|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$538.28 |
| Rate for Payer: Aetna Commercial |
$389.89
|
| Rate for Payer: Aetna Medicare |
$302.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.98
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: BCBS MAPPO |
$290.96
|
| Rate for Payer: BCN Medicare Advantage |
$290.96
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$389.89
|
| Rate for Payer: Cofinity Commercial |
$418.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.96
|
| Rate for Payer: Healthscope Commercial |
$538.28
|
| Rate for Payer: Healthscope Commercial |
$465.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.70
|
| Rate for Payer: Nomi Health Commercial |
$349.15
|
| Rate for Payer: PACE SWMI |
$290.96
|
| Rate for Payer: PHP Medicare Advantage |
$290.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health Medicare |
$290.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.96
|
| Rate for Payer: UHC Medicare Advantage |
$290.96
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$298.93 |
| Max. Negotiated Rate |
$553.02 |
| Rate for Payer: Aetna Commercial |
$400.57
|
| Rate for Payer: Aetna Medicare |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.57
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: BCBS MAPPO |
$298.93
|
| Rate for Payer: BCN Medicare Advantage |
$298.93
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$400.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.93
|
| Rate for Payer: Healthscope Commercial |
$553.02
|
| Rate for Payer: Healthscope Commercial |
$478.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.85
|
| Rate for Payer: Nomi Health Commercial |
$358.72
|
| Rate for Payer: PACE SWMI |
$298.93
|
| Rate for Payer: PHP Medicare Advantage |
$298.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health Medicare |
$298.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.93
|
| Rate for Payer: UHC Medicare Advantage |
$298.93
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$1,253.27 |
| Max. Negotiated Rate |
$2,318.55 |
| Rate for Payer: Aetna Commercial |
$1,679.38
|
| Rate for Payer: Aetna Medicare |
$1,303.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,804.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.38
|
| Rate for Payer: BCBS Complete |
$1,382.80
|
| Rate for Payer: BCBS MAPPO |
$1,253.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,253.27
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,804.71
|
| Rate for Payer: Cofinity Commercial |
$1,679.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,253.27
|
| Rate for Payer: Healthscope Commercial |
$2,005.23
|
| Rate for Payer: Healthscope Commercial |
$2,318.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,247.05
|
| Rate for Payer: Nomi Health Commercial |
$1,503.92
|
| Rate for Payer: PACE SWMI |
$1,253.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,253.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health Medicare |
$1,253.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.27
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$979.99 |
| Max. Negotiated Rate |
$1,812.98 |
| Rate for Payer: Aetna Commercial |
$1,313.19
|
| Rate for Payer: Aetna Medicare |
$1,019.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,411.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.19
|
| Rate for Payer: BCBS Complete |
$1,053.20
|
| Rate for Payer: BCBS MAPPO |
$979.99
|
| Rate for Payer: BCN Medicare Advantage |
$979.99
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,411.19
|
| Rate for Payer: Cofinity Commercial |
$1,313.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.99
|
| Rate for Payer: Healthscope Commercial |
$1,812.98
|
| Rate for Payer: Healthscope Commercial |
$1,567.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,711.45
|
| Rate for Payer: Nomi Health Commercial |
$1,175.99
|
| Rate for Payer: PACE SWMI |
$979.99
|
| Rate for Payer: PHP Medicare Advantage |
$979.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health Medicare |
$979.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.99
|
| Rate for Payer: UHC Medicare Advantage |
$979.99
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$908.00 |
| Max. Negotiated Rate |
$2,152.14 |
| Rate for Payer: Aetna Commercial |
$1,558.85
|
| Rate for Payer: Aetna Medicare |
$1,209.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,675.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,558.85
|
| Rate for Payer: BCBS Complete |
$908.00
|
| Rate for Payer: BCBS MAPPO |
$1,163.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,163.32
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cofinity Commercial |
$1,675.18
|
| Rate for Payer: Cofinity Commercial |
$1,558.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,163.32
|
| Rate for Payer: Healthscope Commercial |
$1,861.31
|
| Rate for Payer: Healthscope Commercial |
$2,152.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,475.50
|
| Rate for Payer: Nomi Health Commercial |
$1,395.98
|
