|
PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$158.09
|
| Rate for Payer: Aetna Medicare |
$122.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.89
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$117.98
|
| Rate for Payer: BCN Commercial |
$217.73
|
| Rate for Payer: BCN Medicare Advantage |
$117.98
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$169.89
|
| Rate for Payer: Cofinity Commercial |
$158.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.98
|
| Rate for Payer: Healthscope Commercial |
$218.26
|
| Rate for Payer: Healthscope Commercial |
$188.77
|
| Rate for Payer: Mclaren Medicaid |
$76.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.88
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.63
|
| Rate for Payer: Nomi Health Commercial |
$141.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.00
|
| Rate for Payer: PACE SWMI |
$117.98
|
| Rate for Payer: PHP Medicare Advantage |
$117.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$215.90
|
| Rate for Payer: Priority Health Medicare |
$117.98
|
| Rate for Payer: Priority Health SBD |
$215.90
|
| Rate for Payer: Priority Health Tiered Network |
$215.90
|
| Rate for Payer: Railroad Medicare Medicare |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.99
|
| Rate for Payer: UHC Core |
$232.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.98
|
| Rate for Payer: UHC Exchange |
$232.99
|
| Rate for Payer: UHC Medicaid |
$76.25
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$431.17 |
| Rate for Payer: Aetna Commercial |
$286.48
|
| Rate for Payer: Aetna Medicare |
$222.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.86
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$213.79
|
| Rate for Payer: BCN Commercial |
$360.54
|
| Rate for Payer: BCN Medicare Advantage |
$213.79
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cofinity Commercial |
$307.86
|
| Rate for Payer: Cofinity Commercial |
$286.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.79
|
| Rate for Payer: Healthscope Commercial |
$395.51
|
| Rate for Payer: Healthscope Commercial |
$342.06
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.48
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$235.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.04
|
| Rate for Payer: Nomi Health Commercial |
$256.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.00
|
| Rate for Payer: PACE SWMI |
$213.79
|
| Rate for Payer: PHP Medicare Advantage |
$213.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$392.75
|
| Rate for Payer: Priority Health Medicare |
$213.79
|
| Rate for Payer: Priority Health SBD |
$392.75
|
| Rate for Payer: Priority Health Tiered Network |
$392.75
|
| Rate for Payer: Railroad Medicare Medicare |
$213.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.17
|
| Rate for Payer: UHC Core |
$431.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$213.79
|
| Rate for Payer: UHC Exchange |
$431.17
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$154.64 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Aetna Commercial |
$322.89
|
| Rate for Payer: Aetna Medicare |
$250.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.98
|
| Rate for Payer: BCBS Complete |
$162.37
|
| Rate for Payer: BCBS MAPPO |
$240.96
|
| Rate for Payer: BCN Commercial |
$405.36
|
| Rate for Payer: BCN Medicare Advantage |
$240.96
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$346.98
|
| Rate for Payer: Cofinity Commercial |
$322.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$445.78
|
| Rate for Payer: Healthscope Commercial |
$385.54
|
| Rate for Payer: Mclaren Medicaid |
$154.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.01
|
| Rate for Payer: Meridian Medicaid |
$162.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.89
|
| Rate for Payer: Nomi Health Commercial |
$289.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.75
|
| Rate for Payer: PACE SWMI |
$240.96
|
| Rate for Payer: PHP Medicare Advantage |
$240.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$441.56
|
| Rate for Payer: Priority Health Medicare |
$240.96
|
| Rate for Payer: Priority Health SBD |
$441.56
|
| Rate for Payer: Priority Health Tiered Network |
$441.56
|
| Rate for Payer: Railroad Medicare Medicare |
$240.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.41
|
| Rate for Payer: UHC Core |
$485.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.96
|
| Rate for Payer: UHC Exchange |
$485.41
|
| Rate for Payer: UHC Medicaid |
$154.64
|
| Rate for Payer: UHCCP Medicaid |
$154.64
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,910.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Aetna Commercial |
$203.36
|
| Rate for Payer: Aetna Medicare |
$157.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.53
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$151.76
|
| Rate for Payer: BCN Commercial |
$258.95
|
| Rate for Payer: BCN Medicare Advantage |
