|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$456.80 |
| Max. Negotiated Rate |
$856.50 |
| Rate for Payer: Aetna Medicare |
$571.00
|
| Rate for Payer: BCBS Complete |
$456.80
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$856.50
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$942.75 |
| Rate for Payer: Aetna Medicare |
$628.50
|
| Rate for Payer: BCBS Complete |
$502.80
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$942.75
|
|
|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$2,704.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$2,028.00 |
| Rate for Payer: Aetna Medicare |
$1,352.00
|
| Rate for Payer: BCBS Complete |
$1,081.60
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,028.00
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$171.68 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna Commercial |
$358.44
|
| Rate for Payer: Aetna Medicare |
$278.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.19
|
| Rate for Payer: BCBS Complete |
$180.26
|
| Rate for Payer: BCBS MAPPO |
$267.49
|
| Rate for Payer: BCN Commercial |
$453.17
|
| Rate for Payer: BCN Medicare Advantage |
$267.49
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cash Price |
$592.00
|
| Rate for Payer: Cofinity Commercial |
$385.19
|
| Rate for Payer: Cofinity Commercial |
$358.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.49
|
| Rate for Payer: Healthscope Commercial |
$494.86
|
| Rate for Payer: Healthscope Commercial |
$427.98
|
| Rate for Payer: Mclaren Medicaid |
$171.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.86
|
| Rate for Payer: Meridian Medicaid |
$180.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$294.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.37
|
| Rate for Payer: Nomi Health Commercial |
$320.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.00
|
| Rate for Payer: PACE SWMI |
$267.49
|
| Rate for Payer: PHP Medicare Advantage |
$267.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$493.64
|
| Rate for Payer: Priority Health Medicare |
$267.49
|
| Rate for Payer: Priority Health SBD |
$493.64
|
| Rate for Payer: Priority Health Tiered Network |
$493.64
|
| Rate for Payer: Railroad Medicare Medicare |
$267.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.91
|
| Rate for Payer: UHC Core |
$541.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$267.49
|
| Rate for Payer: UHC Exchange |
$541.91
|
| Rate for Payer: UHC Medicaid |
$171.68
|
| Rate for Payer: UHCCP Medicaid |
$171.68
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$178.07 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$371.90
|
| Rate for Payer: Aetna Medicare |
$288.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.66
|
| Rate for Payer: BCBS Complete |
$186.97
|
| Rate for Payer: BCBS MAPPO |
$277.54
|
| Rate for Payer: BCN Commercial |
$465.61
|
| Rate for Payer: BCN Medicare Advantage |
$277.54
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$399.66
|
| Rate for Payer: Cofinity Commercial |
$371.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.54
|
| Rate for Payer: Healthscope Commercial |
$513.45
|
| Rate for Payer: Healthscope Commercial |
$444.06
|
| Rate for Payer: Mclaren Medicaid |
$178.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.42
|
| Rate for Payer: Meridian Medicaid |
$186.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$305.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$554.04
|
| Rate for Payer: Nomi Health Commercial |
$333.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.00
|
| Rate for Payer: PACE SWMI |
$277.54
|
| Rate for Payer: PHP Medicare Advantage |
$277.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$507.20
|
| Rate for Payer: Priority Health Medicare |
$277.54
|
| Rate for Payer: Priority Health SBD |
$507.20
|
| Rate for Payer: Priority Health Tiered Network |
$507.20
|
| Rate for Payer: Railroad Medicare Medicare |
$277.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.99
|
| Rate for Payer: UHC Core |
$560.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$277.54
|
| Rate for Payer: UHC Exchange |
$560.99
|
| Rate for Payer: UHC Medicaid |
$178.07
|
| Rate for Payer: UHCCP Medicaid |
$178.07
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,561.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$751.68 |
| Max. Negotiated Rate |
$2,670.75 |
| Rate for Payer: Aetna Commercial |
$1,564.88
|
| Rate for Payer: Aetna Medicare |
$1,214.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,564.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,681.66
|
| Rate for Payer: BCBS Complete |
$789.26
|
| Rate for Payer: BCBS MAPPO |
$1,167.82
|
| Rate for Payer: BCN Commercial |
$1,956.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,167.82
|
| Rate for Payer: Cash Price |
$2,848.80
|
| Rate for Payer: Cash Price |
$2,848.80
|
| Rate for Payer: Cofinity Commercial |
$1,681.66
|
| Rate for Payer: Cofinity Commercial |
$1,564.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,167.82
|
| Rate for Payer: Healthscope Commercial |
$2,160.47
|
| Rate for Payer: Healthscope Commercial |
