|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 95929
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$350.35 |
| Rate for Payer: Aetna Commercial |
$286.55
|
| Rate for Payer: Aetna Medicare |
$222.39
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$213.84
|
| Rate for Payer: BCN Medicare Advantage |
$213.84
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$307.93
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.53
|
| Rate for Payer: Nomi Health Commercial |
$256.61
|
| Rate for Payer: PACE SWMI |
$213.84
|
| Rate for Payer: PHP Medicare Advantage |
$213.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: Priority Health Medicare |
$215.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.84
|
| Rate for Payer: UHC Exchange |
$213.84
|
| Rate for Payer: UHC Medicare Advantage |
$213.84
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 95928
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$307.63 |
| Rate for Payer: Aetna Commercial |
$286.26
|
| Rate for Payer: Aetna Commercial |
$286.26
|
| Rate for Payer: Aetna Medicare |
$222.18
|
| Rate for Payer: Aetna Medicare |
$222.18
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS Complete |
$198.80
|
| Rate for Payer: BCBS MAPPO |
$213.63
|
| Rate for Payer: BCBS MAPPO |
$213.63
|
| Rate for Payer: BCN Medicare Advantage |
$213.63
|
| Rate for Payer: BCN Medicare Advantage |
$213.63
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$307.63
|
| Rate for Payer: Cofinity Commercial |
$286.26
|
| Rate for Payer: Cofinity Commercial |
$307.63
|
| Rate for Payer: Cofinity Commercial |
$286.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.31
|
| Rate for Payer: Nomi Health Commercial |
$256.36
|
| Rate for Payer: Nomi Health Commercial |
$256.36
|
| Rate for Payer: PACE SWMI |
$213.63
|
| Rate for Payer: PACE SWMI |
$213.63
|
| Rate for Payer: PHP Medicare Advantage |
$213.63
|
| Rate for Payer: PHP Medicare Advantage |
$213.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.05
|
| Rate for Payer: Priority Health Medicare |
$215.77
|
| Rate for Payer: Priority Health Medicare |
$215.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.63
|
| Rate for Payer: UHC Exchange |
$213.63
|
| Rate for Payer: UHC Exchange |
$213.63
|
| Rate for Payer: UHC Medicare Advantage |
$213.63
|
| Rate for Payer: UHC Medicare Advantage |
$213.63
|
|
|
PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 95939
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$713.00 |
| Rate for Payer: Aetna Commercial |
$663.49
|
| Rate for Payer: Aetna Medicare |
$514.95
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$495.14
|
| Rate for Payer: BCN Medicare Advantage |
$495.14
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$713.00
|
| Rate for Payer: Cofinity Commercial |
$663.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.90
|
| Rate for Payer: Nomi Health Commercial |
$594.17
|
| Rate for Payer: PACE SWMI |
$495.14
|
| Rate for Payer: PHP Medicare Advantage |
$495.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$500.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.14
|
| Rate for Payer: UHC Exchange |
$495.14
|
| Rate for Payer: UHC Medicare Advantage |
$495.14
|
|
|
PR CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 59160
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$354.90 |
| Rate for Payer: Aetna Commercial |
$243.96
|
| Rate for Payer: Aetna Medicare |
$189.34
|
| Rate for Payer: BCBS Complete |
$218.40
|
| Rate for Payer: BCBS MAPPO |
$182.06
|
| Rate for Payer: BCN Medicare Advantage |
$182.06
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$262.17
|
| Rate for Payer: Cofinity Commercial |
$243.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.16
|
| Rate for Payer: Nomi Health Commercial |
$218.47
|
| Rate for Payer: PACE SWMI |
$182.06
|
| Rate for Payer: PHP Medicare Advantage |
$182.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health Medicare |
$183.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.06
|
| Rate for Payer: UHC Exchange |
$182.06
|
| Rate for Payer: UHC Medicare Advantage |
$182.06
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 46940
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$185.88
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: BCBS Complete |
$191.60
|
| Rate for Payer: BCBS MAPPO |
$138.72
|
| Rate for Payer: BCN Medicare Advantage |
$138.72
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.66
|
| Rate for Payer: Nomi Health Commercial |
$166.46
|
| Rate for Payer: PACE SWMI |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Medicare |
$140.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.72
|
| Rate for Payer: UHC Exchange |
$138.72
|
| Rate for Payer: UHC Medicare Advantage |
$138.72
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 46942
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$166.35
|
| Rate for Payer: Aetna Medicare |
$129.11
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$124.14
|
| Rate for Payer: BCN Medicare Advantage |
$124.14
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$178.76
|
| Rate for Payer: Cofinity Commercial |
$166.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.35
|
| Rate for Payer: Nomi Health Commercial |