$151.76
|
| Rate for Payer: Cash Price |
$2,328.00
|
| Rate for Payer: Cash Price |
$2,328.00
|
| Rate for Payer: Cofinity Commercial |
$218.53
|
| Rate for Payer: Cofinity Commercial |
$203.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.76
|
| Rate for Payer: Healthscope Commercial |
$280.76
|
| Rate for Payer: Healthscope Commercial |
$242.82
|
| Rate for Payer: Mclaren Medicaid |
$96.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.35
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.73
|
| Rate for Payer: Nomi Health Commercial |
$182.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,182.50
|
| Rate for Payer: PACE SWMI |
$151.76
|
| Rate for Payer: PHP Medicare Advantage |
$151.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$282.08
|
| Rate for Payer: Priority Health Medicare |
$151.76
|
| Rate for Payer: Priority Health SBD |
$282.08
|
| Rate for Payer: Priority Health Tiered Network |
$282.08
|
| Rate for Payer: Railroad Medicare Medicare |
$151.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.30
|
| Rate for Payer: UHC Core |
$313.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.76
|
| Rate for Payer: UHC Exchange |
$313.30
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,172.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$3,129.00 |
| Rate for Payer: Aetna Commercial |
$194.10
|
| Rate for Payer: Aetna Medicare |
$150.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.58
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS MAPPO |
$144.85
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: BCN Medicare Advantage |
$144.85
|
| Rate for Payer: Cash Price |
$3,337.60
|
| Rate for Payer: Cash Price |
$3,337.60
|
| Rate for Payer: Cofinity Commercial |
$208.58
|
| Rate for Payer: Cofinity Commercial |
$194.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.85
|
| Rate for Payer: Healthscope Commercial |
$267.97
|
| Rate for Payer: Healthscope Commercial |
$231.76
|
| Rate for Payer: Mclaren Medicaid |
$93.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.09
|
| Rate for Payer: Meridian Medicaid |
$97.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,711.80
|
| Rate for Payer: Nomi Health Commercial |
$173.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,129.00
|
| Rate for Payer: PACE SWMI |
$144.85
|
| Rate for Payer: PHP Medicare Advantage |
$144.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.35
|
| Rate for Payer: Priority Health Medicare |
$144.85
|
| Rate for Payer: Priority Health SBD |
$266.35
|
| Rate for Payer: Priority Health Tiered Network |
$266.35
|
| Rate for Payer: Railroad Medicare Medicare |
$144.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.80
|
| Rate for Payer: UHC Core |
$297.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.85
|
| Rate for Payer: UHC Exchange |
$297.80
|
| Rate for Payer: UHC Medicaid |
$93.08
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Aetna Commercial |
$185.00
|
| Rate for Payer: Aetna Medicare |
$143.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.81
|
| Rate for Payer: BCBS Complete |
$93.48
|
| Rate for Payer: BCBS MAPPO |
$138.06
|
| Rate for Payer: BCN Commercial |
$231.07
|
| Rate for Payer: BCN Medicare Advantage |
$138.06
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$198.81
|
| Rate for Payer: Cofinity Commercial |
$185.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.06
|
| Rate for Payer: Healthscope Commercial |
$255.41
|
| Rate for Payer: Healthscope Commercial |
$220.90
|
| Rate for Payer: Mclaren Medicaid |
$89.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.96
|
| Rate for Payer: Meridian Medicaid |
$93.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$151.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.67
|
| Rate for Payer: Nomi Health Commercial |
$165.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.75
|
| Rate for Payer: PACE SWMI |
$138.06
|
| Rate for Payer: PHP Medicare Advantage |
$138.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$251.71
|
| Rate for Payer: Priority Health Medicare |
$138.06
|
| Rate for Payer: Priority Health SBD |
$251.71
|
| Rate for Payer: Priority Health Tiered Network |
$251.71
|
| Rate for Payer: Railroad Medicare Medicare |
$138.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.01
|
| Rate for Payer: UHC Core |
$273.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.06
|
| Rate for Payer: UHC Exchange |
$273.01
|
| Rate for Payer: UHC Medicaid |
$89.03
|
| Rate for Payer: UHCCP Medicaid |
$89.03
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$594.75 |
| Rate for Payer: Aetna Commercial |
$336.54
|
| Rate for Payer: Aetna Medicare |
$261.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.66
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCBS MAPPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$423.78
|
| Rate for Payer: BCN Medicare Advantage |
$251.15
