|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$570.02 |
| Rate for Payer: Aetna Commercial |
$530.44
|
| Rate for Payer: Aetna Medicare |
$411.68
|
| Rate for Payer: BCBS Complete |
$304.80
|
| Rate for Payer: BCBS MAPPO |
$395.85
|
| Rate for Payer: BCN Medicare Advantage |
$395.85
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$570.02
|
| Rate for Payer: Cofinity Commercial |
$530.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.64
|
| Rate for Payer: Nomi Health Commercial |
$475.02
|
| Rate for Payer: PACE SWMI |
$395.85
|
| Rate for Payer: PHP Medicare Advantage |
$395.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health Medicare |
$399.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.85
|
| Rate for Payer: UHC Exchange |
$395.85
|
| Rate for Payer: UHC Medicare Advantage |
$395.85
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$443.65 |
| Max. Negotiated Rate |
$943.80 |
| Rate for Payer: Aetna Commercial |
$594.49
|
| Rate for Payer: Aetna Medicare |
$461.40
|
| Rate for Payer: BCBS Complete |
$580.80
|
| Rate for Payer: BCBS MAPPO |
$443.65
|
| Rate for Payer: BCN Medicare Advantage |
$443.65
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cofinity Commercial |
$638.86
|
| Rate for Payer: Cofinity Commercial |
$594.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.83
|
| Rate for Payer: Nomi Health Commercial |
$532.38
|
| Rate for Payer: PACE SWMI |
$443.65
|
| Rate for Payer: PHP Medicare Advantage |
$443.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.80
|
| Rate for Payer: Priority Health Medicare |
$448.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.65
|
| Rate for Payer: UHC Exchange |
$443.65
|
| Rate for Payer: UHC Medicare Advantage |
$443.65
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,197.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$854.74 |
| Max. Negotiated Rate |
$2,078.05 |
| Rate for Payer: Aetna Commercial |
$1,145.35
|
| Rate for Payer: Aetna Medicare |
$888.93
|
| Rate for Payer: BCBS Complete |
$1,278.80
|
| Rate for Payer: BCBS MAPPO |
$854.74
|
| Rate for Payer: BCN Medicare Advantage |
$854.74
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cofinity Commercial |
$1,230.83
|
| Rate for Payer: Cofinity Commercial |
$1,145.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$897.48
|
| Rate for Payer: Nomi Health Commercial |
$1,025.69
|
| Rate for Payer: PACE SWMI |
$854.74
|
| Rate for Payer: PHP Medicare Advantage |
$854.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,078.05
|
| Rate for Payer: Priority Health Medicare |
$863.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.74
|
| Rate for Payer: UHC Exchange |
$854.74
|
| Rate for Payer: UHC Medicare Advantage |
$854.74
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$712.24 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Aetna Commercial |
$954.40
|
| Rate for Payer: Aetna Medicare |
$740.73
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$712.24
|
| Rate for Payer: BCN Medicare Advantage |
$712.24
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$1,025.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.85
|
| Rate for Payer: Nomi Health Commercial |
$854.69
|
| Rate for Payer: PACE SWMI |
$712.24
|
| Rate for Payer: PHP Medicare Advantage |
$712.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$719.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.24
|
| Rate for Payer: UHC Exchange |
$712.24
|
| Rate for Payer: UHC Medicare Advantage |
$712.24
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$373.42
|
| Rate for Payer: Aetna Medicare |
$289.82
|
| Rate for Payer: BCBS Complete |
$218.40
|
| Rate for Payer: BCBS MAPPO |
$278.67
|
| Rate for Payer: BCN Medicare Advantage |
$278.67
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$401.28
|
| Rate for Payer: Cofinity Commercial |
$373.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.60
|
| Rate for Payer: Nomi Health Commercial |
$334.40
|
| Rate for Payer: PACE SWMI |
$278.67
|
| Rate for Payer: PHP Medicare Advantage |
$278.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health Medicare |
$281.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.67
|
| Rate for Payer: UHC Exchange |
$278.67
|
| Rate for Payer: UHC Medicare Advantage |