$1,868.51
|
| Rate for Payer: Mclaren Medicaid |
$751.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,226.21
|
| Rate for Payer: Meridian Medicaid |
$789.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,284.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,308.88
|
| Rate for Payer: Nomi Health Commercial |
$1,401.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,670.75
|
| Rate for Payer: PACE SWMI |
$1,167.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,167.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$751.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,131.33
|
| Rate for Payer: Priority Health Medicare |
$1,167.82
|
| Rate for Payer: Priority Health SBD |
$2,131.33
|
| Rate for Payer: Priority Health Tiered Network |
$2,131.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,167.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,324.41
|
| Rate for Payer: UHC Core |
$2,324.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,167.82
|
| Rate for Payer: UHC Exchange |
$2,324.41
|
| Rate for Payer: UHC Medicaid |
$751.68
|
| Rate for Payer: UHCCP Medicaid |
$751.68
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,712.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$576.38 |
| Max. Negotiated Rate |
$2,034.00 |
| Rate for Payer: Aetna Commercial |
$1,203.39
|
| Rate for Payer: Aetna Medicare |
$933.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,293.19
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS MAPPO |
$898.05
|
| Rate for Payer: BCN Commercial |
$1,525.82
|
| Rate for Payer: BCN Medicare Advantage |
$898.05
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cash Price |
$2,169.60
|
| Rate for Payer: Cofinity Commercial |
$1,293.19
|
| Rate for Payer: Cofinity Commercial |
$1,203.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.05
|
| Rate for Payer: Healthscope Commercial |
$1,661.39
|
| Rate for Payer: Healthscope Commercial |
$1,436.88
|
| Rate for Payer: Mclaren Medicaid |
$576.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$942.95
|
| Rate for Payer: Meridian Medicaid |
$605.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$987.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.95
|
| Rate for Payer: Nomi Health Commercial |
$1,077.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,034.00
|
| Rate for Payer: PACE SWMI |
$898.05
|
| Rate for Payer: PHP Medicare Advantage |
$898.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,662.11
|
| Rate for Payer: Priority Health Medicare |
$898.05
|
| Rate for Payer: Priority Health SBD |
$1,662.11
|
| Rate for Payer: Priority Health Tiered Network |
$1,662.11
|
| Rate for Payer: Railroad Medicare Medicare |
$898.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,824.15
|
| Rate for Payer: UHC Core |
$1,824.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$898.05
|
| Rate for Payer: UHC Exchange |
$1,824.15
|
| Rate for Payer: UHC Medicaid |
$576.38
|
| Rate for Payer: UHCCP Medicaid |
$576.38
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$713.98 |
| Max. Negotiated Rate |
$2,137.48 |
| Rate for Payer: Aetna Commercial |
$1,489.26
|
| Rate for Payer: Aetna Medicare |
$1,155.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,489.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,600.40
|
| Rate for Payer: BCBS Complete |
$749.68
|
| Rate for Payer: BCBS MAPPO |
$1,111.39
|
| Rate for Payer: BCN Commercial |
$1,811.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,111.39
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cofinity Commercial |
$1,600.40
|
| Rate for Payer: Cofinity Commercial |
$1,489.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,111.39
|
| Rate for Payer: Healthscope Commercial |
$2,056.07
|
| Rate for Payer: Healthscope Commercial |
$1,778.22
|
| Rate for Payer: Mclaren Medicaid |
$713.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,166.96
|
| Rate for Payer: Meridian Medicaid |
$749.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,222.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,137.48
|
| Rate for Payer: Nomi Health Commercial |
$1,333.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,753.50
|
| Rate for Payer: PACE SWMI |
$1,111.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,111.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,973.49
|
| Rate for Payer: Priority Health Medicare |
$1,111.39
|
| Rate for Payer: Priority Health SBD |
$1,973.49
|
| Rate for Payer: Priority Health Tiered Network |
$1,973.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,111.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,125.04
|
| Rate for Payer: UHC Core |
$2,125.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,111.39
|
| Rate for Payer: UHC Exchange |
$2,125.04
|
| Rate for Payer: UHC Medicaid |
$713.98
|
| Rate for Payer: UHCCP Medicaid |
$713.98
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,156.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$641.98 |
| Max. Negotiated Rate |
$1,959.08 |
| Rate for Payer: Aetna Commercial |
$1,336.84
|
| Rate for Payer: Aetna Medicare |