$148.97
|
| Rate for Payer: PACE SWMI |
$124.14
|
| Rate for Payer: PHP Medicare Advantage |
$124.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$125.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.14
|
| Rate for Payer: UHC Exchange |
$124.14
|
| Rate for Payer: UHC Medicare Advantage |
$124.14
|
|
|
PR CUSTOM EAR PLUGS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00592
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR CUTANANEOUS APPENDICO-VESICOSTOMY
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 50845
|
| Min. Negotiated Rate |
$1,034.80 |
| Max. Negotiated Rate |
$1,723.62 |
| Rate for Payer: Aetna Commercial |
$1,603.93
|
| Rate for Payer: Aetna Medicare |
$1,244.84
|
| Rate for Payer: BCBS Complete |
$1,034.80
|
| Rate for Payer: BCBS MAPPO |
$1,196.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,196.96
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cofinity Commercial |
$1,723.62
|
| Rate for Payer: Cofinity Commercial |
$1,603.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,196.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,256.81
|
| Rate for Payer: Nomi Health Commercial |
$1,436.35
|
| Rate for Payer: PACE SWMI |
$1,196.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,196.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health Medicare |
$1,208.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,196.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,196.96
|
| Rate for Payer: UHC Exchange |
$1,196.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,196.96
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$584.00 |
| Max. Negotiated Rate |
$982.12 |
| Rate for Payer: Aetna Commercial |
$913.92
|
| Rate for Payer: Aetna Medicare |
$709.31
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$682.03
|
| Rate for Payer: BCN Medicare Advantage |
$682.03
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$913.92
|
| Rate for Payer: Cofinity Commercial |
$982.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$682.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.13
|
| Rate for Payer: Nomi Health Commercial |
$818.44
|
| Rate for Payer: PACE SWMI |
$682.03
|
| Rate for Payer: PHP Medicare Advantage |
$682.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health Medicare |
$688.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$682.03
|
| Rate for Payer: UHC Exchange |
$682.03
|
| Rate for Payer: UHC Medicare Advantage |
$682.03
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$13.32
|
| Rate for Payer: BCN Medicare Advantage |
$13.32
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.99
|
| Rate for Payer: Nomi Health Commercial |
$15.98
|
| Rate for Payer: PACE SWMI |
$13.32
|
| Rate for Payer: PHP Medicare Advantage |
$13.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.32
|
| Rate for Payer: UHC Exchange |
$13.32
|
| Rate for Payer: UHC Medicare Advantage |
$13.32
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$45.64
|
| Rate for Payer: Aetna Medicare |
$35.42
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$34.06
|
| Rate for Payer: BCN Medicare Advantage |
$34.06
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Commercial |
$45.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.76
|
| Rate for Payer: Nomi Health Commercial |
$40.87
|
| Rate for Payer: PACE SWMI |
$34.06
|
| Rate for Payer: PHP Medicare Advantage |
$34.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Medicare |
$34.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.06
|
| Rate for Payer: UHC Exchange |
$34.06
|
| Rate for Payer: UHC Medicare Advantage |
$34.06
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$26.33
|
| Rate for Payer: Aetna Medicare |
$20.44
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$19.65
|
| Rate for Payer: BCN Medicare Advantage |
$19.65
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$26.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.63
|
| Rate for Payer: Nomi Health Commercial |
$23.58
|
| Rate for Payer: PACE SWMI |
$19.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Medicare |
$19.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.65
|
| Rate for Payer: UHC Exchange |
$19.65
|
| Rate for Payer: UHC Medicare Advantage |
$19.65
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$69.71
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$67.03
|
| Rate for Payer: BCN Medicare Advantage |
$67.03
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Cofinity Commercial |
$89.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.38
|
| Rate for Payer: Nomi Health Commercial |
$80.44
|
| Rate for Payer: PACE SWMI |
$67.03
|
| Rate for Payer: PHP Medicare Advantage |
$67.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$67.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.03
|
| Rate for Payer: UHC Exchange |
$67.03
|
| Rate for Payer: UHC Medicare Advantage |
$67.03
|
|
|
PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,811.00
|
|
|
Service Code
|
HCPCS 51570
|
| Min. Negotiated Rate |
$1,124.40 |
| Max. Negotiated Rate |
$2,019.92 |
| Rate for Payer: Aetna Commercial |
$1,879.64
|
| Rate for Payer: Aetna Medicare |
$1,458.83
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,402.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,402.72
