|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$200.65 |
| Max. Negotiated Rate |
$4,083.76 |
| Rate for Payer: Aetna Commercial |
$416.70
|
| Rate for Payer: Aetna Medicare |
$323.41
|
| Rate for Payer: BCBS Complete |
$210.68
|
| Rate for Payer: BCBS MAPPO |
$310.97
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.76
|
| Rate for Payer: BCN Commercial |
$456.42
|
| Rate for Payer: BCN Medicare Advantage |
$310.97
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$416.70
|
| Rate for Payer: Cofinity Commercial |
$447.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.97
|
| Rate for Payer: Mclaren Medicaid |
$200.65
|
| Rate for Payer: Meridian Medicaid |
$210.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$326.52
|
| Rate for Payer: PACE SWMI |
$310.97
|
| Rate for Payer: PHP Medicare Advantage |
$310.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.70
|
| Rate for Payer: Priority Health Medicare |
$310.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.97
|
| Rate for Payer: UHC Medicare Advantage |
$320.30
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$894.94 |
| Rate for Payer: Aetna Commercial |
$363.02
|
| Rate for Payer: Aetna Medicare |
$281.75
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCBS MAPPO |
$270.91
|
| Rate for Payer: BCBS Trust/PPO |
$894.94
|
| Rate for Payer: BCN Commercial |
$397.79
|
| Rate for Payer: BCN Medicare Advantage |
$270.91
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cofinity Commercial |
$363.02
|
| Rate for Payer: Cofinity Commercial |
$390.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.91
|
| Rate for Payer: Mclaren Medicaid |
$174.45
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.46
|
| Rate for Payer: PACE SWMI |
$270.91
|
| Rate for Payer: PHP Medicare Advantage |
$270.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.85
|
| Rate for Payer: Priority Health Medicare |
$270.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.91
|
| Rate for Payer: UHC Medicare Advantage |
$279.04
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,276.43 |
| Rate for Payer: Aetna Commercial |
$66.21
|
| Rate for Payer: Aetna Medicare |
$51.39
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$49.41
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$1,276.43
|
| Rate for Payer: BCN Medicare Advantage |
$49.41
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.41
|
| Rate for Payer: Mclaren Medicaid |
$31.74
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.88
|
| Rate for Payer: PACE SWMI |
$49.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.97
|
| Rate for Payer: Priority Health Medicare |
$49.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.41
|
| Rate for Payer: UHC Medicare Advantage |
$50.89
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$272.85
|
| Rate for Payer: Aetna Medicare |
$211.76
|
| Rate for Payer: BCBS Complete |
$138.21
|
| Rate for Payer: BCBS MAPPO |
$203.62
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: BCN Commercial |
$1,866.75
|
| Rate for Payer: BCN Medicare Advantage |
$203.62
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cofinity Commercial |
$272.85
|
| Rate for Payer: Cofinity Commercial |
$293.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.62
|
| Rate for Payer: Mclaren Medicaid |
$131.63
|
| Rate for Payer: Meridian Medicaid |
$138.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$213.80
|
| Rate for Payer: PACE SWMI |
$203.62
|
| Rate for Payer: PHP Medicare Advantage |
$203.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,542.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.70
|
| Rate for Payer: Priority Health Medicare |
$203.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.62
|
| Rate for Payer: UHC Medicare Advantage |
$209.73
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$2,807.39 |
| Rate for Payer: Aetna Commercial |
$238.01
|
| Rate for Payer: Aetna Medicare |
$184.72
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$177.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.39
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: BCN Medicare Advantage |
$177.62
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$238.01
|
| Rate for Payer: Cofinity Commercial |
$255.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.62
|
| Rate for Payer: Mclaren Medicaid |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.50
|
| Rate for Payer: PACE SWMI |
$177.62
|
| Rate for Payer: PHP Medicare Advantage |
$177.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.10
|
| Rate for Payer: Priority Health Medicare |
$177.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.62
|
| Rate for Payer: UHC Medicare Advantage |
$182.95
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$3,253.27 |
| Rate for Payer: Aetna Commercial |
$616.82
|
| Rate for Payer: Aetna Medicare |
$478.72
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS MAPPO |
$460.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.27
|
| Rate for Payer: BCN Commercial |
$682.20
|
| Rate for Payer: BCN Medicare Advantage |
$460.31
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$616.82
|
| Rate for Payer: Cofinity Commercial |
$662.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.31
|
| Rate for Payer: Mclaren Medicaid |
$302.03
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$483.33
