healthcare VA CCN |
$487.35
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9825220401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$923.48 |
| Rate for Payer: Aetna of VT Commercial |
$521.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$497.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$923.48
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$228.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$336.77
|
| Rate for Payer: Multiplan Commercial |
$516.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare Commercial |
$201.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare VA CCN |
$131.20
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9605220402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$801.53 |
| Max. Negotiated Rate |
$1,028.85 |
| Rate for Payer: Aetna of VT Commercial |
$1,028.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$801.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$801.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$920.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$909.72
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$866.40
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$866.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$866.40
|
| Rate for Payer: Multiplan Commercial |
$1,007.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$920.55
|
| Rate for Payer: United Healthcare Commercial |
$1,028.85
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Professional
|
Both
|
$2,896.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
5105220401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$2,722.24 |
| Rate for Payer: Aetna of VT Commercial |
$2,722.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,594.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,594.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$923.48
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cigna Commercial |
$228.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$336.77
|
| Rate for Payer: Multiplan Commercial |
$2,693.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare Commercial |
$201.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare VA CCN |
$131.20
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
OP
|
$2,896.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
5105220401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,282.64 |
| Max. Negotiated Rate |
$2,751.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,751.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,594.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,282.64
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,594.53
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,743.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,461.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,345.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,303.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,302.32
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cigna Commercial |
$2,316.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,316.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,316.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,303.20
|
| Rate for Payer: Multiplan Commercial |
$2,693.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,461.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,303.20
|
| Rate for Payer: United Healthcare Commercial |
$2,751.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,303.20
|
| Rate for Payer: United Healthcare VA CCN |
$1,303.20
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
IP
|
$2,896.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
5105220401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,143.33 |
| Max. Negotiated Rate |
$2,751.20 |
| Rate for Payer: Aetna of VT Commercial |
$2,751.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,143.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,143.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,461.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,432.64
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,316.80
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cigna Commercial |
$2,316.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,316.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,316.80
|
| Rate for Payer: Multiplan Commercial |
$2,693.28
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,461.60
|
| Rate for Payer: United Healthcare Commercial |
$2,751.20
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9605220402
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$1,018.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,018.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$135.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$183.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$923.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$150.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$923.48
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$228.27
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$545.68
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$545.68
|
| Rate for Payer: Martins Point Health Care Commercial |
$336.77
|
| Rate for Payer: Multiplan Commercial |
$1,007.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.30
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare Commercial |
$201.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.20
|
| Rate for Payer: United Healthcare VA CCN |
$131.20
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9825220401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$410.76 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Aetna of VT Commercial |
$527.25
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$410.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$410.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$444.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$444.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$444.00
|
| Rate for Payer: Multiplan Commercial |
$516.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$471.75
|
| Rate for Payer: United Healthcare Commercial |
$527.25
|
|
|
CYSTOSCOPY W/BIOPSY(S)
|
Facility
|
IP
|
$3,979.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
9605220401
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,944.86 |
| Max. Negotiated Rate |
$3,780.05 |
| Rate for Payer: Aetna of VT Commercial |
$3,780.05
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,944.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,944.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$3,382.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$3,342.36
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$3,183.20
|
| Rate for Payer: Cash Price |
$1,989.50
|
| Rate for Payer: Cigna Commercial |
$3,183.20
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3,183.20
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3,183.20
|
| Rate for Payer: Multiplan Commercial |
$3,700.47
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3,382.15
|
| Rate for Payer: United Healthcare Commercial |
$3,780.05
|
|
|
CYSTOURETERO & OR PYELOSCOPE
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 52351
|
| Hospital Charge Code |
9825235101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$489.40 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,049.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$989.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$489.40
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$989.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$665.21
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$939.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$895.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$497.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$878.48
|
| Rate for Payer: Cash Price |
$552.50
|
| Rate for Payer: Cigna Commercial |
$884.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$497.25
|
| Rate for Payer: Multiplan Commercial |
$1,027.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$939.25
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$497.25
|
| Rate for Payer: United Healthcare Commercial |
$1,049.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$497.25
|
| Rate for Payer: United Healthcare VA CCN |
$497.25
|
|
|
CYSTOURETERO & OR PYELOSCOPE
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 52351
|
| Hospital Charge Code |
9825235101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$817.81 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Aetna of VT Commercial |
$1,049.75
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$817.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$817.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$939.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$928.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$884.00
|
| Rate for Payer: Cash Price |
$552.50
|
| Rate for Payer: Cigna Commercial |
$884.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$884.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$884.00
|
| Rate for Payer: Multiplan Commercial |
$1,027.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$939.25
|
| Rate for Payer: United Healthcare Commercial |