$278.67
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$449.18 |
| Max. Negotiated Rate |
$1,592.50 |
| Rate for Payer: Aetna Commercial |
$601.90
|
| Rate for Payer: Aetna Medicare |
$467.15
|
| Rate for Payer: BCBS Complete |
$980.00
|
| Rate for Payer: BCBS MAPPO |
$449.18
|
| Rate for Payer: BCN Medicare Advantage |
$449.18
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cofinity Commercial |
$646.82
|
| Rate for Payer: Cofinity Commercial |
$601.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.64
|
| Rate for Payer: Nomi Health Commercial |
$539.02
|
| Rate for Payer: PACE SWMI |
$449.18
|
| Rate for Payer: PHP Medicare Advantage |
$449.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,592.50
|
| Rate for Payer: Priority Health Medicare |
$453.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.18
|
| Rate for Payer: UHC Exchange |
$449.18
|
| Rate for Payer: UHC Medicare Advantage |
$449.18
|
|
|
PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
HCPCS 51525
|
| Min. Negotiated Rate |
$800.80 |
| Max. Negotiated Rate |
$1,301.30 |
| Rate for Payer: Aetna Commercial |
$1,097.85
|
| Rate for Payer: Aetna Medicare |
$852.06
|
| Rate for Payer: BCBS Complete |
$800.80
|
| Rate for Payer: BCBS MAPPO |
$819.29
|
| Rate for Payer: BCN Medicare Advantage |
$819.29
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.78
|
| Rate for Payer: Cofinity Commercial |
$1,097.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$860.25
|
| Rate for Payer: Nomi Health Commercial |
$983.15
|
| Rate for Payer: PACE SWMI |
$819.29
|
| Rate for Payer: PHP Medicare Advantage |
$819.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.30
|
| Rate for Payer: Priority Health Medicare |
$827.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$819.29
|
| Rate for Payer: UHC Exchange |
$819.29
|
| Rate for Payer: UHC Medicare Advantage |
$819.29
|
|
|
PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 51535
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Aetna Commercial |
$998.77
|
| Rate for Payer: Aetna Medicare |
$775.16
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$745.35
|
| Rate for Payer: BCN Medicare Advantage |
$745.35
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$998.77
|
| Rate for Payer: Cofinity Commercial |
$1,073.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.62
|
| Rate for Payer: Nomi Health Commercial |
$894.42
|
| Rate for Payer: PACE SWMI |
$745.35
|
| Rate for Payer: PHP Medicare Advantage |
$745.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$752.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$745.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.35
|
| Rate for Payer: UHC Exchange |
$745.35
|
| Rate for Payer: UHC Medicare Advantage |
$745.35
|
|
|
PR CYSTOTOMY EXCISION BLADDER TUMOR
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 51530
|
| Min. Negotiated Rate |
$556.00 |
| Max. Negotiated Rate |
$1,059.31 |
| Rate for Payer: Aetna Commercial |
$985.74
|
| Rate for Payer: Aetna Medicare |
$765.06
|
| Rate for Payer: BCBS Complete |
$556.00
|
| Rate for Payer: BCBS MAPPO |
$735.63
|
| Rate for Payer: BCN Medicare Advantage |
$735.63
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cofinity Commercial |
$985.74
|
| Rate for Payer: Cofinity Commercial |
$1,059.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$772.41
|
| Rate for Payer: Nomi Health Commercial |
$882.76
|
| Rate for Payer: PACE SWMI |
$735.63
|
| Rate for Payer: PHP Medicare Advantage |
$735.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.50
|
| Rate for Payer: Priority Health Medicare |
$742.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.63
|
| Rate for Payer: UHC Exchange |
$735.63
|
| Rate for Payer: UHC Medicare Advantage |
$735.63
|
|
|
PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 51520
|
| Min. Negotiated Rate |
$491.20 |
| Max. Negotiated Rate |
$820.83 |
| Rate for Payer: Aetna Commercial |
$763.83
|
| Rate for Payer: Aetna Medicare |
$592.82
|
| Rate for Payer: BCBS Complete |
$491.20
|
| Rate for Payer: BCBS MAPPO |
$570.02
|
| Rate for Payer: BCN Medicare Advantage |
$570.02
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cofinity Commercial |
$820.83
|
| Rate for Payer: Cofinity Commercial |