|
| Rate for Payer: PACE SWMI |
$460.31
|
| Rate for Payer: PHP Medicare Advantage |
$460.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.35
|
| Rate for Payer: Priority Health Medicare |
$460.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$754.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$460.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.31
|
| Rate for Payer: UHC Medicare Advantage |
$474.12
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$6,449.49 |
| Rate for Payer: Aetna Commercial |
$342.45
|
| Rate for Payer: Aetna Medicare |
$265.78
|
| Rate for Payer: BCBS Complete |
$173.55
|
| Rate for Payer: BCBS MAPPO |
$255.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,449.49
|
| Rate for Payer: BCN Commercial |
$884.01
|
| Rate for Payer: BCN Medicare Advantage |
$255.56
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$368.01
|
| Rate for Payer: Cofinity Commercial |
$342.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.56
|
| Rate for Payer: Mclaren Medicaid |
$165.29
|
| Rate for Payer: Meridian Medicaid |
$173.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.34
|
| Rate for Payer: PACE SWMI |
$255.56
|
| Rate for Payer: PHP Medicare Advantage |
$255.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.99
|
| Rate for Payer: Priority Health Medicare |
$255.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.56
|
| Rate for Payer: UHC Medicare Advantage |
$263.23
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$261.56 |
| Max. Negotiated Rate |
$656.54 |
| Rate for Payer: Aetna Commercial |
$542.07
|
| Rate for Payer: Aetna Medicare |
$420.71
|
| Rate for Payer: BCBS Complete |
$274.64
|
| Rate for Payer: BCBS MAPPO |
$404.53
|
| Rate for Payer: BCBS Trust/PPO |
$475.77
|
| Rate for Payer: BCN Commercial |
$593.74
|
| Rate for Payer: BCN Medicare Advantage |
$404.53
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$582.52
|
| Rate for Payer: Cofinity Commercial |
$542.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.53
|
| Rate for Payer: Mclaren Medicaid |
$261.56
|
| Rate for Payer: Meridian Medicaid |
$274.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$424.76
|
| Rate for Payer: PACE SWMI |
$404.53
|
| Rate for Payer: PHP Medicare Advantage |
$404.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$656.54
|
| Rate for Payer: Priority Health Medicare |
$404.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$656.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.53
|
| Rate for Payer: UHC Medicare Advantage |
$416.67
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$293.09 |
| Max. Negotiated Rate |
$7,524.58 |
| Rate for Payer: Aetna Commercial |
$607.33
|
| Rate for Payer: Aetna Medicare |
$471.36
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS MAPPO |
$453.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.58
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: BCN Medicare Advantage |
$453.23
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cofinity Commercial |
$652.65
|
| Rate for Payer: Cofinity Commercial |
$607.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.23
|
| Rate for Payer: Mclaren Medicaid |
$293.09
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$475.89
|
| Rate for Payer: PACE SWMI |
$453.23
|
| Rate for Payer: PHP Medicare Advantage |
$453.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.42
|
| Rate for Payer: Priority Health Medicare |
$453.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$735.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.23
|
| Rate for Payer: UHC Medicare Advantage |
$466.83
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$569.78 |
| Max. Negotiated Rate |
$2,193.80 |
| Rate for Payer: Aetna Commercial |
$1,175.72
|
| Rate for Payer: Aetna Medicare |
$912.50
|
| Rate for Payer: BCBS Complete |
$598.27
|
| Rate for Payer: BCBS MAPPO |
$877.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: BCN Commercial |
$1,294.51
|
| Rate for Payer: BCN Medicare Advantage |
$877.40
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cofinity Commercial |
$1,263.46
|
| Rate for Payer: Cofinity Commercial |
$1,175.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$877.40
|
| Rate for Payer: Mclaren Medicaid |
$569.78
|
| Rate for Payer: Meridian Medicaid |
$598.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$921.27
|
| Rate for Payer: PACE SWMI |
$877.40
|
| Rate for Payer: PHP Medicare Advantage |
$877.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$569.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,193.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,431.40
|
| Rate for Payer: Priority Health Medicare |
$877.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,431.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$877.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$877.40
|
| Rate for Payer: UHC Medicare Advantage |
$903.72
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$2,379.46 |
| Rate for Payer: Aetna Commercial |
$980.28
|
| Rate for Payer: Aetna Medicare |
$760.81
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$731.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.46
|
| Rate for Payer: BCN Commercial |
$1,080.96
|
| Rate for Payer: BCN Medicare Advantage |
$731.55
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$980.28