| Rate for Payer: PACE SWMI |
$1,163.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health Medicare |
$1,163.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,163.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.32
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$837.20 |
| Max. Negotiated Rate |
$1,972.45 |
| Rate for Payer: Aetna Commercial |
$1,428.69
|
| Rate for Payer: Aetna Medicare |
$1,108.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,428.69
|
| Rate for Payer: BCBS Complete |
$837.20
|
| Rate for Payer: BCBS MAPPO |
$1,066.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,066.19
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$1,535.31
|
| Rate for Payer: Cofinity Commercial |
$1,428.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,066.19
|
| Rate for Payer: Healthscope Commercial |
$1,972.45
|
| Rate for Payer: Healthscope Commercial |
$1,705.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,119.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,360.45
|
| Rate for Payer: Nomi Health Commercial |
$1,279.43
|
| Rate for Payer: PACE SWMI |
$1,066.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,066.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health Medicare |
$1,066.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,066.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,066.19
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$894.40 |
| Max. Negotiated Rate |
$1,896.32 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Aetna Medicare |
$1,066.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.55
|
| Rate for Payer: BCBS Complete |
$894.40
|
| Rate for Payer: BCBS MAPPO |
$1,025.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.04
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.06
|
| Rate for Payer: Cofinity Commercial |
$1,373.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.04
|
| Rate for Payer: Healthscope Commercial |
$1,640.06
|
| Rate for Payer: Healthscope Commercial |
$1,896.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,076.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,453.40
|
| Rate for Payer: Nomi Health Commercial |
$1,230.05
|
| Rate for Payer: PACE SWMI |
$1,025.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health Medicare |
$1,025.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.04
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$1,986.29 |
| Rate for Payer: Aetna Commercial |
$1,438.72
|
| Rate for Payer: Aetna Medicare |
$1,116.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,546.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,438.72
|
| Rate for Payer: BCBS Complete |
$938.00
|
| Rate for Payer: BCBS MAPPO |
$1,073.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,073.67
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cofinity Commercial |
$1,546.08
|
| Rate for Payer: Cofinity Commercial |
$1,438.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,073.67
|
| Rate for Payer: Healthscope Commercial |
$1,986.29
|
| Rate for Payer: Healthscope Commercial |
$1,717.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.25
|
| Rate for Payer: Nomi Health Commercial |
$1,288.40
|
| Rate for Payer: PACE SWMI |
$1,073.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,073.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.25
|
| Rate for Payer: Priority Health Medicare |
$1,073.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,073.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.67
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$2,205.70 |
| Rate for Payer: Aetna Commercial |
$1,597.64
|
| Rate for Payer: Aetna Medicare |
$1,239.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.64
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: BCBS MAPPO |
$1,192.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.27
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,716.87
|
| Rate for Payer: Cofinity Commercial |
$1,597.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.27
|
| Rate for Payer: Healthscope Commercial |
$1,907.63
|
| Rate for Payer: Healthscope Commercial |
$2,205.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,665.95
|
| Rate for Payer: Nomi Health Commercial |
$1,430.72
|
| Rate for Payer: PACE SWMI |
$1,192.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health Medicare |
$1,192.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.27
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$707.60 |
| Max. Negotiated Rate |
$1,488.64 |
| Rate for Payer: Aetna Commercial |
$1,078.26
|
| Rate for Payer: Aetna Medicare |
$836.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.26
|
| Rate for Payer: BCBS Complete |
$707.60
|
| Rate for Payer: BCBS MAPPO |
$804.67
|
| Rate for Payer: BCN Medicare Advantage |
$804.67
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cofinity Commercial |
$1,158.72
|
| Rate for Payer: Cofinity Commercial |
$1,078.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.67
|
| Rate for Payer: Healthscope Commercial |