$763.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.52
|
| Rate for Payer: Nomi Health Commercial |
$684.02
|
| Rate for Payer: PACE SWMI |
$570.02
|
| Rate for Payer: PHP Medicare Advantage |
$570.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.20
|
| Rate for Payer: Priority Health Medicare |
$575.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.02
|
| Rate for Payer: UHC Exchange |
$570.02
|
| Rate for Payer: UHC Medicare Advantage |
$570.02
|
|
|
PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 51065
|
| Min. Negotiated Rate |
$555.47 |
| Max. Negotiated Rate |
$1,279.85 |
| Rate for Payer: Aetna Commercial |
$744.33
|
| Rate for Payer: Aetna Medicare |
$577.69
|
| Rate for Payer: BCBS Complete |
$787.60
|
| Rate for Payer: BCBS MAPPO |
$555.47
|
| Rate for Payer: BCN Medicare Advantage |
$555.47
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$799.88
|
| Rate for Payer: Cofinity Commercial |
$744.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.24
|
| Rate for Payer: Nomi Health Commercial |
$666.56
|
| Rate for Payer: PACE SWMI |
$555.47
|
| Rate for Payer: PHP Medicare Advantage |
$555.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.85
|
| Rate for Payer: Priority Health Medicare |
$561.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.47
|
| Rate for Payer: UHC Exchange |
$555.47
|
| Rate for Payer: UHC Medicare Advantage |
$555.47
|
|
|
PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
HCPCS 51045
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$677.33 |
| Rate for Payer: Aetna Commercial |
$630.30
|
| Rate for Payer: Aetna Medicare |
$489.18
|
| Rate for Payer: BCBS Complete |
$412.80
|
| Rate for Payer: BCBS MAPPO |
$470.37
|
| Rate for Payer: BCN Medicare Advantage |
$470.37
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cofinity Commercial |
$677.33
|
| Rate for Payer: Cofinity Commercial |
$630.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.89
|
| Rate for Payer: Nomi Health Commercial |
$564.44
|
| Rate for Payer: PACE SWMI |
$470.37
|
| Rate for Payer: PHP Medicare Advantage |
$470.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.80
|
| Rate for Payer: Priority Health Medicare |
$475.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.37
|
| Rate for Payer: UHC Exchange |
$470.37
|
| Rate for Payer: UHC Medicare Advantage |
$470.37
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$567.78 |
| Rate for Payer: Aetna Commercial |
$528.35
|
| Rate for Payer: Aetna Medicare |
$410.06
|
| Rate for Payer: BCBS Complete |
$339.20
|
| Rate for Payer: BCBS MAPPO |
$394.29
|
| Rate for Payer: BCN Medicare Advantage |
$394.29
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$567.78
|
| Rate for Payer: Cofinity Commercial |
$528.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.00
|
| Rate for Payer: Nomi Health Commercial |
$473.15
|
| Rate for Payer: PACE SWMI |
$394.29
|
| Rate for Payer: PHP Medicare Advantage |
$394.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.20
|
| Rate for Payer: Priority Health Medicare |
$398.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.29
|
| Rate for Payer: UHC Exchange |
$394.29
|
| Rate for Payer: UHC Medicare Advantage |
$394.29
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$76.36 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$102.32
|
| Rate for Payer: Aetna Medicare |
$79.41
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$76.36
|
| Rate for Payer: BCN Medicare Advantage |
$76.36
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Cofinity Commercial |
$102.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.18
|
| Rate for Payer: Nomi Health Commercial |
$91.63
|
| Rate for Payer: PACE SWMI |
$76.36
|
| Rate for Payer: PHP Medicare Advantage |
$76.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$77.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.36
|
| Rate for Payer: UHC Exchange |
$76.36
|
| Rate for Payer: UHC Medicare Advantage |
$76.36
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$161.29 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna Medicare |
$167.74
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS MAPPO |
$161.29
|
| Rate for Payer: BCN Medicare Advantage |
$161.29