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Cofinity Commercial |
$336.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.15
|
| Rate for Payer: Healthscope Commercial |
$464.63
|
| Rate for Payer: Healthscope Commercial |
$401.84
|
| Rate for Payer: Mclaren Medicaid |
$161.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.71
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$276.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.73
|
| Rate for Payer: Nomi Health Commercial |
$301.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.75
|
| Rate for Payer: PACE SWMI |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$251.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$461.64
|
| Rate for Payer: Priority Health Medicare |
$251.15
|
| Rate for Payer: Priority Health SBD |
$461.64
|
| Rate for Payer: Priority Health Tiered Network |
$461.64
|
| Rate for Payer: Railroad Medicare Medicare |
$251.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.49
|
| Rate for Payer: UHC Core |
$507.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$251.15
|
| Rate for Payer: UHC Exchange |
$507.49
|
| Rate for Payer: UHC Medicaid |
$161.24
|
| Rate for Payer: UHCCP Medicaid |
$161.24
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$1,797.00 |
| Rate for Payer: Aetna Commercial |
$235.06
|
| Rate for Payer: Aetna Medicare |
$182.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.60
|
| Rate for Payer: BCBS Complete |
$117.64
|
| Rate for Payer: BCBS MAPPO |
$175.42
|
| Rate for Payer: BCN Commercial |
$299.28
|
| Rate for Payer: BCN Medicare Advantage |
$175.42
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cofinity Commercial |
$252.60
|
| Rate for Payer: Cofinity Commercial |
$235.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.42
|
| Rate for Payer: Healthscope Commercial |
$324.53
|
| Rate for Payer: Healthscope Commercial |
$280.67
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.19
|
| Rate for Payer: Meridian Medicaid |
$117.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.44
|
| Rate for Payer: Nomi Health Commercial |
$210.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.00
|
| Rate for Payer: PACE SWMI |
$175.42
|
| Rate for Payer: PHP Medicare Advantage |
$175.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$326.02
|
| Rate for Payer: Priority Health Medicare |
$175.42
|
| Rate for Payer: Priority Health SBD |
$326.02
|
| Rate for Payer: Priority Health Tiered Network |
$326.02
|
| Rate for Payer: Railroad Medicare Medicare |
$175.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.53
|
| Rate for Payer: UHC Core |
$362.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.42
|
| Rate for Payer: UHC Exchange |
$362.53
|
| Rate for Payer: UHC Medicaid |
$112.04
|
| Rate for Payer: UHCCP Medicaid |
$112.04
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$831.75 |
| Rate for Payer: Aetna Commercial |
$288.23
|
| Rate for Payer: Aetna Medicare |
$223.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.74
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$215.10
|
| Rate for Payer: BCN Commercial |
$363.53
|
| Rate for Payer: BCN Medicare Advantage |
$215.10
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Cofinity Commercial |
$309.74
|
| Rate for Payer: Cofinity Commercial |
$288.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.10
|
| Rate for Payer: Healthscope Commercial |
$397.94
|
| Rate for Payer: Healthscope Commercial |
$344.16
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.85
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.59
|
| Rate for Payer: Nomi Health Commercial |
$258.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$831.75
|
| Rate for Payer: PACE SWMI |
$215.10
|
| Rate for Payer: PHP Medicare Advantage |
$215.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$396.00
|
| Rate for Payer: Priority Health Medicare |
$215.10
|
| Rate for Payer: Priority Health SBD |
$396.00
|
| Rate for Payer: Priority Health Tiered Network |
$396.00
|
| Rate for Payer: Railroad Medicare Medicare |
$215.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.25
|
| Rate for Payer: UHC Core |
$434.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.10
|
| Rate for Payer: UHC Exchange |
$434.25
|
| Rate for Payer: UHC Medicaid |
$138.24
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$494.56 |
| Rate for Payer: Aetna Commercial |
$328.90
|
| Rate for Payer: Aetna Medicare |
$255.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.45
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS MAPPO |
$245.45
|
| Rate for Payer: BCN Commercial |
$413.33
|
| Rate for Payer: BCN Medicare Advantage |
$245.45
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$353.45
|
| Rate for Payer: Cofinity Commercial |
$328.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.45
|
| Rate for Payer: Healthscope Commercial |
$454.08
|
| Rate for Payer: Healthscope Commercial |
