|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$3,767.31 |
| Rate for Payer: Aetna Commercial |
$375.17
|
| Rate for Payer: Aetna Medicare |
$291.18
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS MAPPO |
$279.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,767.31
|
| Rate for Payer: BCN Commercial |
$411.47
|
| Rate for Payer: BCN Medicare Advantage |
$279.98
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cofinity Commercial |
$375.17
|
| Rate for Payer: Cofinity Commercial |
$403.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.98
|
| Rate for Payer: Mclaren Medicaid |
$181.26
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.98
|
| Rate for Payer: PACE SWMI |
$279.98
|
| Rate for Payer: PHP Medicare Advantage |
$279.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.98
|
| Rate for Payer: Priority Health Medicare |
$279.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$454.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.98
|
| Rate for Payer: UHC Medicare Advantage |
$288.38
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$4,858.78 |
| Rate for Payer: Aetna Commercial |
$509.88
|
| Rate for Payer: Aetna Medicare |
$395.73
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS MAPPO |
$380.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,858.78
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$380.51
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Cofinity Commercial |
$509.88
|
| Rate for Payer: Cofinity Commercial |
$547.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.51
|
| Rate for Payer: Mclaren Medicaid |
$246.02
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.54
|
| Rate for Payer: PACE SWMI |
$380.51
|
| Rate for Payer: PHP Medicare Advantage |
$380.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.63
|
| Rate for Payer: Priority Health Medicare |
$380.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.51
|
| Rate for Payer: UHC Medicare Advantage |
$391.93
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$1,421.13 |
| Rate for Payer: Aetna Commercial |
$274.78
|
| Rate for Payer: Aetna Medicare |
$213.26
|
| Rate for Payer: BCBS Complete |
$139.11
|
| Rate for Payer: BCBS MAPPO |
$205.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,421.13
|
| Rate for Payer: BCN Commercial |
$418.29
|
| Rate for Payer: BCN Medicare Advantage |
$205.06
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$295.29
|
| Rate for Payer: Cofinity Commercial |
$274.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.06
|
| Rate for Payer: Mclaren Medicaid |
$132.49
|
| Rate for Payer: Meridian Medicaid |
$139.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$215.31
|
| Rate for Payer: PACE SWMI |
$205.06
|
| Rate for Payer: PHP Medicare Advantage |
$205.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.39
|
| Rate for Payer: Priority Health Medicare |
$205.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.06
|
| Rate for Payer: UHC Medicare Advantage |
$211.21
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$5,029.94 |
| Rate for Payer: Aetna Commercial |
$211.64
|
| Rate for Payer: Aetna Medicare |
$164.26
|
| Rate for Payer: BCBS Complete |
$107.57
|
| Rate for Payer: BCBS MAPPO |
$157.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,029.94
|
| Rate for Payer: BCN Commercial |
$549.27
|
| Rate for Payer: BCN Medicare Advantage |
$157.94
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$211.64
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.94
|
| Rate for Payer: Mclaren Medicaid |
$102.45
|
| Rate for Payer: Meridian Medicaid |
$107.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.84
|
| Rate for Payer: PACE SWMI |
$157.94
|
| Rate for Payer: PHP Medicare Advantage |
$157.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.21
|
| Rate for Payer: Priority Health Medicare |
$157.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.94
|
| Rate for Payer: UHC Medicare Advantage |
$162.68
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$2,759.84 |
| Rate for Payer: Aetna Commercial |
$343.54
|
| Rate for Payer: Aetna Medicare |
$266.62
|
| Rate for Payer: BCBS Complete |
$174.23
|
| Rate for Payer: BCBS MAPPO |
$256.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,759.84
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$256.37
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cofinity Commercial |
$369.17
|
| Rate for Payer: Cofinity Commercial |
$343.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.37
|
| Rate for Payer: Mclaren Medicaid |
$165.93
|
| Rate for Payer: Meridian Medicaid |
$174.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$269.19
|
| Rate for Payer: PACE SWMI |
$256.37
|
| Rate for Payer: PHP Medicare Advantage |
$256.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.62
|
| Rate for Payer: Priority Health Medicare |
$256.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$416.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.37