$1,488.64
|
| Rate for Payer: Healthscope Commercial |
$1,287.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$844.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,149.85
|
| Rate for Payer: Nomi Health Commercial |
$965.60
|
| Rate for Payer: PACE SWMI |
$804.67
|
| Rate for Payer: PHP Medicare Advantage |
$804.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health Medicare |
$804.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.67
|
| Rate for Payer: UHC Medicare Advantage |
$804.67
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$1,802.12 |
| Rate for Payer: Aetna Commercial |
$1,305.32
|
| Rate for Payer: Aetna Medicare |
$1,013.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.32
|
| Rate for Payer: BCBS Complete |
$813.60
|
| Rate for Payer: BCBS MAPPO |
$974.12
|
| Rate for Payer: BCN Medicare Advantage |
$974.12
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,402.73
|
| Rate for Payer: Cofinity Commercial |
$1,305.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.12
|
| Rate for Payer: Healthscope Commercial |
$1,558.59
|
| Rate for Payer: Healthscope Commercial |
$1,802.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.10
|
| Rate for Payer: Nomi Health Commercial |
$1,168.94
|
| Rate for Payer: PACE SWMI |
$974.12
|
| Rate for Payer: PHP Medicare Advantage |
$974.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health Medicare |
$974.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.12
|
| Rate for Payer: UHC Medicare Advantage |
$974.12
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$844.00 |
| Max. Negotiated Rate |
$2,000.29 |
| Rate for Payer: Aetna Commercial |
$1,448.86
|
| Rate for Payer: Aetna Medicare |
$1,124.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.86
|
| Rate for Payer: BCBS Complete |
$844.00
|
| Rate for Payer: BCBS MAPPO |
$1,081.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,081.24
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,556.99
|
| Rate for Payer: Cofinity Commercial |
$1,448.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,081.24
|
| Rate for Payer: Healthscope Commercial |
$2,000.29
|
| Rate for Payer: Healthscope Commercial |
$1,729.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,371.50
|
| Rate for Payer: Nomi Health Commercial |
$1,297.49
|
| Rate for Payer: PACE SWMI |
$1,081.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,081.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health Medicare |
$1,081.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,081.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.24
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$771.20 |
| Max. Negotiated Rate |
$1,638.66 |
| Rate for Payer: Aetna Commercial |
$1,186.92
|
| Rate for Payer: Aetna Medicare |
$921.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.92
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$885.76
|
| Rate for Payer: BCN Medicare Advantage |
$885.76
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,275.49
|
| Rate for Payer: Cofinity Commercial |
$1,186.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.76
|
| Rate for Payer: Healthscope Commercial |
$1,417.22
|
| Rate for Payer: Healthscope Commercial |
$1,638.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.20
|
| Rate for Payer: Nomi Health Commercial |
$1,062.91
|
| Rate for Payer: PACE SWMI |
$885.76
|
| Rate for Payer: PHP Medicare Advantage |
$885.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health Medicare |
$885.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.76
|
| Rate for Payer: UHC Medicare Advantage |
$885.76
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$545.20 |
| Max. Negotiated Rate |
$1,325.45 |
| Rate for Payer: Aetna Commercial |
$960.06
|
| Rate for Payer: Aetna Medicare |
$745.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.70
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$716.46
|
| Rate for Payer: BCN Medicare Advantage |
$716.46
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$960.06
|
| Rate for Payer: Cofinity Commercial |
$1,031.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.46
|
| Rate for Payer: Healthscope Commercial |
$1,325.45
|
| Rate for Payer: Healthscope Commercial |
$1,146.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.95
|
| Rate for Payer: Nomi Health Commercial |
$859.75
|
| Rate for Payer: PACE SWMI |
$716.46
|
| Rate for Payer: PHP Medicare Advantage |
$716.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$716.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.46
|
| Rate for Payer: UHC Medicare Advantage |
$716.46
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$725.44 |
| Rate for Payer: Aetna Commercial |
$525.45
|
| Rate for Payer: Aetna Medicare |
$407.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.45
|
| Rate for Payer: BCBS Complete |
$309.60
|
| Rate for Payer: BCBS MAPPO |
$392.13
|
| Rate for Payer: BCN Medicare Advantage |
$392.13
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$564.67
|