$1,037.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.60
|
| Rate for Payer: BCBS Complete |
$674.08
|
| Rate for Payer: BCBS MAPPO |
$997.64
|
| Rate for Payer: BCN Commercial |
$1,662.76
|
| Rate for Payer: BCN Medicare Advantage |
$997.64
|
| Rate for Payer: Cash Price |
$1,724.80
|
| Rate for Payer: Cash Price |
$1,724.80
|
| Rate for Payer: Cofinity Commercial |
$1,436.60
|
| Rate for Payer: Cofinity Commercial |
$1,336.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$997.64
|
| Rate for Payer: Healthscope Commercial |
$1,845.63
|
| Rate for Payer: Healthscope Commercial |
$1,596.22
|
| Rate for Payer: Mclaren Medicaid |
$641.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,047.52
|
| Rate for Payer: Meridian Medicaid |
$674.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,097.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,956.65
|
| Rate for Payer: Nomi Health Commercial |
$1,197.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,617.00
|
| Rate for Payer: PACE SWMI |
$997.64
|
| Rate for Payer: PHP Medicare Advantage |
$997.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$641.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,811.29
|
| Rate for Payer: Priority Health Medicare |
$997.64
|
| Rate for Payer: Priority Health SBD |
$1,811.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,811.29
|
| Rate for Payer: Railroad Medicare Medicare |
$997.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,959.08
|
| Rate for Payer: UHC Core |
$1,959.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$997.64
|
| Rate for Payer: UHC Exchange |
$1,959.08
|
| Rate for Payer: UHC Medicaid |
$641.98
|
| Rate for Payer: UHCCP Medicaid |
$641.98
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$614.29 |
| Max. Negotiated Rate |
$1,900.31 |
| Rate for Payer: Aetna Commercial |
$1,277.11
|
| Rate for Payer: Aetna Medicare |
$991.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,372.42
|
| Rate for Payer: BCBS Complete |
$645.00
|
| Rate for Payer: BCBS MAPPO |
$953.07
|
| Rate for Payer: BCN Commercial |
$1,602.51
|
| Rate for Payer: BCN Medicare Advantage |
$953.07
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$1,372.42
|
| Rate for Payer: Cofinity Commercial |
$1,277.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.07
|
| Rate for Payer: Healthscope Commercial |
$1,763.18
|
| Rate for Payer: Healthscope Commercial |
$1,524.91
|
| Rate for Payer: Mclaren Medicaid |
$614.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,000.72
|
| Rate for Payer: Meridian Medicaid |
$645.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,048.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.80
|
| Rate for Payer: Nomi Health Commercial |
$1,143.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,727.25
|
| Rate for Payer: PACE SWMI |
$953.07
|
| Rate for Payer: PHP Medicare Advantage |
$953.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,745.65
|
| Rate for Payer: Priority Health Medicare |
$953.07
|
| Rate for Payer: Priority Health SBD |
$1,745.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,745.65
|
| Rate for Payer: Railroad Medicare Medicare |
$953.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,900.31
|
| Rate for Payer: UHC Core |
$1,900.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$953.07
|
| Rate for Payer: UHC Exchange |
$1,900.31
|
| Rate for Payer: UHC Medicaid |
$614.29
|
| Rate for Payer: UHCCP Medicaid |
$614.29
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,415.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$642.83 |
| Max. Negotiated Rate |
$1,993.20 |
| Rate for Payer: Aetna Commercial |
$1,336.97
|
| Rate for Payer: Aetna Medicare |
$1,037.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.75
|
| Rate for Payer: BCBS Complete |
$674.97
|
| Rate for Payer: BCBS MAPPO |
$997.74
|
| Rate for Payer: BCN Commercial |
$1,678.19
|
| Rate for Payer: BCN Medicare Advantage |
$997.74
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cofinity Commercial |
$1,436.75
|
| Rate for Payer: Cofinity Commercial |
$1,336.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$997.74
|
| Rate for Payer: Healthscope Commercial |
$1,845.82
|
| Rate for Payer: Healthscope Commercial |
$1,596.38
|
| Rate for Payer: Mclaren Medicaid |
$642.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,047.63
|
| Rate for Payer: Meridian Medicaid |
$674.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,097.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,978.11
|
| Rate for Payer: Nomi Health Commercial |
$1,197.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,811.25
|
| Rate for Payer: PACE SWMI |
$997.74
|
| Rate for Payer: PHP Medicare Advantage |
$997.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,828.11
|
| Rate for Payer: Priority Health Medicare |
$997.74
|
| Rate for Payer: Priority Health SBD |
$1,828.11
|
| Rate for Payer: Priority Health Tiered Network |
$1,828.11
|
| Rate for Payer: Railroad Medicare Medicare |
$997.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,993.20
|
| Rate for Payer: UHC Core |