|
| Rate for Payer: UHC Medicare Advantage |
$264.06
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$4,237.49 |
| Rate for Payer: Aetna Commercial |
$235.83
|
| Rate for Payer: Aetna Medicare |
$183.03
|
| Rate for Payer: BCBS Complete |
$119.88
|
| Rate for Payer: BCBS MAPPO |
$175.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,237.49
|
| Rate for Payer: BCN Commercial |
$617.20
|
| Rate for Payer: BCN Medicare Advantage |
$175.99
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$253.43
|
| Rate for Payer: Cofinity Commercial |
$235.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.99
|
| Rate for Payer: Mclaren Medicaid |
$114.17
|
| Rate for Payer: Meridian Medicaid |
$119.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.79
|
| Rate for Payer: PACE SWMI |
$175.99
|
| Rate for Payer: PHP Medicare Advantage |
$175.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.39
|
| Rate for Payer: Priority Health Medicare |
$175.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$286.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.99
|
| Rate for Payer: UHC Medicare Advantage |
$181.27
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$5,563.53 |
| Rate for Payer: Aetna Commercial |
$322.58
|
| Rate for Payer: Aetna Medicare |
$250.36
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS MAPPO |
$240.73
|
| Rate for Payer: BCBS Trust/PPO |
$5,563.53
|
| Rate for Payer: BCN Commercial |
$790.68
|
| Rate for Payer: BCN Medicare Advantage |
$240.73
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cofinity Commercial |
$322.58
|
| Rate for Payer: Cofinity Commercial |
$346.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.73
|
| Rate for Payer: Mclaren Medicaid |
$155.92
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$252.77
|
| Rate for Payer: PACE SWMI |
$240.73
|
| Rate for Payer: PHP Medicare Advantage |
$240.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.21
|
| Rate for Payer: Priority Health Medicare |
$240.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.73
|
| Rate for Payer: UHC Medicare Advantage |
$247.95
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$1,981.65 |
| Rate for Payer: Aetna Commercial |
$183.15
|
| Rate for Payer: Aetna Medicare |
$142.15
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS MAPPO |
$136.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,981.65
|
| Rate for Payer: BCN Commercial |
$554.65
|
| Rate for Payer: BCN Medicare Advantage |
$136.68
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cofinity Commercial |
$196.82
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.68
|
| Rate for Payer: Mclaren Medicaid |
$89.25
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.51
|
| Rate for Payer: PACE SWMI |
$136.68
|
| Rate for Payer: PHP Medicare Advantage |
$136.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.63
|
| Rate for Payer: Priority Health Medicare |
$136.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.68
|
| Rate for Payer: UHC Medicare Advantage |
$140.78
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$978.60 |
| Rate for Payer: Aetna Commercial |
$320.10
|
| Rate for Payer: Aetna Medicare |
$248.44
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cofinity Commercial |
$320.10
|
| Rate for Payer: Cofinity Commercial |
$343.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Mclaren Medicaid |
$154.43
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.98
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.88
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
|
|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$606.49 |
| Rate for Payer: Aetna Commercial |
$261.61
|
| Rate for Payer: Aetna Medicare |
$203.04
|
| Rate for Payer: BCBS Complete |
$133.08
|
| Rate for Payer: BCBS MAPPO |
$195.23
|
| Rate for Payer: BCBS Trust/PPO |
$606.49
|
| Rate for Payer: BCN Commercial |
$517.51
|
| Rate for Payer: BCN Medicare Advantage |
$195.23
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$281.13
|
| Rate for Payer: Cofinity Commercial |
$261.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.23
|
| Rate for Payer: Mclaren Medicaid |
$126.74
|
| Rate for Payer: Meridian Medicaid |
$133.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.99
|
| Rate for Payer: PACE SWMI |
$195.23
|
| Rate for Payer: PHP Medicare Advantage |
$195.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.74
|
| Rate for Payer: Priority Health Medicare |
$195.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.23
|
| Rate for Payer: UHC Medicare Advantage |
$201.09
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$152.93 |
| Max. Negotiated Rate |
$1,479.24 |
| Rate for Payer: Aetna Commercial |
$317.16
|
| Rate for Payer: Aetna Medicare |
$246.16
|
| Rate for Payer: BCBS Complete |
$160.58
|
| Rate for Payer: BCBS MAPPO |
$236.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.24
|
| Rate for Payer: BCN Commercial |
$347.94
|