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$232.26
|
| Rate for Payer: Cofinity Commercial |
$216.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.35
|
| Rate for Payer: Nomi Health Commercial |
$193.55
|
| Rate for Payer: PACE SWMI |
$161.29
|
| Rate for Payer: PHP Medicare Advantage |
$161.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Medicare |
$162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.29
|
| Rate for Payer: UHC Exchange |
$161.29
|
| Rate for Payer: UHC Medicare Advantage |
$161.29
|
|
|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$460.71 |
| Rate for Payer: Aetna Commercial |
$428.72
|
| Rate for Payer: Aetna Medicare |
$332.74
|
| Rate for Payer: BCBS Complete |
$260.00
|
| Rate for Payer: BCBS MAPPO |
$319.94
|
| Rate for Payer: BCN Medicare Advantage |
$319.94
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$460.71
|
| Rate for Payer: Cofinity Commercial |
$428.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.94
|
| Rate for Payer: Nomi Health Commercial |
$383.93
|
| Rate for Payer: PACE SWMI |
$319.94
|
| Rate for Payer: PHP Medicare Advantage |
$319.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health Medicare |
$323.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.94
|
| Rate for Payer: UHC Exchange |
$319.94
|
| Rate for Payer: UHC Medicare Advantage |
$319.94
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$326.91 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$236.10
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$227.02
|
| Rate for Payer: BCN Medicare Advantage |
$227.02
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$326.91
|
| Rate for Payer: Cofinity Commercial |
$304.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.37
|
| Rate for Payer: Nomi Health Commercial |
$272.42
|
| Rate for Payer: PACE SWMI |
$227.02
|
| Rate for Payer: PHP Medicare Advantage |
$227.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$229.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.02
|
| Rate for Payer: UHC Exchange |
$227.02
|
| Rate for Payer: UHC Medicare Advantage |
$227.02
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$187.58 |
| Max. Negotiated Rate |
$415.35 |
| Rate for Payer: Aetna Commercial |
$251.36
|
| Rate for Payer: Aetna Medicare |
$195.08
|
| Rate for Payer: BCBS Complete |
$255.60
|
| Rate for Payer: BCBS MAPPO |
$187.58
|
| Rate for Payer: BCN Medicare Advantage |
$187.58
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$270.12
|
| Rate for Payer: Cofinity Commercial |
$251.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.96
|
| Rate for Payer: Nomi Health Commercial |
$225.10
|
| Rate for Payer: PACE SWMI |
$187.58
|
| Rate for Payer: PHP Medicare Advantage |
$187.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.35
|
| Rate for Payer: Priority Health Medicare |
$189.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.58
|
| Rate for Payer: UHC Exchange |
$187.58
|
| Rate for Payer: UHC Medicare Advantage |
$187.58
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$273.12 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Medicare |
$284.04
|
| Rate for Payer: BCBS Complete |
$466.80
|
| Rate for Payer: BCBS MAPPO |
$273.12
|
| Rate for Payer: BCN Medicare Advantage |
$273.12
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cofinity Commercial |
$393.29
|
| Rate for Payer: Cofinity Commercial |
$365.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.78
|
| Rate for Payer: Nomi Health Commercial |
$327.74
|
| Rate for Payer: PACE SWMI |
$273.12
|
| Rate for Payer: PHP Medicare Advantage |
$273.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.55
|
| Rate for Payer: Priority Health Medicare |
$275.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.12
|
| Rate for Payer: UHC Exchange |
$273.12
|
| Rate for Payer: UHC Medicare Advantage |
$273.12
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$370.96 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$385.80
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCN Medicare Advantage |
$370.96
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cofinity Commercial |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$445.15
|
| Rate for Payer: PACE SWMI |
$370.96
|
| Rate for Payer: PHP Medicare Advantage |