$1,993.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$997.74
|
| Rate for Payer: UHC Exchange |
$1,993.20
|
| Rate for Payer: UHC Medicaid |
$642.83
|
| Rate for Payer: UHCCP Medicaid |
$642.83
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$735.70 |
| Max. Negotiated Rate |
$2,192.62 |
| Rate for Payer: Aetna Commercial |
$1,538.09
|
| Rate for Payer: Aetna Medicare |
$1,193.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,538.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,652.88
|
| Rate for Payer: BCBS Complete |
$772.49
|
| Rate for Payer: BCBS MAPPO |
$1,147.83
|
| Rate for Payer: BCN Commercial |
$1,844.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,147.83
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cofinity Commercial |
$1,652.88
|
| Rate for Payer: Cofinity Commercial |
$1,538.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,147.83
|
| Rate for Payer: Healthscope Commercial |
$2,123.49
|
| Rate for Payer: Healthscope Commercial |
$1,836.53
|
| Rate for Payer: Mclaren Medicaid |
$735.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,205.22
|
| Rate for Payer: Meridian Medicaid |
$772.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,192.62
|
| Rate for Payer: Nomi Health Commercial |
$1,377.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,980.00
|
| Rate for Payer: PACE SWMI |
$1,147.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,147.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$735.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,008.74
|
| Rate for Payer: Priority Health Medicare |
$1,147.83
|
| Rate for Payer: Priority Health SBD |
$2,008.74
|
| Rate for Payer: Priority Health Tiered Network |
$2,008.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,181.14
|
| Rate for Payer: UHC Core |
$2,181.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,147.83
|
| Rate for Payer: UHC Exchange |
$2,181.14
|
| Rate for Payer: UHC Medicaid |
$735.70
|
| Rate for Payer: UHCCP Medicaid |
$735.70
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,822.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$485.43 |
| Max. Negotiated Rate |
$1,486.05 |
| Rate for Payer: Aetna Commercial |
$1,006.54
|
| Rate for Payer: Aetna Medicare |
$781.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.66
|
| Rate for Payer: BCBS Complete |
$509.70
|
| Rate for Payer: BCBS MAPPO |
$751.15
|
| Rate for Payer: BCN Commercial |
$1,260.88
|
| Rate for Payer: BCN Medicare Advantage |
$751.15
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cash Price |
$1,457.60
|
| Rate for Payer: Cofinity Commercial |
$1,081.66
|
| Rate for Payer: Cofinity Commercial |
$1,006.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.15
|
| Rate for Payer: Healthscope Commercial |
$1,389.63
|
| Rate for Payer: Healthscope Commercial |
$1,201.84
|
| Rate for Payer: Mclaren Medicaid |
$485.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.71
|
| Rate for Payer: Meridian Medicaid |
$509.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$826.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.43
|
| Rate for Payer: Nomi Health Commercial |
$901.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,366.50
|
| Rate for Payer: PACE SWMI |
$751.15
|
| Rate for Payer: PHP Medicare Advantage |
$751.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,373.51
|
| Rate for Payer: Priority Health Medicare |
$751.15
|
| Rate for Payer: Priority Health SBD |
$1,373.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,373.51
|
| Rate for Payer: Railroad Medicare Medicare |
$751.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,486.05
|
| Rate for Payer: UHC Core |
$1,486.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.15
|
| Rate for Payer: UHC Exchange |
$1,486.05
|
| Rate for Payer: UHC Medicaid |
$485.43
|
| Rate for Payer: UHCCP Medicaid |
$485.43
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,095.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$596.83 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: Aetna Commercial |
$1,246.05
|
| Rate for Payer: Aetna Medicare |
$967.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,339.04
|
| Rate for Payer: BCBS Complete |
$626.67
|
| Rate for Payer: BCBS MAPPO |
$929.89
|
| Rate for Payer: BCN Commercial |
$1,510.38
|
| Rate for Payer: BCN Medicare Advantage |
$929.89
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cofinity Commercial |
$1,339.04
|
| Rate for Payer: Cofinity Commercial |
$1,246.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$929.89
|
| Rate for Payer: Healthscope Commercial |
$1,720.30
|
| Rate for Payer: Healthscope Commercial |
$1,487.82
|
| Rate for Payer: Mclaren Medicaid |
$596.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.38
|
| Rate for Payer: Meridian Medicaid |
$626.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,022.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,794.28
|
| Rate for Payer: Nomi Health Commercial |
$1,115.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,571.25
|
| Rate for Payer: PACE SWMI |
$929.89
|
| Rate for Payer: PHP Medicare Advantage |