$392.72
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.72
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.41
|
| Rate for Payer: Nomi Health Commercial |
$294.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.25
|
| Rate for Payer: PACE SWMI |
$245.45
|
| Rate for Payer: PHP Medicare Advantage |
$245.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$450.25
|
| Rate for Payer: Priority Health Medicare |
$245.45
|
| Rate for Payer: Priority Health SBD |
$450.25
|
| Rate for Payer: Priority Health Tiered Network |
$450.25
|
| Rate for Payer: Railroad Medicare Medicare |
$245.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.56
|
| Rate for Payer: UHC Core |
$494.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.45
|
| Rate for Payer: UHC Exchange |
$494.56
|
| Rate for Payer: UHC Medicaid |
$157.62
|
| Rate for Payer: UHCCP Medicaid |
$157.62
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$162.73 |
| Max. Negotiated Rate |
$512.41 |
| Rate for Payer: Aetna Commercial |
$339.64
|
| Rate for Payer: Aetna Medicare |
$263.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.98
|
| Rate for Payer: BCBS Complete |
$170.87
|
| Rate for Payer: BCBS MAPPO |
$253.46
|
| Rate for Payer: BCN Commercial |
$428.27
|
| Rate for Payer: BCN Medicare Advantage |
$253.46
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$364.98
|
| Rate for Payer: Cofinity Commercial |
$339.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.46
|
| Rate for Payer: Healthscope Commercial |
$468.90
|
| Rate for Payer: Healthscope Commercial |
$405.54
|
| Rate for Payer: Mclaren Medicaid |
$162.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.13
|
| Rate for Payer: Meridian Medicaid |
$170.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$278.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.50
|
| Rate for Payer: Nomi Health Commercial |
$304.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.00
|
| Rate for Payer: PACE SWMI |
$253.46
|
| Rate for Payer: PHP Medicare Advantage |
$253.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$466.52
|
| Rate for Payer: Priority Health Medicare |
$253.46
|
| Rate for Payer: Priority Health SBD |
$466.52
|
| Rate for Payer: Priority Health Tiered Network |
$466.52
|
| Rate for Payer: Railroad Medicare Medicare |
$253.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$512.41
|
| Rate for Payer: UHC Core |
$512.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$253.46
|
| Rate for Payer: UHC Exchange |
$512.41
|
| Rate for Payer: UHC Medicaid |
$162.73
|
| Rate for Payer: UHCCP Medicaid |
$162.73
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$178.82
|
| Rate for Payer: Aetna Medicare |
$138.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.17
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$133.45
|
| Rate for Payer: BCN Commercial |
$225.09
|
| Rate for Payer: BCN Medicare Advantage |
$133.45
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$192.17
|
| Rate for Payer: Cofinity Commercial |
$178.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.45
|
| Rate for Payer: Healthscope Commercial |
$246.88
|
| Rate for Payer: Healthscope Commercial |
$213.52
|
| Rate for Payer: Mclaren Medicaid |
$85.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.12
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$146.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.94
|
| Rate for Payer: Nomi Health Commercial |
$160.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.00
|
| Rate for Payer: PACE SWMI |
$133.45
|
| Rate for Payer: PHP Medicare Advantage |
$133.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$245.20
|
| Rate for Payer: Priority Health Medicare |
$133.45
|
| Rate for Payer: Priority Health SBD |
$245.20
|
| Rate for Payer: Priority Health Tiered Network |
$245.20
|
| Rate for Payer: Railroad Medicare Medicare |
$133.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.64
|
| Rate for Payer: UHC Core |
$266.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.45
|
| Rate for Payer: UHC Exchange |
$266.64
|
| Rate for Payer: UHC Medicaid |
$85.84
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$1,014.00 |
| Rate for Payer: Aetna Commercial |
$301.27
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.76
|
| Rate for Payer: BCBS Complete |
$150.74
|
| Rate for Payer: BCBS MAPPO |
$224.83
|
| Rate for Payer: BCN Commercial |
$381.95
|
| Rate for Payer: BCN Medicare Advantage |
$224.83
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cofinity Commercial |
$323.76
|
| Rate for Payer: Cofinity Commercial |
$301.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.83
|
| Rate for Payer: Healthscope Commercial |
$415.94
|
| Rate for Payer: Healthscope Commercial |
$359.73
|
| Rate for Payer: Mclaren Medicaid |
$143.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.07
|
| Rate for Payer: Meridian Medicaid |