|
| Rate for Payer: Cofinity Commercial |
$1,053.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.55
|
| Rate for Payer: Mclaren Medicaid |
$475.84
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$768.13
|
| Rate for Payer: PACE SWMI |
$731.55
|
| Rate for Payer: PHP Medicare Advantage |
$731.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.26
|
| Rate for Payer: Priority Health Medicare |
$731.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,195.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$731.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$731.55
|
| Rate for Payer: UHC Medicare Advantage |
$753.50
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$3,051.99 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Aetna Medicare |
$294.62
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$283.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,051.99
|
| Rate for Payer: BCN Commercial |
$422.22
|
| Rate for Payer: BCN Medicare Advantage |
$283.29
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$407.94
|
| Rate for Payer: Cofinity Commercial |
$379.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.29
|
| Rate for Payer: Mclaren Medicaid |
$187.44
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$297.45
|
| Rate for Payer: PACE SWMI |
$283.29
|
| Rate for Payer: PHP Medicare Advantage |
$283.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$466.88
|
| Rate for Payer: Priority Health Medicare |
$283.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.29
|
| Rate for Payer: UHC Medicare Advantage |
$291.79
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$2,402.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$301.61 |
| Max. Negotiated Rate |
$3,049.88 |
| Rate for Payer: Aetna Commercial |
$614.15
|
| Rate for Payer: Aetna Medicare |
$476.65
|
| Rate for Payer: BCBS Complete |
$316.69
|
| Rate for Payer: BCBS MAPPO |
$458.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,049.88
|
| Rate for Payer: BCN Commercial |
$680.73
|
| Rate for Payer: BCN Medicare Advantage |
$458.32
|
| Rate for Payer: Cash Price |
$1,921.60
|
| Rate for Payer: Cash Price |
$1,921.60
|
| Rate for Payer: Cofinity Commercial |
$614.15
|
| Rate for Payer: Cofinity Commercial |
$659.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.32
|
| Rate for Payer: Mclaren Medicaid |
$301.61
|
| Rate for Payer: Meridian Medicaid |
$316.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$481.24
|
| Rate for Payer: PACE SWMI |
$458.32
|
| Rate for Payer: PHP Medicare Advantage |
$458.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.72
|
| Rate for Payer: Priority Health Medicare |
$458.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.32
|
| Rate for Payer: UHC Medicare Advantage |
$472.07
|
|
|
PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE
|
Professional
|
Both
|
$1,963.00
|
|
|
Service Code
|
HCPCS 51525
|
| Min. Negotiated Rate |
$544.85 |
| Max. Negotiated Rate |
$3,181.95 |
| Rate for Payer: Aetna Commercial |
$1,125.79
|
| Rate for Payer: Aetna Medicare |
$873.75
|
| Rate for Payer: BCBS Complete |
$572.09
|
| Rate for Payer: BCBS MAPPO |
$840.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,181.95
|
| Rate for Payer: BCN Commercial |
$1,239.29
|
| Rate for Payer: BCN Medicare Advantage |
$840.14
|
| Rate for Payer: Cash Price |
$1,570.40
|
| Rate for Payer: Cash Price |
$1,570.40
|
| Rate for Payer: Cofinity Commercial |
$1,125.79
|
| Rate for Payer: Cofinity Commercial |
$1,209.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.14
|
| Rate for Payer: Mclaren Medicaid |
$544.85
|
| Rate for Payer: Meridian Medicaid |
$572.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$882.15
|
| Rate for Payer: PACE SWMI |
$840.14
|
| Rate for Payer: PHP Medicare Advantage |
$840.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,370.35
|
| Rate for Payer: Priority Health Medicare |
$840.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,370.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$840.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$840.14
|
| Rate for Payer: UHC Medicare Advantage |
$865.34
|
|
|
PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE
|
Professional
|
Both
|
$1,695.00
|
|
|
Service Code
|
HCPCS 51535
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$3,177.20 |
| Rate for Payer: Aetna Commercial |
$1,020.48
|
| Rate for Payer: Aetna Medicare |
$792.01
|
| Rate for Payer: BCBS Complete |
$520.65
|
| Rate for Payer: BCBS MAPPO |
$761.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,177.20
|
| Rate for Payer: BCN Commercial |
$1,124.45
|
| Rate for Payer: BCN Medicare Advantage |
$761.55
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.63
|
| Rate for Payer: Cofinity Commercial |
$1,020.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.55
|
| Rate for Payer: Mclaren Medicaid |
$495.86
|
| Rate for Payer: Meridian Medicaid |
$520.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$799.63
|
| Rate for Payer: PACE SWMI |
$761.55
|
| Rate for Payer: PHP Medicare Advantage |
$761.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$495.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.36
|
| Rate for Payer: Priority Health Medicare |
$761.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,243.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$761.55