$929.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$596.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,645.29
|
| Rate for Payer: Priority Health Medicare |
$929.89
|
| Rate for Payer: Priority Health SBD |
$1,645.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,645.29
|
| Rate for Payer: Railroad Medicare Medicare |
$929.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,766.43
|
| Rate for Payer: UHC Core |
$1,766.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$929.89
|
| Rate for Payer: UHC Exchange |
$1,766.43
|
| Rate for Payer: UHC Medicaid |
$596.83
|
| Rate for Payer: UHCCP Medicaid |
$596.83
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,173.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$654.98 |
| Max. Negotiated Rate |
$2,003.56 |
| Rate for Payer: Aetna Commercial |
$1,364.84
|
| Rate for Payer: Aetna Medicare |
$1,059.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.70
|
| Rate for Payer: BCBS Complete |
$687.73
|
| Rate for Payer: BCBS MAPPO |
$1,018.54
|
| Rate for Payer: BCN Commercial |
$1,685.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.54
|
| Rate for Payer: Cash Price |
$1,738.40
|
| Rate for Payer: Cash Price |
$1,738.40
|
| Rate for Payer: Cofinity Commercial |
$1,466.70
|
| Rate for Payer: Cofinity Commercial |
$1,364.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.54
|
| Rate for Payer: Healthscope Commercial |
$1,884.30
|
| Rate for Payer: Healthscope Commercial |
$1,629.66
|
| Rate for Payer: Mclaren Medicaid |
$654.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,069.47
|
| Rate for Payer: Meridian Medicaid |
$687.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,120.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,003.56
|
| Rate for Payer: Nomi Health Commercial |
$1,222.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,629.75
|
| Rate for Payer: PACE SWMI |
$1,018.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,835.70
|
| Rate for Payer: Priority Health Medicare |
$1,018.54
|
| Rate for Payer: Priority Health SBD |
$1,835.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,835.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,018.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,000.74
|
| Rate for Payer: UHC Core |
$2,000.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,018.54
|
| Rate for Payer: UHC Exchange |
$2,000.74
|
| Rate for Payer: UHC Medicaid |
$654.98
|
| Rate for Payer: UHCCP Medicaid |
$654.98
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$531.01 |
| Max. Negotiated Rate |
$1,641.31 |
| Rate for Payer: Aetna Commercial |
$1,103.29
|
| Rate for Payer: Aetna Medicare |
$856.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.62
|
| Rate for Payer: BCBS Complete |
$557.56
|
| Rate for Payer: BCBS MAPPO |
$823.35
|
| Rate for Payer: BCN Commercial |
$1,385.38
|
| Rate for Payer: BCN Medicare Advantage |
$823.35
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,185.62
|
| Rate for Payer: Cofinity Commercial |
$1,103.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.35
|
| Rate for Payer: Healthscope Commercial |
$1,523.20
|
| Rate for Payer: Healthscope Commercial |
$1,317.36
|
| Rate for Payer: Mclaren Medicaid |
$531.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$864.52
|
| Rate for Payer: Meridian Medicaid |
$557.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$905.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.48
|
| Rate for Payer: Nomi Health Commercial |
$988.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.50
|
| Rate for Payer: PACE SWMI |
$823.35
|
| Rate for Payer: PHP Medicare Advantage |
$823.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,509.13
|
| Rate for Payer: Priority Health Medicare |
$823.35
|
| Rate for Payer: Priority Health SBD |
$1,509.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,509.13
|
| Rate for Payer: Railroad Medicare Medicare |
$823.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,641.31
|
| Rate for Payer: UHC Core |
$1,641.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$823.35
|
| Rate for Payer: UHC Exchange |
$1,641.31
|
| Rate for Payer: UHC Medicaid |
$531.01
|
| Rate for Payer: UHCCP Medicaid |
$531.01
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,404.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,324.48 |
| Rate for Payer: Aetna Commercial |
$891.02
|
| Rate for Payer: Aetna Medicare |
$691.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.51
|
| Rate for Payer: BCBS Complete |
$450.43
|
| Rate for Payer: BCBS MAPPO |
$664.94
|
| Rate for Payer: BCN Commercial |
$1,120.46
|
| Rate for Payer: BCN Medicare Advantage |
$664.94
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cofinity Commercial |
$957.51
|
| Rate for Payer: Cofinity Commercial |
$891.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.94
|
| Rate for Payer: Healthscope Commercial |
$1,230.14
|
| Rate for Payer: Healthscope Commercial |
$1,063.90
|
| Rate for Payer: Mclaren Medicaid |
$428.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$698.19
|
| Rate for Payer: Meridian Medicaid |