$150.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$247.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.25
|
| Rate for Payer: Nomi Health Commercial |
$269.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,014.00
|
| Rate for Payer: PACE SWMI |
$224.83
|
| Rate for Payer: PHP Medicare Advantage |
$224.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$416.07
|
| Rate for Payer: Priority Health Medicare |
$224.83
|
| Rate for Payer: Priority Health SBD |
$416.07
|
| Rate for Payer: Priority Health Tiered Network |
$416.07
|
| Rate for Payer: Railroad Medicare Medicare |
$224.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.03
|
| Rate for Payer: UHC Core |
$467.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$224.83
|
| Rate for Payer: UHC Exchange |
$467.03
|
| Rate for Payer: UHC Medicaid |
$143.56
|
| Rate for Payer: UHCCP Medicaid |
$143.56
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$609.54 |
| Rate for Payer: Aetna Commercial |
$403.03
|
| Rate for Payer: Aetna Medicare |
$312.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.11
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$300.77
|
| Rate for Payer: BCN Commercial |
$508.43
|
| Rate for Payer: BCN Medicare Advantage |
$300.77
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cofinity Commercial |
$433.11
|
| Rate for Payer: Cofinity Commercial |
$403.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.77
|
| Rate for Payer: Healthscope Commercial |
$556.42
|
| Rate for Payer: Healthscope Commercial |
$481.23
|
| Rate for Payer: Mclaren Medicaid |
$192.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.81
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$330.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.31
|
| Rate for Payer: Nomi Health Commercial |
$360.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.75
|
| Rate for Payer: PACE SWMI |
$300.77
|
| Rate for Payer: PHP Medicare Advantage |
$300.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$553.86
|
| Rate for Payer: Priority Health Medicare |
$300.77
|
| Rate for Payer: Priority Health SBD |
$553.86
|
| Rate for Payer: Priority Health Tiered Network |
$553.86
|
| Rate for Payer: Railroad Medicare Medicare |
$300.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.54
|
| Rate for Payer: UHC Core |
$609.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$300.77
|
| Rate for Payer: UHC Exchange |
$609.54
|
| Rate for Payer: UHC Medicaid |
$192.98
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$1,187.25 |
| Rate for Payer: Aetna Commercial |
$333.18
|
| Rate for Payer: Aetna Medicare |
$258.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.04
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$248.64
|
| Rate for Payer: BCN Commercial |
$419.30
|
| Rate for Payer: BCN Medicare Advantage |
$248.64
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cofinity Commercial |
$358.04
|
| Rate for Payer: Cofinity Commercial |
$333.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.64
|
| Rate for Payer: Healthscope Commercial |
$459.98
|
| Rate for Payer: Healthscope Commercial |
$397.82
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.07
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.80
|
| Rate for Payer: Nomi Health Commercial |
$298.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.25
|
| Rate for Payer: PACE SWMI |
$248.64
|
| Rate for Payer: PHP Medicare Advantage |
$248.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$456.76
|
| Rate for Payer: Priority Health Medicare |
$248.64
|
| Rate for Payer: Priority Health SBD |
$456.76
|
| Rate for Payer: Priority Health Tiered Network |
$456.76
|
| Rate for Payer: Railroad Medicare Medicare |
$248.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.41
|
| Rate for Payer: UHC Core |
$502.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.64
|
| Rate for Payer: UHC Exchange |
$502.41
|
| Rate for Payer: UHC Medicaid |
$159.75
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$1,322.25 |
| Rate for Payer: Aetna Commercial |
$362.28
|
| Rate for Payer: Aetna Medicare |
$281.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.32
|
| Rate for Payer: BCBS Complete |
$182.28
|
| Rate for Payer: BCBS MAPPO |
$270.36
|
| Rate for Payer: BCN Commercial |
$456.64
|
| Rate for Payer: BCN Medicare Advantage |
$270.36
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cash Price |
$1,410.40
|
| Rate for Payer: Cofinity Commercial |
$389.32
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.36
|
| Rate for Payer: Healthscope Commercial |
$500.17
|
| Rate for Payer: Healthscope Commercial |
$432.58
|
| Rate for Payer: Mclaren Medicaid |
$173.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.88
|
| Rate for Payer: Meridian Medicaid |
$182.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.37
|
| Rate for Payer: Nomi Health Commercial |
$324.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,322.25
|