|
| Rate for Payer: UHC Medicare Advantage |
$784.40
|
|
|
PR CYSTOTOMY EXCISION BLADDER TUMOR
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 51530
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$2,404.29 |
| Rate for Payer: Aetna Commercial |
$1,007.49
|
| Rate for Payer: Aetna Medicare |
$781.93
|
| Rate for Payer: BCBS Complete |
$514.40
|
| Rate for Payer: BCBS MAPPO |
$751.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,404.29
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$751.86
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$1,007.49
|
| Rate for Payer: Cofinity Commercial |
$1,082.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.86
|
| Rate for Payer: Mclaren Medicaid |
$489.90
|
| Rate for Payer: Meridian Medicaid |
$514.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$789.45
|
| Rate for Payer: PACE SWMI |
$751.86
|
| Rate for Payer: PHP Medicare Advantage |
$751.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,227.70
|
| Rate for Payer: Priority Health Medicare |
$751.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,227.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.86
|
| Rate for Payer: UHC Medicare Advantage |
$774.42
|
|
|
PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 51520
|
| Min. Negotiated Rate |
$380.42 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$779.22
|
| Rate for Payer: Aetna Medicare |
$604.77
|
| Rate for Payer: BCBS Complete |
$399.44
|
| Rate for Payer: BCBS MAPPO |
$581.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$861.05
|
| Rate for Payer: BCN Medicare Advantage |
$581.51
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$779.22
|
| Rate for Payer: Cofinity Commercial |
$837.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.51
|
| Rate for Payer: Mclaren Medicaid |
$380.42
|
| Rate for Payer: Meridian Medicaid |
$399.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$610.59
|
| Rate for Payer: PACE SWMI |
$581.51
|
| Rate for Payer: PHP Medicare Advantage |
$581.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.11
|
| Rate for Payer: Priority Health Medicare |
$581.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$952.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.51
|
| Rate for Payer: UHC Medicare Advantage |
$598.96
|
|
|
PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 51065
|
| Min. Negotiated Rate |
$370.83 |
| Max. Negotiated Rate |
$2,864.97 |
| Rate for Payer: Aetna Commercial |
$759.40
|
| Rate for Payer: Aetna Medicare |
$589.39
|
| Rate for Payer: BCBS Complete |
$389.37
|
| Rate for Payer: BCBS MAPPO |
$566.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,864.97
|
| Rate for Payer: BCN Commercial |
$839.06
|
| Rate for Payer: BCN Medicare Advantage |
$566.72
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cofinity Commercial |
$759.40
|
| Rate for Payer: Cofinity Commercial |
$816.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.72
|
| Rate for Payer: Mclaren Medicaid |
$370.83
|
| Rate for Payer: Meridian Medicaid |
$389.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$595.06
|
| Rate for Payer: PACE SWMI |
$566.72
|
| Rate for Payer: PHP Medicare Advantage |
$566.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$927.79
|
| Rate for Payer: Priority Health Medicare |
$566.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$927.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$566.72
|
| Rate for Payer: UHC Medicare Advantage |
$583.72
|
|
|
PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX
|
Professional
|
Both
|
$1,012.00
|
|
|
Service Code
|
HCPCS 51045
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$3,133.88 |
| Rate for Payer: Aetna Commercial |
$657.83
|
| Rate for Payer: Aetna Medicare |
$510.56
|
| Rate for Payer: BCBS Complete |
$335.02
|
| Rate for Payer: BCBS MAPPO |
$490.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,133.88
|
| Rate for Payer: BCN Commercial |
$728.13
|
| Rate for Payer: BCN Medicare Advantage |
$490.92
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cofinity Commercial |
$657.83
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.92
|
| Rate for Payer: Mclaren Medicaid |
$319.07
|
| Rate for Payer: Meridian Medicaid |
$335.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.47
|
| Rate for Payer: PACE SWMI |
$490.92
|
| Rate for Payer: PHP Medicare Advantage |
$490.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$708.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.13
|
| Rate for Payer: Priority Health Medicare |
$490.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$805.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.92
|
| Rate for Payer: UHC Medicare Advantage |
$505.65
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$654.37 |
| Rate for Payer: Aetna Commercial |
$540.41
|
| Rate for Payer: Aetna Medicare |
$419.42
|
| Rate for Payer: BCBS Complete |
$273.75
|
| Rate for Payer: BCBS MAPPO |
$403.29
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: BCN Commercial |
$591.79
|
| Rate for Payer: BCN Medicare Advantage |
$403.29
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cofinity Commercial |
$580.74
|
| Rate for Payer: Cofinity Commercial |
$540.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.29
|
| Rate for Payer: Mclaren Medicaid |
$260.71
|