$450.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$731.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,324.48
|
| Rate for Payer: Nomi Health Commercial |
$797.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.00
|
| Rate for Payer: PACE SWMI |
$664.94
|
| Rate for Payer: PHP Medicare Advantage |
$664.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,220.55
|
| Rate for Payer: Priority Health Medicare |
$664.94
|
| Rate for Payer: Priority Health SBD |
$1,220.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,220.55
|
| Rate for Payer: Railroad Medicare Medicare |
$664.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,322.28
|
| Rate for Payer: UHC Core |
$1,322.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.94
|
| Rate for Payer: UHC Exchange |
$1,322.28
|
| Rate for Payer: UHC Medicaid |
$428.98
|
| Rate for Payer: UHCCP Medicaid |
$428.98
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$241.76 |
| Max. Negotiated Rate |
$718.31 |
| Rate for Payer: Aetna Commercial |
$497.81
|
| Rate for Payer: Aetna Medicare |
$386.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.96
|
| Rate for Payer: BCBS Complete |
$253.85
|
| Rate for Payer: BCBS MAPPO |
$371.50
|
| Rate for Payer: BCN Commercial |
$618.00
|
| Rate for Payer: BCN Medicare Advantage |
$371.50
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cofinity Commercial |
$534.96
|
| Rate for Payer: Cofinity Commercial |
$497.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.50
|
| Rate for Payer: Healthscope Commercial |
$687.27
|
| Rate for Payer: Healthscope Commercial |
$594.40
|
| Rate for Payer: Mclaren Medicaid |
$241.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.07
|
| Rate for Payer: Meridian Medicaid |
$253.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$408.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.29
|
| Rate for Payer: Nomi Health Commercial |
$445.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.75
|
| Rate for Payer: PACE SWMI |
$371.50
|
| Rate for Payer: PHP Medicare Advantage |
$371.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$673.20
|
| Rate for Payer: Priority Health Medicare |
$371.50
|
| Rate for Payer: Priority Health SBD |
$673.20
|
| Rate for Payer: Priority Health Tiered Network |
$673.20
|
| Rate for Payer: Railroad Medicare Medicare |
$371.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.31
|
| Rate for Payer: UHC Core |
$718.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.50
|
| Rate for Payer: UHC Exchange |
$718.31
|
| Rate for Payer: UHC Medicaid |
$241.76
|
| Rate for Payer: UHCCP Medicaid |
$241.76
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$268.81 |
| Max. Negotiated Rate |
$1,216.50 |
| Rate for Payer: Aetna Commercial |
$554.71
|
| Rate for Payer: Aetna Medicare |
$430.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.10
|
| Rate for Payer: BCBS Complete |
$282.25
|
| Rate for Payer: BCBS MAPPO |
$413.96
|
| Rate for Payer: BCN Commercial |
$688.71
|
| Rate for Payer: BCN Medicare Advantage |
$413.96
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cash Price |
$1,297.60
|
| Rate for Payer: Cofinity Commercial |
$596.10
|
| Rate for Payer: Cofinity Commercial |
$554.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.96
|
| Rate for Payer: Healthscope Commercial |
$765.83
|
| Rate for Payer: Healthscope Commercial |
$662.34
|
| Rate for Payer: Mclaren Medicaid |
$268.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.66
|
| Rate for Payer: Meridian Medicaid |
$282.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$455.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.63
|
| Rate for Payer: Nomi Health Commercial |
$496.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,216.50
|
| Rate for Payer: PACE SWMI |
$413.96
|
| Rate for Payer: PHP Medicare Advantage |
$413.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$750.22
|
| Rate for Payer: Priority Health Medicare |
$413.96
|
| Rate for Payer: Priority Health SBD |
$750.22
|
| Rate for Payer: Priority Health Tiered Network |
$750.22
|
| Rate for Payer: Railroad Medicare Medicare |
$413.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.45
|
| Rate for Payer: UHC Core |
$804.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$413.96
|
| Rate for Payer: UHC Exchange |
$804.45
|
| Rate for Payer: UHC Medicaid |
$268.81
|
| Rate for Payer: UHCCP Medicaid |
$268.81
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,094.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$560.83 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: Aetna Commercial |
$1,164.53
|
| Rate for Payer: Aetna Medicare |
$903.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.43
|
| Rate for Payer: BCBS Complete |
$588.87
|
| Rate for Payer: BCBS MAPPO |
$869.05
|
| Rate for Payer: BCN Commercial |
$1,461.57
|
| Rate for Payer: BCN Medicare Advantage |
$869.05
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cash Price |
$1,675.20
|
| Rate for Payer: Cofinity Commercial |
$1,251.43
|
| Rate for Payer: Cofinity Commercial |
$1,164.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$869.05