| Rate for Payer: Cofinity Commercial |
$525.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.13
|
| Rate for Payer: Healthscope Commercial |
$627.41
|
| Rate for Payer: Healthscope Commercial |
$725.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.10
|
| Rate for Payer: Nomi Health Commercial |
$470.56
|
| Rate for Payer: PACE SWMI |
$392.13
|
| Rate for Payer: PHP Medicare Advantage |
$392.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.10
|
| Rate for Payer: Priority Health Medicare |
$392.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.13
|
| Rate for Payer: UHC Medicare Advantage |
$392.13
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$437.65 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$586.45
|
| Rate for Payer: Aetna Medicare |
$455.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.45
|
| Rate for Payer: BCBS Complete |
$630.00
|
| Rate for Payer: BCBS MAPPO |
$437.65
|
| Rate for Payer: BCN Medicare Advantage |
$437.65
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cofinity Commercial |
$630.22
|
| Rate for Payer: Cofinity Commercial |
$586.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.65
|
| Rate for Payer: Healthscope Commercial |
$809.65
|
| Rate for Payer: Healthscope Commercial |
$700.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.75
|
| Rate for Payer: Nomi Health Commercial |
$525.18
|
| Rate for Payer: PACE SWMI |
$437.65
|
| Rate for Payer: PHP Medicare Advantage |
$437.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health Medicare |
$437.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.65
|
| Rate for Payer: UHC Medicare Advantage |
$437.65
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$813.20 |
| Max. Negotiated Rate |
$1,727.73 |
| Rate for Payer: Aetna Commercial |
$1,251.44
|
| Rate for Payer: Aetna Medicare |
$971.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.44
|
| Rate for Payer: BCBS Complete |
$813.20
|
| Rate for Payer: BCBS MAPPO |
$933.91
|
| Rate for Payer: BCN Medicare Advantage |
$933.91
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,344.83
|
| Rate for Payer: Cofinity Commercial |
$1,251.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.91
|
| Rate for Payer: Healthscope Commercial |
$1,494.26
|
| Rate for Payer: Healthscope Commercial |
$1,727.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,321.45
|
| Rate for Payer: Nomi Health Commercial |
$1,120.69
|
| Rate for Payer: PACE SWMI |
$933.91
|
| Rate for Payer: PHP Medicare Advantage |
$933.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health Medicare |
$933.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.91
|
| Rate for Payer: UHC Medicare Advantage |
$933.91
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,417.04 |
| Rate for Payer: Aetna Commercial |
$1,026.40
|
| Rate for Payer: Aetna Medicare |
$796.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.40
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$765.97
|
| Rate for Payer: BCN Medicare Advantage |
$765.97
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,103.00
|
| Rate for Payer: Cofinity Commercial |
$1,026.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.97
|
| Rate for Payer: Healthscope Commercial |
$1,417.04
|
| Rate for Payer: Healthscope Commercial |
$1,225.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.60
|
| Rate for Payer: Nomi Health Commercial |
$919.16
|
| Rate for Payer: PACE SWMI |
$765.97
|
| Rate for Payer: PHP Medicare Advantage |
$765.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$765.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.97
|
| Rate for Payer: UHC Medicare Advantage |
$765.97
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$1,543.12 |
| Rate for Payer: Aetna Commercial |
$1,117.72
|
| Rate for Payer: Aetna Medicare |
$867.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,201.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.72
|
| Rate for Payer: BCBS Complete |
$725.60
|
| Rate for Payer: BCBS MAPPO |
$834.12
|
| Rate for Payer: BCN Medicare Advantage |
$834.12
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,201.13
|
| Rate for Payer: Cofinity Commercial |
$1,117.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.12
|
| Rate for Payer: Healthscope Commercial |
$1,334.59
|
| Rate for Payer: Healthscope Commercial |
$1,543.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.10
|
| Rate for Payer: Nomi Health Commercial |
$1,000.94
|
| Rate for Payer: PACE SWMI |
$834.12
|
| Rate for Payer: PHP Medicare Advantage |
$834.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health Medicare |
$834.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.12
|
| Rate for Payer: UHC Medicare Advantage |
$834.12
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$705.60 |
| Max. Negotiated Rate |
$1,722.37 |
| Rate for Payer: Aetna Commercial |
$1,247.55
|
| Rate for Payer: Aetna Medicare |
$968.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,340.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.55
|