$1,049.75
|
|
|
CYSTOURETERO & OR PYELOSCOPE
|
Professional
|
Both
|
$1,105.00
|
|
|
Service Code
|
CPT 52351
|
| Hospital Charge Code |
9825235101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$279.15 |
| Max. Negotiated Rate |
$1,038.70 |
| Rate for Payer: Aetna of VT Commercial |
$1,038.70
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$989.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$287.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$989.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$390.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$546.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$546.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$321.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$546.37
|
| Rate for Payer: Cash Price |
$552.50
|
| Rate for Payer: Cash Price |
$552.50
|
| Rate for Payer: Cigna Commercial |
$485.85
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$462.36
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$462.36
|
| Rate for Payer: Martins Point Health Care Commercial |
$279.16
|
| Rate for Payer: Multiplan Commercial |
$1,027.65
|
| Rate for Payer: MVP Health Care of NY Commercial |
$396.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$279.15
|
| Rate for Payer: United Healthcare Commercial |
$429.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.15
|
| Rate for Payer: United Healthcare VA CCN |
$279.15
|
|
|
CYSTO/URETERO STRICTURE TX
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 52344
|
| Hospital Charge Code |
9825234401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$340.25 |
| Max. Negotiated Rate |
$716.61 |
| Rate for Payer: Aetna of VT Commercial |
$529.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$350.46
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$476.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$716.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$716.61
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$391.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$716.61
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$592.39
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$563.16
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$563.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$340.25
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$483.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$340.25
|
| Rate for Payer: United Healthcare Commercial |
$523.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$340.25
|
| Rate for Payer: United Healthcare VA CCN |
$340.25
|
|
|
CYSTO/URETERO STRICTURE TX
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 52344
|
| Hospital Charge Code |
9825234401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$249.35 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna of VT Commercial |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$249.35
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$504.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$338.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$478.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$456.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$253.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$447.58
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$450.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$253.35
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$478.55
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$253.35
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$253.35
|
| Rate for Payer: United Healthcare VA CCN |
$253.35
|
|
|
CYSTO/URETERO STRICTURE TX
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 52344
|
| Hospital Charge Code |
9825234401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$416.68 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna of VT Commercial |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$416.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$416.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$478.55
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$472.92
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$450.40
|
| Rate for Payer: Cash Price |
$281.50
|
| Rate for Payer: Cigna Commercial |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$450.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$450.40
|
| Rate for Payer: Multiplan Commercial |
$523.59
|
| Rate for Payer: MVP Health Care of NY Commercial |
$478.55
|
| Rate for Payer: United Healthcare Commercial |
$534.85
|
|
|
CYSTOURETERO W/BIOPSY
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
CPT 52354
|
| Hospital Charge Code |
9825235401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,287.77 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,653.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,287.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,287.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,479.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,461.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,392.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,392.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,392.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,392.00
|
| Rate for Payer: Multiplan Commercial |
$1,618.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,479.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
|
|
CYSTOURETERO W/BIOPSY
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
CPT 52354
|
| Hospital Charge Code |
9825235401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$384.08 |
| Max. Negotiated Rate |
$1,635.60 |
| Rate for Payer: Aetna of VT Commercial |
$1,635.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,558.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,558.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$537.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$683.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$683.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$441.69
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$683.63
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$668.05
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$636.19
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$636.19
|
| Rate for Payer: Martins Point Health Care Commercial |
$384.08
|
| Rate for Payer: Multiplan Commercial |
$1,618.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$545.39
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$384.08
|
| Rate for Payer: United Healthcare Commercial |
$590.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$384.08
|
| Rate for Payer: United Healthcare VA CCN |
$384.08
|
|
|
CYSTOURETERO W/BIOPSY
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
CPT 52354
|
| Hospital Charge Code |
9825235401
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$770.65 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Aetna of VT Commercial |
$1,653.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,558.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$770.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,558.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,047.48
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,479.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,409.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$783.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,383.30
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,392.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,392.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,392.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$783.00
|
| Rate for Payer: Multiplan Commercial |
$1,618.20
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,479.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$783.00
|
| Rate for Payer: United Healthcare Commercial |
$1,653.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$783.00
|
| Rate for Payer: United Healthcare VA CCN |
$783.00
|
|
|
CYSTO/URETERO W/LITHOTRIPSY
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
CPT 52356
|
| Hospital Charge Code |
9825235601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$382.63 |
| Max. Negotiated Rate |
$1,018.02 |
| Rate for Payer: Aetna of VT Commercial |
$1,018.02
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$394.11
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$970.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$535.68
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$566.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$566.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$440.02
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$566.54
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$665.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$633.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$633.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$382.63
|
| Rate for Payer: Multiplan Commercial |
$1,007.19
|
| Rate for Payer: MVP Health Care of NY Commercial |
$543.33
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$382.63
|
| Rate for Payer: United Healthcare Commercial |
$588.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.63
|
| Rate for Payer: United Healthcare VA CCN |
$382.63
|
|