|
| Rate for Payer: Healthscope Commercial |
$1,607.74
|
| Rate for Payer: Healthscope Commercial |
$1,390.48
|
| Rate for Payer: Mclaren Medicaid |
$560.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.50
|
| Rate for Payer: Meridian Medicaid |
$588.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$955.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,719.70
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,570.50
|
| Rate for Payer: PACE SWMI |
$869.05
|
| Rate for Payer: PHP Medicare Advantage |
$869.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$560.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,592.13
|
| Rate for Payer: Priority Health Medicare |
$869.05
|
| Rate for Payer: Priority Health SBD |
$1,592.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.13
|
| Rate for Payer: Railroad Medicare Medicare |
$869.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.79
|
| Rate for Payer: UHC Core |
$1,728.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$869.05
|
| Rate for Payer: UHC Exchange |
$1,728.79
|
| Rate for Payer: UHC Medicaid |
$560.83
|
| Rate for Payer: UHCCP Medicaid |
$560.83
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$461.57 |
| Max. Negotiated Rate |
$1,414.81 |
| Rate for Payer: Aetna Commercial |
$956.85
|
| Rate for Payer: Aetna Medicare |
$742.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,028.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.85
|
| Rate for Payer: BCBS Complete |
$484.65
|
| Rate for Payer: BCBS MAPPO |
$714.07
|
| Rate for Payer: BCN Commercial |
$1,200.63
|
| Rate for Payer: BCN Medicare Advantage |
$714.07
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cash Price |
$1,256.00
|
| Rate for Payer: Cofinity Commercial |
$956.85
|
| Rate for Payer: Cofinity Commercial |
$1,028.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.07
|
| Rate for Payer: Healthscope Commercial |
$1,321.03
|
| Rate for Payer: Healthscope Commercial |
$1,142.51
|
| Rate for Payer: Mclaren Medicaid |
$461.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.77
|
| Rate for Payer: Meridian Medicaid |
$484.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$785.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.45
|
| Rate for Payer: Nomi Health Commercial |
$856.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,177.50
|
| Rate for Payer: PACE SWMI |
$714.07
|
| Rate for Payer: PHP Medicare Advantage |
$714.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,307.87
|
| Rate for Payer: Priority Health Medicare |
$714.07
|
| Rate for Payer: Priority Health SBD |
$1,307.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,307.87
|
| Rate for Payer: Railroad Medicare Medicare |
$714.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,414.81
|
| Rate for Payer: UHC Core |
$1,414.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$714.07
|
| Rate for Payer: UHC Exchange |
$1,414.81
|
| Rate for Payer: UHC Medicaid |
$461.57
|
| Rate for Payer: UHCCP Medicaid |
$461.57
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$502.04 |
| Max. Negotiated Rate |
$1,542.18 |
| Rate for Payer: Aetna Commercial |
$1,041.56
|
| Rate for Payer: Aetna Medicare |
$808.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.28
|
| Rate for Payer: BCBS Complete |
$527.14
|
| Rate for Payer: BCBS MAPPO |
$777.28
|
| Rate for Payer: BCN Commercial |
$1,306.20
|
| Rate for Payer: BCN Medicare Advantage |
$777.28
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cofinity Commercial |
$1,119.28
|
| Rate for Payer: Cofinity Commercial |
$1,041.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$777.28
|
| Rate for Payer: Healthscope Commercial |
$1,437.97
|
| Rate for Payer: Healthscope Commercial |
$1,243.65
|
| Rate for Payer: Mclaren Medicaid |
$502.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$816.14
|
| Rate for Payer: Meridian Medicaid |
$527.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$855.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,534.72
|
| Rate for Payer: Nomi Health Commercial |
$932.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,401.00
|
| Rate for Payer: PACE SWMI |
$777.28
|
| Rate for Payer: PHP Medicare Advantage |
$777.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$502.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,422.88
|
| Rate for Payer: Priority Health Medicare |
$777.28
|
| Rate for Payer: Priority Health SBD |
$1,422.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,422.88
|
| Rate for Payer: Railroad Medicare Medicare |
$777.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,542.18
|
| Rate for Payer: UHC Core |
$1,542.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$777.28
|
| Rate for Payer: UHC Exchange |
$1,542.18
|
| Rate for Payer: UHC Medicaid |
$502.04
|
| Rate for Payer: UHCCP Medicaid |
$502.04
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$556.78 |
| Max. Negotiated Rate |
$1,717.83 |
| Rate for Payer: Aetna Commercial |
$1,157.91
|
| Rate for Payer: Aetna Medicare |
$898.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.32
|