| Rate for Payer: BCN Medicare Advantage |
$236.69
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$340.83
|
| Rate for Payer: Cofinity Commercial |
$317.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.69
|
| Rate for Payer: Mclaren Medicaid |
$152.93
|
| Rate for Payer: Meridian Medicaid |
$160.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$248.52
|
| Rate for Payer: PACE SWMI |
$236.69
|
| Rate for Payer: PHP Medicare Advantage |
$236.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.74
|
| Rate for Payer: Priority Health Medicare |
$236.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.69
|
| Rate for Payer: UHC Medicare Advantage |
$243.79
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$1,188.68 |
| Rate for Payer: Aetna Commercial |
$357.99
|
| Rate for Payer: Aetna Medicare |
$277.85
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCBS MAPPO |
$267.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.68
|
| Rate for Payer: BCN Commercial |
$686.59
|
| Rate for Payer: BCN Medicare Advantage |
$267.16
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$384.71
|
| Rate for Payer: Cofinity Commercial |
$357.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.16
|
| Rate for Payer: Mclaren Medicaid |
$172.32
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$280.52
|
| Rate for Payer: PACE SWMI |
$267.16
|
| Rate for Payer: PHP Medicare Advantage |
$267.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.90
|
| Rate for Payer: Priority Health Medicare |
$267.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$433.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.16
|
| Rate for Payer: UHC Medicare Advantage |
$275.17
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,770.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$2,177.12 |
| Rate for Payer: Aetna Commercial |
$229.09
|
| Rate for Payer: Aetna Medicare |
$177.80
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS MAPPO |
$170.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,177.12
|
| Rate for Payer: BCN Commercial |
$1,100.50
|
| Rate for Payer: BCN Medicare Advantage |
$170.96
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cofinity Commercial |
$229.09
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.96
|
| Rate for Payer: Mclaren Medicaid |
$109.70
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.51
|
| Rate for Payer: PACE SWMI |
$170.96
|
| Rate for Payer: PHP Medicare Advantage |
$170.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,939.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.66
|
| Rate for Payer: Priority Health Medicare |
$170.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.96
|
| Rate for Payer: UHC Medicare Advantage |
$176.09
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$2,268.52 |
| Rate for Payer: Aetna Commercial |
$202.25
|
| Rate for Payer: Aetna Medicare |
$156.97
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$150.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,268.52
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: BCN Medicare Advantage |
$150.93
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$217.34
|
| Rate for Payer: Cofinity Commercial |
$202.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.93
|
| Rate for Payer: Mclaren Medicaid |
$97.98
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.48
|
| Rate for Payer: PACE SWMI |
$150.93
|
| Rate for Payer: PHP Medicare Advantage |
$150.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.87
|
| Rate for Payer: Priority Health Medicare |
$150.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.93
|
| Rate for Payer: UHC Medicare Advantage |
$155.46
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$180.41 |
| Max. Negotiated Rate |
$1,930.41 |
| Rate for Payer: Aetna Commercial |
$373.51
|
| Rate for Payer: Aetna Medicare |
$289.89
|
| Rate for Payer: BCBS Complete |
$189.43
|
| Rate for Payer: BCBS MAPPO |
$278.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.41
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$278.74
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cofinity Commercial |
$401.39
|
| Rate for Payer: Cofinity Commercial |
$373.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.74
|
| Rate for Payer: Mclaren Medicaid |
$180.41
|
| Rate for Payer: Meridian Medicaid |
$189.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.68
|
| Rate for Payer: PACE SWMI |
$278.74
|
| Rate for Payer: PHP Medicare Advantage |
$278.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.81
|
| Rate for Payer: Priority Health Medicare |
$278.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.74
|
| Rate for Payer: UHC Medicare Advantage |
$287.10
|
|
|
PR CYSTO W/REMOVAL OF LESIONS MINOR
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$2,846.48 |
| Rate for Payer: Aetna Commercial |
$265.35
|
| Rate for Payer: Aetna Medicare |
$205.94
|
| Rate for Payer: BCBS Complete |
$133.30
|