| Rate for Payer: PACE SWMI |
$270.36
|
| Rate for Payer: PHP Medicare Advantage |
$270.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$497.44
|
| Rate for Payer: Priority Health Medicare |
$270.36
|
| Rate for Payer: Priority Health SBD |
$497.44
|
| Rate for Payer: Priority Health Tiered Network |
$497.44
|
| Rate for Payer: Railroad Medicare Medicare |
$270.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.46
|
| Rate for Payer: UHC Core |
$545.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$270.36
|
| Rate for Payer: UHC Exchange |
$545.46
|
| Rate for Payer: UHC Medicaid |
$173.60
|
| Rate for Payer: UHCCP Medicaid |
$173.60
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$849.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$219.18 |
| Max. Negotiated Rate |
$694.42 |
| Rate for Payer: Aetna Commercial |
$457.94
|
| Rate for Payer: Aetna Medicare |
$355.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.12
|
| Rate for Payer: BCBS Complete |
$230.14
|
| Rate for Payer: BCBS MAPPO |
$341.75
|
| Rate for Payer: BCN Commercial |
$577.66
|
| Rate for Payer: BCN Medicare Advantage |
$341.75
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cofinity Commercial |
$492.12
|
| Rate for Payer: Cofinity Commercial |
$457.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.75
|
| Rate for Payer: Healthscope Commercial |
$632.24
|
| Rate for Payer: Healthscope Commercial |
$546.80
|
| Rate for Payer: Mclaren Medicaid |
$219.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.84
|
| Rate for Payer: Meridian Medicaid |
$230.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$375.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.92
|
| Rate for Payer: Nomi Health Commercial |
$410.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$636.75
|
| Rate for Payer: PACE SWMI |
$341.75
|
| Rate for Payer: PHP Medicare Advantage |
$341.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$629.26
|
| Rate for Payer: Priority Health Medicare |
$341.75
|
| Rate for Payer: Priority Health SBD |
$629.26
|
| Rate for Payer: Priority Health Tiered Network |
$629.26
|
| Rate for Payer: Railroad Medicare Medicare |
$341.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$694.42
|
| Rate for Payer: UHC Core |
$694.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$341.75
|
| Rate for Payer: UHC Exchange |
$694.42
|
| Rate for Payer: UHC Medicaid |
$219.18
|
| Rate for Payer: UHCCP Medicaid |
$219.18
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$3,090.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$198.73 |
| Max. Negotiated Rate |
$2,317.50 |
| Rate for Payer: Aetna Commercial |
$415.09
|
| Rate for Payer: Aetna Medicare |
$322.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.07
|
| Rate for Payer: BCBS Complete |
$208.67
|
| Rate for Payer: BCBS MAPPO |
$309.77
|
| Rate for Payer: BCN Commercial |
$523.38
|
| Rate for Payer: BCN Medicare Advantage |
$309.77
|
| Rate for Payer: Cash Price |
$2,472.00
|
| Rate for Payer: Cash Price |
$2,472.00
|
| Rate for Payer: Cofinity Commercial |
$446.07
|
| Rate for Payer: Cofinity Commercial |
$415.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.77
|
| Rate for Payer: Healthscope Commercial |
$573.07
|
| Rate for Payer: Healthscope Commercial |
$495.63
|
| Rate for Payer: Mclaren Medicaid |
$198.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.26
|
| Rate for Payer: Meridian Medicaid |
$208.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.71
|
| Rate for Payer: Nomi Health Commercial |
$371.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,317.50
|
| Rate for Payer: PACE SWMI |
$309.77
|
| Rate for Payer: PHP Medicare Advantage |
$309.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$570.13
|
| Rate for Payer: Priority Health Medicare |
$309.77
|
| Rate for Payer: Priority Health SBD |
$570.13
|
| Rate for Payer: Priority Health Tiered Network |
$570.13
|
| Rate for Payer: Railroad Medicare Medicare |
$309.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.00
|
| Rate for Payer: UHC Core |
$628.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$309.77
|
| Rate for Payer: UHC Exchange |
$628.00
|
| Rate for Payer: UHC Medicaid |
$198.73
|
| Rate for Payer: UHCCP Medicaid |
$198.73
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$169.97 |
| Max. Negotiated Rate |
$534.53 |
| Rate for Payer: Aetna Commercial |
$354.79
|
| Rate for Payer: Aetna Medicare |
$275.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.27
|
| Rate for Payer: BCBS Complete |
$178.47
|
| Rate for Payer: BCBS MAPPO |
$264.77
|
| Rate for Payer: BCN Commercial |
$447.69
|
| Rate for Payer: BCN Medicare Advantage |
$264.77
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$381.27
|
| Rate for Payer: Cofinity Commercial |
$354.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$264.77
|
| Rate for Payer: Healthscope Commercial |
$489.82
|
| Rate for Payer: Healthscope Commercial |