| Rate for Payer: Meridian Medicaid |
$273.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$423.45
|
| Rate for Payer: PACE SWMI |
$403.29
|
| Rate for Payer: PHP Medicare Advantage |
$403.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.37
|
| Rate for Payer: Priority Health Medicare |
$403.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.29
|
| Rate for Payer: UHC Medicare Advantage |
$415.39
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,840.07 |
| Rate for Payer: Aetna Commercial |
$105.23
|
| Rate for Payer: Aetna Medicare |
$81.67
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$78.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.07
|
| Rate for Payer: BCN Commercial |
$352.33
|
| Rate for Payer: BCN Medicare Advantage |
$78.53
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Cofinity Commercial |
$113.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.53
|
| Rate for Payer: Mclaren Medicaid |
$50.69
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.46
|
| Rate for Payer: PACE SWMI |
$78.53
|
| Rate for Payer: PHP Medicare Advantage |
$78.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.52
|
| Rate for Payer: Priority Health Medicare |
$78.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.53
|
| Rate for Payer: UHC Medicare Advantage |
$80.89
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,222.49 |
| Rate for Payer: Aetna Commercial |
$221.18
|
| Rate for Payer: Aetna Medicare |
$171.66
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$165.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.49
|
| Rate for Payer: BCN Commercial |
$570.29
|
| Rate for Payer: BCN Medicare Advantage |
$165.06
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$237.69
|
| Rate for Payer: Cofinity Commercial |
$221.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.06
|
| Rate for Payer: Mclaren Medicaid |
$106.29
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$173.31
|
| Rate for Payer: PACE SWMI |
$165.06
|
| Rate for Payer: PHP Medicare Advantage |
$165.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.02
|
| Rate for Payer: Priority Health Medicare |
$165.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.06
|
| Rate for Payer: UHC Medicare Advantage |
$170.01
|
|
|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$211.72 |
| Max. Negotiated Rate |
$1,714.86 |
| Rate for Payer: Aetna Commercial |
$437.90
|
| Rate for Payer: Aetna Medicare |
$339.86
|
| Rate for Payer: BCBS Complete |
$222.31
|
| Rate for Payer: BCBS MAPPO |
$326.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,714.86
|
| Rate for Payer: BCN Commercial |
$479.88
|
| Rate for Payer: BCN Medicare Advantage |
$326.79
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$437.90
|
| Rate for Payer: Cofinity Commercial |
$470.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.79
|
| Rate for Payer: Mclaren Medicaid |
$211.72
|
| Rate for Payer: Meridian Medicaid |
$222.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.13
|
| Rate for Payer: PACE SWMI |
$326.79
|
| Rate for Payer: PHP Medicare Advantage |
$326.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.63
|
| Rate for Payer: Priority Health Medicare |
$326.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.79
|
| Rate for Payer: UHC Medicare Advantage |
$336.59
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$4,966.55 |
| Rate for Payer: Aetna Commercial |
$311.35
|
| Rate for Payer: Aetna Medicare |
$241.64
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$232.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,966.55
|
| Rate for Payer: BCN Commercial |
$341.58
|
| Rate for Payer: BCN Medicare Advantage |
$232.35
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Cofinity Commercial |
$311.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.35
|
| Rate for Payer: Mclaren Medicaid |
$150.17
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$243.97
|
| Rate for Payer: PACE SWMI |
$232.35
|
| Rate for Payer: PHP Medicare Advantage |
$232.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.71
|
| Rate for Payer: Priority Health Medicare |
$232.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$377.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.35
|
| Rate for Payer: UHC Medicare Advantage |
$239.32
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$1,483.99 |
| Rate for Payer: Aetna Commercial |
$254.47
|
| Rate for Payer: Aetna Medicare |
$197.50
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$189.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,483.99
|
| Rate for Payer: BCN Commercial |
$513.12
|
| Rate for Payer: BCN Medicare Advantage |
$189.90
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$273.46
|
| Rate for Payer: Cofinity Commercial |
$254.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.90
|
| Rate for Payer: Mclaren Medicaid |
$123.54
|
| Rate for Payer: Meridian Medicaid |
$129.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.40
|
| Rate for Payer: PACE SWMI |
$189.90
|
| Rate for Payer: PHP Medicare Advantage |
$189.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.08
|
| Rate for Payer: Priority Health Medicare |
$189.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$309.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.90
|
| Rate for Payer: UHC Medicare Advantage |
$195.60
|
|