| Rate for Payer: BCBS MAPPO |
$198.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.48
|
| Rate for Payer: BCN Commercial |
$1,149.37
|
| Rate for Payer: BCN Medicare Advantage |
$198.02
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$285.15
|
| Rate for Payer: Cofinity Commercial |
$265.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.02
|
| Rate for Payer: Mclaren Medicaid |
$126.95
|
| Rate for Payer: Meridian Medicaid |
$133.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$207.92
|
| Rate for Payer: PACE SWMI |
$198.02
|
| Rate for Payer: PHP Medicare Advantage |
$198.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,596.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.43
|
| Rate for Payer: Priority Health Medicare |
$198.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.02
|
| Rate for Payer: UHC Medicare Advantage |
$203.96
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$5,244.96 |
| Rate for Payer: Aetna Commercial |
$319.80
|
| Rate for Payer: Aetna Medicare |
$248.21
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS MAPPO |
$238.66
|
| Rate for Payer: BCBS Trust/PPO |
$5,244.96
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$238.66
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$319.80
|
| Rate for Payer: Cofinity Commercial |
$343.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.66
|
| Rate for Payer: Mclaren Medicaid |
$154.43
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.59
|
| Rate for Payer: PACE SWMI |
$238.66
|
| Rate for Payer: PHP Medicare Advantage |
$238.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.98
|
| Rate for Payer: Priority Health Medicare |
$238.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.66
|
| Rate for Payer: UHC Medicare Advantage |
$245.82
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$175.73 |
| Max. Negotiated Rate |
$1,512.52 |
| Rate for Payer: Aetna Commercial |
$365.08
|
| Rate for Payer: Aetna Medicare |
$283.35
|
| Rate for Payer: BCBS Complete |
$184.52
|
| Rate for Payer: BCBS MAPPO |
$272.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.52
|
| Rate for Payer: BCN Commercial |
$400.23
|
| Rate for Payer: BCN Medicare Advantage |
$272.45
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$365.08
|
| Rate for Payer: Cofinity Commercial |
$392.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.45
|
| Rate for Payer: Mclaren Medicaid |
$175.73
|
| Rate for Payer: Meridian Medicaid |
$184.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$286.07
|
| Rate for Payer: PACE SWMI |
$272.45
|
| Rate for Payer: PHP Medicare Advantage |
$272.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.56
|
| Rate for Payer: Priority Health Medicare |
$272.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$442.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.45
|
| Rate for Payer: UHC Medicare Advantage |
$280.62
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$571.22
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$182.12 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$377.06
|
| Rate for Payer: Aetna Medicare |
$292.65
|
| Rate for Payer: BCBS Complete |
$191.23
|
| Rate for Payer: BCBS MAPPO |
$281.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$281.39
|
| Rate for Payer: Cash Price |
$456.98
|
| Rate for Payer: Cash Price |
$456.98
|
| Rate for Payer: Cofinity Commercial |
$405.20
|
| Rate for Payer: Cofinity Commercial |
$377.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.39
|
| Rate for Payer: Mclaren Medicaid |
$182.12
|
| Rate for Payer: Meridian Medicaid |
$191.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$295.46
|
| Rate for Payer: PACE SWMI |
$281.39
|
| Rate for Payer: PHP Medicare Advantage |
$281.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.15
|
| Rate for Payer: Priority Health Medicare |
$281.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.39
|
| Rate for Payer: UHC Medicare Advantage |
$289.83
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$197.23
|
| Rate for Payer: Aetna Medicare |
$153.08
|
| Rate for Payer: BCBS Complete |
$100.19
|
| Rate for Payer: BCBS MAPPO |
$147.19
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$466.69
|
| Rate for Payer: BCN Medicare Advantage |
$147.19
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cofinity Commercial |
$211.95
|
| Rate for Payer: Cofinity Commercial |
$197.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.19
|
| Rate for Payer: Mclaren Medicaid |
$95.42
|
| Rate for Payer: Meridian Medicaid |
$100.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$154.55
|
| Rate for Payer: PACE SWMI |
$147.19
|
| Rate for Payer: PHP Medicare Advantage |
$147.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.38
|
| Rate for Payer: Priority Health Medicare |
$147.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.19
|
| Rate for Payer: UHC Medicare Advantage |
$151.61
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$2,129.58 |