$423.63
|
| Rate for Payer: Mclaren Medicaid |
$169.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.01
|
| Rate for Payer: Meridian Medicaid |
$178.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$291.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.07
|
| Rate for Payer: Nomi Health Commercial |
$317.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$469.50
|
| Rate for Payer: PACE SWMI |
$264.77
|
| Rate for Payer: PHP Medicare Advantage |
$264.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$487.68
|
| Rate for Payer: Priority Health Medicare |
$264.77
|
| Rate for Payer: Priority Health SBD |
$487.68
|
| Rate for Payer: Priority Health Tiered Network |
$487.68
|
| Rate for Payer: Railroad Medicare Medicare |
$264.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.53
|
| Rate for Payer: UHC Core |
$534.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$264.77
|
| Rate for Payer: UHC Exchange |
$534.53
|
| Rate for Payer: UHC Medicaid |
$169.97
|
| Rate for Payer: UHCCP Medicaid |
$169.97
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$911.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$249.64 |
| Max. Negotiated Rate |
$789.77 |
| Rate for Payer: Aetna Commercial |
$521.96
|
| Rate for Payer: Aetna Medicare |
$405.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.91
|
| Rate for Payer: BCBS Complete |
$262.12
|
| Rate for Payer: BCBS MAPPO |
$389.52
|
| Rate for Payer: BCN Commercial |
$657.83
|
| Rate for Payer: BCN Medicare Advantage |
$389.52
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cash Price |
$728.80
|
| Rate for Payer: Cofinity Commercial |
$560.91
|
| Rate for Payer: Cofinity Commercial |
$521.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.52
|
| Rate for Payer: Healthscope Commercial |
$720.61
|
| Rate for Payer: Healthscope Commercial |
$623.23
|
| Rate for Payer: Mclaren Medicaid |
$249.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.00
|
| Rate for Payer: Meridian Medicaid |
$262.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$428.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$779.24
|
| Rate for Payer: Nomi Health Commercial |
$467.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$683.25
|
| Rate for Payer: PACE SWMI |
$389.52
|
| Rate for Payer: PHP Medicare Advantage |
$389.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$716.60
|
| Rate for Payer: Priority Health Medicare |
$389.52
|
| Rate for Payer: Priority Health SBD |
$716.60
|
| Rate for Payer: Priority Health Tiered Network |
$716.60
|
| Rate for Payer: Railroad Medicare Medicare |
$389.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.77
|
| Rate for Payer: UHC Core |
$789.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$389.52
|
| Rate for Payer: UHC Exchange |
$789.77
|
| Rate for Payer: UHC Medicaid |
$249.64
|
| Rate for Payer: UHCCP Medicaid |
$249.64
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$823.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$207.04 |
| Max. Negotiated Rate |
$652.59 |
| Rate for Payer: Aetna Commercial |
$432.55
|
| Rate for Payer: Aetna Medicare |
$335.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.83
|
| Rate for Payer: BCBS Complete |
$217.39
|
| Rate for Payer: BCBS MAPPO |
$322.80
|
| Rate for Payer: BCN Commercial |
$545.29
|
| Rate for Payer: BCN Medicare Advantage |
$322.80
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Cofinity Commercial |
$464.83
|
| Rate for Payer: Cofinity Commercial |
$432.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.80
|
| Rate for Payer: Healthscope Commercial |
$597.18
|
| Rate for Payer: Healthscope Commercial |
$516.48
|
| Rate for Payer: Mclaren Medicaid |
$207.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.94
|
| Rate for Payer: Meridian Medicaid |
$217.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$355.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$643.99
|
| Rate for Payer: Nomi Health Commercial |
$387.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$617.25
|
| Rate for Payer: PACE SWMI |
$322.80
|
| Rate for Payer: PHP Medicare Advantage |
$322.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$593.99
|
| Rate for Payer: Priority Health Medicare |
$322.80
|
| Rate for Payer: Priority Health SBD |
$593.99
|
| Rate for Payer: Priority Health Tiered Network |
$593.99
|
| Rate for Payer: Railroad Medicare Medicare |
$322.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.59
|
| Rate for Payer: UHC Core |
$652.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$322.80
|
| Rate for Payer: UHC Exchange |
$652.59
|
| Rate for Payer: UHC Medicaid |
$207.04
|
| Rate for Payer: UHCCP Medicaid |
$207.04
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$220.88 |
| Max. Negotiated Rate |
$870.75 |
| Rate for Payer: Aetna Commercial |
$461.59
|
| Rate for Payer: Aetna Medicare |
$358.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.04
|