| Rate for Payer: BCBS Complete |
$705.60
|
| Rate for Payer: BCBS MAPPO |
$931.01
|
| Rate for Payer: BCN Medicare Advantage |
$931.01
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cofinity Commercial |
$1,340.65
|
| Rate for Payer: Cofinity Commercial |
$1,247.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.01
|
| Rate for Payer: Healthscope Commercial |
$1,722.37
|
| Rate for Payer: Healthscope Commercial |
$1,489.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,146.60
|
| Rate for Payer: Nomi Health Commercial |
$1,117.21
|
| Rate for Payer: PACE SWMI |
$931.01
|
| Rate for Payer: PHP Medicare Advantage |
$931.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health Medicare |
$931.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.01
|
| Rate for Payer: UHC Medicare Advantage |
$931.01
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$861.75 |
| Rate for Payer: Aetna Commercial |
$624.19
|
| Rate for Payer: Aetna Medicare |
$484.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.19
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS MAPPO |
$465.81
|
| Rate for Payer: BCN Medicare Advantage |
$465.81
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$670.77
|
| Rate for Payer: Cofinity Commercial |
$624.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.81
|
| Rate for Payer: Healthscope Commercial |
$745.30
|
| Rate for Payer: Healthscope Commercial |
$861.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.05
|
| Rate for Payer: Nomi Health Commercial |
$558.97
|
| Rate for Payer: PACE SWMI |
$465.81
|
| Rate for Payer: PHP Medicare Advantage |
$465.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health Medicare |
$465.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.81
|
| Rate for Payer: UHC Medicare Advantage |
$465.81
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$861.19 |
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna Medicare |
$484.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.78
|
| Rate for Payer: BCBS Complete |
$369.20
|
| Rate for Payer: BCBS MAPPO |
$465.51
|
| Rate for Payer: BCN Medicare Advantage |
$465.51
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$670.33
|
| Rate for Payer: Cofinity Commercial |
$623.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.51
|
| Rate for Payer: Healthscope Commercial |
$861.19
|
| Rate for Payer: Healthscope Commercial |
$744.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.95
|
| Rate for Payer: Nomi Health Commercial |
$558.61
|
| Rate for Payer: PACE SWMI |
$465.51
|
| Rate for Payer: PHP Medicare Advantage |
$465.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.95
|
| Rate for Payer: Priority Health Medicare |
$465.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.51
|
| Rate for Payer: UHC Medicare Advantage |
$465.51
|
|
|
PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 53010
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$526.23 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna Medicare |
$295.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.16
|
| Rate for Payer: BCBS Complete |
$221.20
|
| Rate for Payer: BCBS MAPPO |
$284.45
|
| Rate for Payer: BCN Medicare Advantage |
$284.45
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cofinity Commercial |
$409.61
|
| Rate for Payer: Cofinity Commercial |
$381.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.45
|
| Rate for Payer: Healthscope Commercial |
$455.12
|
| Rate for Payer: Healthscope Commercial |
$526.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.45
|
| Rate for Payer: Nomi Health Commercial |
$341.34
|
| Rate for Payer: PACE SWMI |
$284.45
|
| Rate for Payer: PHP Medicare Advantage |
$284.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.45
|
| Rate for Payer: Priority Health Medicare |
$284.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.45
|
| Rate for Payer: UHC Medicare Advantage |
$284.45
|
|
|
PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 50650
|
| Min. Negotiated Rate |
$990.46 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Aetna Medicare |
$1,030.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.22
|
| Rate for Payer: BCBS Complete |
$1,340.00
|
| Rate for Payer: BCBS MAPPO |
$990.46
|
| Rate for Payer: BCN Medicare Advantage |
$990.46
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cofinity Commercial |
$1,426.26
|
| Rate for Payer: Cofinity Commercial |
$1,327.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$990.46
|
| Rate for Payer: Healthscope Commercial |
$1,832.35
|
| Rate for Payer: Healthscope Commercial |
$1,584.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,177.50
|
| Rate for Payer: Nomi Health Commercial |
$1,188.55
|
| Rate for Payer: PACE SWMI |
$990.46
|
| Rate for Payer: PHP Medicare Advantage |
$990.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.50
|
| Rate for Payer: Priority Health Medicare |
$990.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$990.46
|
| Rate for Payer: UHC Medicare Advantage |
$990.46
|
|