| Rate for Payer: BCBS Complete |
$584.62
|
| Rate for Payer: BCBS MAPPO |
$864.11
|
| Rate for Payer: BCN Commercial |
$1,454.60
|
| Rate for Payer: BCN Medicare Advantage |
$864.11
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,244.32
|
| Rate for Payer: Cofinity Commercial |
$1,157.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.11
|
| Rate for Payer: Healthscope Commercial |
$1,598.60
|
| Rate for Payer: Healthscope Commercial |
$1,382.58
|
| Rate for Payer: Mclaren Medicaid |
$556.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.32
|
| Rate for Payer: Meridian Medicaid |
$584.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$950.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,717.83
|
| Rate for Payer: Nomi Health Commercial |
$1,036.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,362.75
|
| Rate for Payer: PACE SWMI |
$864.11
|
| Rate for Payer: PHP Medicare Advantage |
$864.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,584.53
|
| Rate for Payer: Priority Health Medicare |
$864.11
|
| Rate for Payer: Priority Health SBD |
$1,584.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,584.53
|
| Rate for Payer: Railroad Medicare Medicare |
$864.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,717.66
|
| Rate for Payer: UHC Core |
$1,717.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$864.11
|
| Rate for Payer: UHC Exchange |
$1,717.66
|
| Rate for Payer: UHC Medicaid |
$556.78
|
| Rate for Payer: UHCCP Medicaid |
$556.78
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$284.99 |
| Max. Negotiated Rate |
$853.99 |
| Rate for Payer: Aetna Commercial |
$588.25
|
| Rate for Payer: Aetna Medicare |
$456.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.15
|
| Rate for Payer: BCBS Complete |
$299.24
|
| Rate for Payer: BCBS MAPPO |
$438.99
|
| Rate for Payer: BCN Commercial |
$732.53
|
| Rate for Payer: BCN Medicare Advantage |
$438.99
|
| Rate for Payer: Cash Price |
$804.80
|
| Rate for Payer: Cash Price |
$804.80
|
| Rate for Payer: Cofinity Commercial |
$632.15
|
| Rate for Payer: Cofinity Commercial |
$588.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.99
|
| Rate for Payer: Healthscope Commercial |
$812.13
|
| Rate for Payer: Healthscope Commercial |
$702.38
|
| Rate for Payer: Mclaren Medicaid |
$284.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$460.94
|
| Rate for Payer: Meridian Medicaid |
$299.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$482.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.78
|
| Rate for Payer: Nomi Health Commercial |
$526.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$754.50
|
| Rate for Payer: PACE SWMI |
$438.99
|
| Rate for Payer: PHP Medicare Advantage |
$438.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$797.97
|
| Rate for Payer: Priority Health Medicare |
$438.99
|
| Rate for Payer: Priority Health SBD |
$797.97
|
| Rate for Payer: Priority Health Tiered Network |
$797.97
|
| Rate for Payer: Railroad Medicare Medicare |
$438.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.99
|
| Rate for Payer: UHC Core |
$853.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$438.99
|
| Rate for Payer: UHC Exchange |
$853.99
|
| Rate for Payer: UHC Medicaid |
$284.99
|
| Rate for Payer: UHCCP Medicaid |
$284.99
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$951.00
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$284.78 |
| Max. Negotiated Rate |
$853.42 |
| Rate for Payer: Aetna Commercial |
$587.84
|
| Rate for Payer: Aetna Medicare |
$456.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.71
|
| Rate for Payer: BCBS Complete |
$299.02
|
| Rate for Payer: BCBS MAPPO |
$438.69
|
| Rate for Payer: BCN Commercial |
$732.03
|
| Rate for Payer: BCN Medicare Advantage |
$438.69
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Cofinity Commercial |
$631.71
|
| Rate for Payer: Cofinity Commercial |
$587.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.69
|
| Rate for Payer: Healthscope Commercial |
$811.58
|
| Rate for Payer: Healthscope Commercial |
$701.90
|
| Rate for Payer: Mclaren Medicaid |
$284.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$460.62
|
| Rate for Payer: Meridian Medicaid |
$299.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$482.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$853.22
|
| Rate for Payer: Nomi Health Commercial |
$526.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$713.25
|
| Rate for Payer: PACE SWMI |
$438.69
|
| Rate for Payer: PHP Medicare Advantage |
$438.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$797.41
|
| Rate for Payer: Priority Health Medicare |
$438.69
|
| Rate for Payer: Priority Health SBD |
$797.41
|
| Rate for Payer: Priority Health Tiered Network |
$797.41
|
| Rate for Payer: Railroad Medicare Medicare |
$438.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.42
|
| Rate for Payer: UHC Core |
$853.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$438.69
|
| Rate for Payer: UHC Exchange |
$853.42
|
| Rate for Payer: UHC Medicaid |
$284.78
|
| Rate for Payer: UHCCP Medicaid |
$284.78
|
|