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cofinity Commercial |
$2,019.92
|
| Rate for Payer: Cofinity Commercial |
$1,879.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,402.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,472.86
|
| Rate for Payer: Nomi Health Commercial |
$1,683.26
|
| Rate for Payer: PACE SWMI |
$1,402.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,402.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.15
|
| Rate for Payer: Priority Health Medicare |
$1,416.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,402.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,402.72
|
| Rate for Payer: UHC Exchange |
$1,402.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,402.72
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$7,752.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$1,203.80 |
| Max. Negotiated Rate |
$5,038.80 |
| Rate for Payer: Aetna Commercial |
$1,613.09
|
| Rate for Payer: Aetna Medicare |
$1,251.95
|
| Rate for Payer: BCBS Complete |
$3,100.80
|
| Rate for Payer: BCBS MAPPO |
$1,203.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,203.80
|
| Rate for Payer: Cash Price |
$6,201.60
|
| Rate for Payer: Cash Price |
$6,201.60
|
| Rate for Payer: Cofinity Commercial |
$1,733.47
|
| Rate for Payer: Cofinity Commercial |
$1,613.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,203.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,263.99
|
| Rate for Payer: Nomi Health Commercial |
$1,444.56
|
| Rate for Payer: PACE SWMI |
$1,203.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,203.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,038.80
|
| Rate for Payer: Priority Health Medicare |
$1,215.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,203.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,203.80
|
| Rate for Payer: UHC Exchange |
$1,203.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,203.80
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,326.25 |
| Rate for Payer: Aetna Commercial |
$1,234.15
|
| Rate for Payer: Aetna Medicare |
$957.85
|
| Rate for Payer: BCBS Complete |
$618.00
|
| Rate for Payer: BCBS MAPPO |
$921.01
|
| Rate for Payer: BCN Medicare Advantage |
$921.01
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cofinity Commercial |
$1,326.25
|
| Rate for Payer: Cofinity Commercial |
$1,234.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.06
|
| Rate for Payer: Nomi Health Commercial |
$1,105.21
|
| Rate for Payer: PACE SWMI |
$921.01
|
| Rate for Payer: PHP Medicare Advantage |
$921.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.25
|
| Rate for Payer: Priority Health Medicare |
$930.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$921.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.01
|
| Rate for Payer: UHC Exchange |
$921.01
|
| Rate for Payer: UHC Medicare Advantage |
$921.01
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$3,796.00
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,518.40 |
| Max. Negotiated Rate |
$2,489.01 |
| Rate for Payer: Aetna Commercial |
$2,316.16
|
| Rate for Payer: Aetna Medicare |
$1,797.62
|
| Rate for Payer: BCBS Complete |
$1,518.40
|
| Rate for Payer: BCBS MAPPO |
$1,728.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,728.48
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cofinity Commercial |
$2,489.01
|
| Rate for Payer: Cofinity Commercial |
$2,316.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,728.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,814.90
|
| Rate for Payer: Nomi Health Commercial |
$2,074.18
|
| Rate for Payer: PACE SWMI |
$1,728.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,728.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,467.40
|
| Rate for Payer: Priority Health Medicare |
$1,745.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,728.48
|
| Rate for Payer: UHC Exchange |
$1,728.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,728.48
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$144.58 |
| Max. Negotiated Rate |
$502.45 |
| Rate for Payer: Aetna Commercial |
$193.74
|
| Rate for Payer: Aetna Medicare |
$150.36
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: BCBS MAPPO |
$144.58
|
| Rate for Payer: BCN Medicare Advantage |
$144.58
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$208.20
|
| Rate for Payer: Cofinity Commercial |
$193.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$173.50
|
| Rate for Payer: PACE SWMI |
$144.58
|
| Rate for Payer: PHP Medicare Advantage |
$144.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health Medicare |
$146.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.58
|
| Rate for Payer: UHC Exchange |
$144.58
|
| Rate for Payer: UHC Medicare Advantage |
$144.58
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$406.46
|
| Rate for Payer: Aetna Medicare |
$315.46
|
| Rate for Payer: BCBS Complete |
$266.00
|
| Rate for Payer: BCBS MAPPO |
$303.33
|
| Rate for Payer: BCN Medicare Advantage |
$303.33
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.50
|
| Rate for Payer: Nomi Health Commercial |
$364.00
|
| Rate for Payer: PACE SWMI |
$303.33
|
| Rate for Payer: PHP Medicare Advantage |