| Rate for Payer: BCBS Complete |
$231.92
|
| Rate for Payer: BCBS MAPPO |
$344.47
|
| Rate for Payer: BCN Commercial |
$581.64
|
| Rate for Payer: BCN Medicare Advantage |
$344.47
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cofinity Commercial |
$496.04
|
| Rate for Payer: Cofinity Commercial |
$461.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.47
|
| Rate for Payer: Healthscope Commercial |
$637.27
|
| Rate for Payer: Healthscope Commercial |
$551.15
|
| Rate for Payer: Mclaren Medicaid |
$220.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.69
|
| Rate for Payer: Meridian Medicaid |
$231.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$378.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$688.52
|
| Rate for Payer: Nomi Health Commercial |
$413.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.75
|
| Rate for Payer: PACE SWMI |
$344.47
|
| Rate for Payer: PHP Medicare Advantage |
$344.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$633.60
|
| Rate for Payer: Priority Health Medicare |
$344.47
|
| Rate for Payer: Priority Health SBD |
$633.60
|
| Rate for Payer: Priority Health Tiered Network |
$633.60
|
| Rate for Payer: Railroad Medicare Medicare |
$344.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.14
|
| Rate for Payer: UHC Core |
$698.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$344.47
|
| Rate for Payer: UHC Exchange |
$698.14
|
| Rate for Payer: UHC Medicaid |
$220.88
|
| Rate for Payer: UHCCP Medicaid |
$220.88
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$448.15 |
| Max. Negotiated Rate |
$1,402.27 |
| Rate for Payer: Aetna Commercial |
$905.50
|
| Rate for Payer: Aetna Medicare |
$702.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.08
|
| Rate for Payer: BCBS Complete |
$470.56
|
| Rate for Payer: BCBS MAPPO |
$675.75
|
| Rate for Payer: BCN Commercial |
$1,197.15
|
| Rate for Payer: BCN Medicare Advantage |
$675.75
|
| Rate for Payer: Cash Price |
$1,295.20
|
| Rate for Payer: Cash Price |
$1,295.20
|
| Rate for Payer: Cofinity Commercial |
$973.08
|
| Rate for Payer: Cofinity Commercial |
$905.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.75
|
| Rate for Payer: Healthscope Commercial |
$1,250.14
|
| Rate for Payer: Healthscope Commercial |
$1,081.20
|
| Rate for Payer: Mclaren Medicaid |
$448.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.54
|
| Rate for Payer: Meridian Medicaid |
$470.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$743.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,395.76
|
| Rate for Payer: Nomi Health Commercial |
$810.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,214.25
|
| Rate for Payer: PACE SWMI |
$675.75
|
| Rate for Payer: PHP Medicare Advantage |
$675.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,402.27
|
| Rate for Payer: Priority Health Medicare |
$675.75
|
| Rate for Payer: Priority Health SBD |
$1,402.27
|
| Rate for Payer: Priority Health Tiered Network |
$1,402.27
|
| Rate for Payer: Railroad Medicare Medicare |
$675.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,328.87
|
| Rate for Payer: UHC Core |
$1,328.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$675.75
|
| Rate for Payer: UHC Exchange |
$1,328.87
|
| Rate for Payer: UHC Medicaid |
$448.15
|
| Rate for Payer: UHCCP Medicaid |
$448.15
|
|
|
PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01996
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$133.50
|
| Rate for Payer: Priority Health SBD |
$133.50
|
| Rate for Payer: Priority Health Tiered Network |
$133.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.00
|
| Rate for Payer: UHC Core |
$120.00
|
| Rate for Payer: UHC Exchange |
$120.00
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Aetna Commercial |
$32.62
|
| Rate for Payer: Aetna Medicare |
$25.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.62
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$24.34
|
| Rate for Payer: BCN Commercial |
$31.42
|
| Rate for Payer: BCN Medicare Advantage |
$24.34
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$32.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$45.03
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.56
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$29.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: PACE SWMI |
$24.34
|
| Rate for Payer: PHP Medicare Advantage |
$24.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36.47
|
| Rate for Payer: Priority Health Medicare |
$24.34
|
| Rate for Payer: Priority Health SBD |
$36.47
|
| Rate for Payer: Priority Health Tiered Network |
$36.47
|
| Rate for Payer: Railroad Medicare Medicare |
$24.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.63
|
| Rate for Payer: UHC Core |
$50.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.34
|
| Rate for Payer: UHC Exchange |
$50.63
|
| Rate for Payer: UHC Medicaid |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