$370.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
| Rate for Payer: Priority Health Medicare |
$374.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.96
|
| Rate for Payer: UHC Exchange |
$370.96
|
| Rate for Payer: UHC Medicare Advantage |
$370.96
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$287.94 |
| Rate for Payer: Aetna Commercial |
$267.95
|
| Rate for Payer: Aetna Medicare |
$207.96
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$199.96
|
| Rate for Payer: BCN Medicare Advantage |
$199.96
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$287.94
|
| Rate for Payer: Cofinity Commercial |
$267.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.96
|
| Rate for Payer: Nomi Health Commercial |
$239.95
|
| Rate for Payer: PACE SWMI |
$199.96
|
| Rate for Payer: PHP Medicare Advantage |
$199.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$201.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.96
|
| Rate for Payer: UHC Exchange |
$199.96
|
| Rate for Payer: UHC Medicare Advantage |
$199.96
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$414.70 |
| Rate for Payer: Aetna Commercial |
$207.00
|
| Rate for Payer: Aetna Medicare |
$160.66
|
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCBS MAPPO |
$154.48
|
| Rate for Payer: BCN Medicare Advantage |
$154.48
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$222.45
|
| Rate for Payer: Cofinity Commercial |
$207.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.20
|
| Rate for Payer: Nomi Health Commercial |
$185.38
|
| Rate for Payer: PACE SWMI |
$154.48
|
| Rate for Payer: PHP Medicare Advantage |
$154.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health Medicare |
$156.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.48
|
| Rate for Payer: UHC Exchange |
$154.48
|
| Rate for Payer: UHC Medicare Advantage |
$154.48
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$250.77 |
| Max. Negotiated Rate |
$728.65 |
| Rate for Payer: Aetna Commercial |
$336.03
|
| Rate for Payer: Aetna Medicare |
$260.80
|
| Rate for Payer: BCBS Complete |
$448.40
|
| Rate for Payer: BCBS MAPPO |
$250.77
|
| Rate for Payer: BCN Medicare Advantage |
$250.77
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Cofinity Commercial |
$336.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.31
|
| Rate for Payer: Nomi Health Commercial |
$300.92
|
| Rate for Payer: PACE SWMI |
$250.77
|
| Rate for Payer: PHP Medicare Advantage |
$250.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.65
|
| Rate for Payer: Priority Health Medicare |
$253.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.77
|
| Rate for Payer: UHC Exchange |
$250.77
|
| Rate for Payer: UHC Medicare Advantage |
$250.77
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$172.95 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$179.87
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$172.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.95
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$249.05
|
| Rate for Payer: Cofinity Commercial |
$231.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.60
|
| Rate for Payer: Nomi Health Commercial |
$207.54
|
| Rate for Payer: PACE SWMI |
$172.95
|
| Rate for Payer: PHP Medicare Advantage |
$172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$174.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.95
|
| Rate for Payer: UHC Exchange |
$172.95
|
| Rate for Payer: UHC Medicare Advantage |
$172.95
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$635.05 |
| Rate for Payer: Aetna Commercial |
$316.48
|
| Rate for Payer: Aetna Medicare |
$245.63
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS MAPPO |
$236.18
|
| Rate for Payer: BCN Medicare Advantage |
$236.18
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$340.10
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.99
|
| Rate for Payer: Nomi Health Commercial |
$283.42
|
| Rate for Payer: PACE SWMI |
$236.18
|
| Rate for Payer: PHP Medicare Advantage |
$236.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health Medicare |
$238.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.18
|
| Rate for Payer: UHC Exchange |
$236.18
|
| Rate for Payer: UHC Medicare Advantage |
$236.18
|
|