$303.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health Medicare |
$306.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.33
|
| Rate for Payer: UHC Exchange |
$303.33
|
| Rate for Payer: UHC Medicare Advantage |
$303.33
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$379.31 |
| Rate for Payer: Aetna Commercial |
$352.97
|
| Rate for Payer: Aetna Medicare |
$273.95
|
| Rate for Payer: BCBS Complete |
$218.80
|
| Rate for Payer: BCBS MAPPO |
$263.41
|
| Rate for Payer: BCN Medicare Advantage |
$263.41
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$379.31
|
| Rate for Payer: Cofinity Commercial |
$352.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.58
|
| Rate for Payer: Nomi Health Commercial |
$316.09
|
| Rate for Payer: PACE SWMI |
$263.41
|
| Rate for Payer: PHP Medicare Advantage |
$263.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health Medicare |
$266.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.41
|
| Rate for Payer: UHC Exchange |
$263.41
|
| Rate for Payer: UHC Medicare Advantage |
$263.41
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$1,118.00 |
| Rate for Payer: Aetna Commercial |
$65.00
|
| Rate for Payer: Aetna Medicare |
$50.45
|
| Rate for Payer: BCBS Complete |
$688.00
|
| Rate for Payer: BCBS MAPPO |
$48.51
|
| Rate for Payer: BCN Medicare Advantage |
$48.51
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$69.85
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.94
|
| Rate for Payer: Nomi Health Commercial |
$58.21
|
| Rate for Payer: PACE SWMI |
$48.51
|
| Rate for Payer: PHP Medicare Advantage |
$48.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.00
|
| Rate for Payer: Priority Health Medicare |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.51
|
| Rate for Payer: UHC Exchange |
$48.51
|
| Rate for Payer: UHC Medicare Advantage |
$48.51
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$199.63 |
| Max. Negotiated Rate |
$1,461.20 |
| Rate for Payer: Aetna Commercial |
$267.50
|
| Rate for Payer: Aetna Medicare |
$207.62
|
| Rate for Payer: BCBS Complete |
$899.20
|
| Rate for Payer: BCBS MAPPO |
$199.63
|
| Rate for Payer: BCN Medicare Advantage |
$199.63
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cofinity Commercial |
$287.47
|
| Rate for Payer: Cofinity Commercial |
$267.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.61
|
| Rate for Payer: Nomi Health Commercial |
$239.56
|
| Rate for Payer: PACE SWMI |
$199.63
|
| Rate for Payer: PHP Medicare Advantage |
$199.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,461.20
|
| Rate for Payer: Priority Health Medicare |
$201.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.63
|
| Rate for Payer: UHC Exchange |
$199.63
|
| Rate for Payer: UHC Medicare Advantage |
$199.63
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$174.15 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$233.36
|
| Rate for Payer: Aetna Medicare |
$181.12
|
| Rate for Payer: BCBS Complete |
$377.60
|
| Rate for Payer: BCBS MAPPO |
$174.15
|
| Rate for Payer: BCN Medicare Advantage |
$174.15
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$250.78
|
| Rate for Payer: Cofinity Commercial |
$233.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.86
|
| Rate for Payer: Nomi Health Commercial |
$208.98
|
| Rate for Payer: PACE SWMI |
$174.15
|
| Rate for Payer: PHP Medicare Advantage |
$174.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health Medicare |
$175.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.15
|
| Rate for Payer: UHC Exchange |
$174.15
|
| Rate for Payer: UHC Medicare Advantage |
$174.15
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$674.70 |
| Rate for Payer: Aetna Commercial |
$606.54
|
| Rate for Payer: Aetna Medicare |
$470.75
|
| Rate for Payer: BCBS Complete |
$415.20
|
| Rate for Payer: BCBS MAPPO |
$452.64
|
| Rate for Payer: BCN Medicare Advantage |
$452.64
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$651.80
|
| Rate for Payer: Cofinity Commercial |
$606.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.27
|
| Rate for Payer: Nomi Health Commercial |
$543.17
|
| Rate for Payer: PACE SWMI |
$452.64
|
| Rate for Payer: PHP Medicare Advantage |
$452.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health Medicare |
$457.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.64
|
| Rate for Payer: UHC Exchange |
$452.64
|
| Rate for Payer: UHC Medicare Advantage |
$452.64
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$334.72
|
| Rate for Payer: Aetna Medicare |
$259.78
|
| Rate for Payer: BCBS Complete |
$420.00
|
| Rate for Payer: BCBS MAPPO |
$249.79
|
| Rate for Payer: BCN Medicare Advantage |
$249.79
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$359.70
|
| Rate for Payer: Cofinity Commercial |
$334.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.28
|
| Rate for Payer: Nomi Health Commercial |
$299.75
|
| Rate for Payer: PACE SWMI |
$249.79
|
| Rate for Payer: PHP Medicare Advantage |
$249.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health Medicare |
$252.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.79
|
| Rate for Payer: UHC Exchange |
$249.79
|
| Rate for Payer: UHC Medicare Advantage |
$249.79
|
|