| Rate for Payer: Aetna Commercial |
$338.16
|
| Rate for Payer: Aetna Medicare |
$262.45
|
| Rate for Payer: BCBS Complete |
$170.43
|
| Rate for Payer: BCBS MAPPO |
$252.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,129.58
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: BCN Medicare Advantage |
$252.36
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cofinity Commercial |
$363.40
|
| Rate for Payer: Cofinity Commercial |
$338.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.36
|
| Rate for Payer: Mclaren Medicaid |
$162.31
|
| Rate for Payer: Meridian Medicaid |
$170.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$264.98
|
| Rate for Payer: PACE SWMI |
$252.36
|
| Rate for Payer: PHP Medicare Advantage |
$252.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.51
|
| Rate for Payer: Priority Health Medicare |
$252.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.36
|
| Rate for Payer: UHC Medicare Advantage |
$259.93
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$215.77 |
| Max. Negotiated Rate |
$2,659.46 |
| Rate for Payer: Aetna Commercial |
$447.64
|
| Rate for Payer: Aetna Medicare |
$347.42
|
| Rate for Payer: BCBS Complete |
$226.56
|
| Rate for Payer: BCBS MAPPO |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.46
|
| Rate for Payer: BCN Commercial |
$490.63
|
| Rate for Payer: BCN Medicare Advantage |
$334.06
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$481.05
|
| Rate for Payer: Cofinity Commercial |
$447.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.06
|
| Rate for Payer: Mclaren Medicaid |
$215.77
|
| Rate for Payer: Meridian Medicaid |
$226.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$350.76
|
| Rate for Payer: PACE SWMI |
$334.06
|
| Rate for Payer: PHP Medicare Advantage |
$334.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$542.52
|
| Rate for Payer: Priority Health Medicare |
$334.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$542.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$334.06
|
| Rate for Payer: UHC Medicare Advantage |
$344.08
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$2,160.75 |
| Rate for Payer: Aetna Commercial |
$369.84
|
| Rate for Payer: Aetna Medicare |
$287.04
|
| Rate for Payer: BCBS Complete |
$187.41
|
| Rate for Payer: BCBS MAPPO |
$276.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.75
|
| Rate for Payer: BCN Commercial |
$405.60
|
| Rate for Payer: BCN Medicare Advantage |
$276.00
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cofinity Commercial |
$397.44
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.00
|
| Rate for Payer: Mclaren Medicaid |
$178.49
|
| Rate for Payer: Meridian Medicaid |
$187.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.80
|
| Rate for Payer: PACE SWMI |
$276.00
|
| Rate for Payer: PHP Medicare Advantage |
$276.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.49
|
| Rate for Payer: Priority Health Medicare |
$276.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.00
|
| Rate for Payer: UHC Medicare Advantage |
$284.28
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$1,174.60 |
| Rate for Payer: Aetna Commercial |
$401.53
|
| Rate for Payer: Aetna Medicare |
$311.64
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$299.65
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$440.30
|
| Rate for Payer: BCN Medicare Advantage |
$299.65
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cofinity Commercial |
$431.50
|
| Rate for Payer: Cofinity Commercial |
$401.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.65
|
| Rate for Payer: Mclaren Medicaid |
$194.26
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$314.63
|
| Rate for Payer: PACE SWMI |
$299.65
|
| Rate for Payer: PHP Medicare Advantage |
$299.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.86
|
| Rate for Payer: Priority Health Medicare |
$299.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.65
|
| Rate for Payer: UHC Medicare Advantage |
$308.64
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$7,607.52 |
| Rate for Payer: Aetna Commercial |
$509.88
|
| Rate for Payer: Aetna Medicare |
$395.73
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS MAPPO |
$380.51
|
| Rate for Payer: BCBS Trust/PPO |
$7,607.52
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$380.51
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$547.93
|
| Rate for Payer: Cofinity Commercial |
$509.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.51
|
| Rate for Payer: Mclaren Medicaid |
$245.80
|
| Rate for Payer: Meridian Medicaid |
$258.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.54
|
| Rate for Payer: PACE SWMI |
$380.51
|
| Rate for Payer: PHP Medicare Advantage |
$380.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.63
|
| Rate for Payer: Priority Health Medicare |
$380.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.51
|
| Rate for Payer: UHC Medicare Advantage |
$391.93
|
|
