|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$151.44 |
| Max. Negotiated Rate |
$4,966.55 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$236.10
|
| Rate for Payer: BCBS Complete |
$159.01
|
| Rate for Payer: BCBS MAPPO |
$227.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,966.55
|
| Rate for Payer: BCN Commercial |
$341.58
|
| 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: Mclaren Medicaid |
$151.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.37
|
| Rate for Payer: Meridian Medicaid |
$159.01
|
| 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 Choice Medicaid |
$151.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health HMO/PPO |
$375.49
|
| Rate for Payer: Priority Health Medicare |
$229.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.49
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$151.44
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$1,483.99 |
| Rate for Payer: Aetna Commercial |
$251.36
|
| Rate for Payer: Aetna Medicare |
$195.08
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$187.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,483.99
|
| Rate for Payer: BCN Commercial |
$513.12
|
| 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: Mclaren Medicaid |
$125.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.96
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| 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 Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.35
|
| Rate for Payer: Priority Health HMO/PPO |
$308.91
|
| Rate for Payer: Priority Health Medicare |
$189.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.91
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$125.03
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$182.12 |
| Max. Negotiated Rate |
$3,767.31 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Medicare |
$284.04
|
| Rate for Payer: BCBS Complete |
$191.23
|
| Rate for Payer: BCBS MAPPO |
$273.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,767.31
|
| Rate for Payer: BCN Commercial |
$411.47
|
| 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: Mclaren Medicaid |
$182.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.78
|
| Rate for Payer: Meridian Medicaid |
$191.23
|
| 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 Choice Medicaid |
$182.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.55
|
| Rate for Payer: Priority Health HMO/PPO |
$453.25
|
| Rate for Payer: Priority Health Medicare |
$275.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$453.25
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$4,858.78 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$385.80
|
| Rate for Payer: BCBS Complete |
$259.43
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$4,858.78
|
| Rate for Payer: BCN Commercial |
$558.56
|
| 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: Mclaren Medicaid |
$247.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.51
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| 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 Choice Medicaid |
$247.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
| Rate for Payer: Priority Health HMO/PPO |
$615.15
|
| Rate for Payer: Priority Health Medicare |
$374.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.15
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$247.08
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$1,421.13 |
| Rate for Payer: Aetna Commercial |
$267.95
|
| Rate for Payer: Aetna Medicare |
$207.96
|
| Rate for Payer: BCBS Complete |
$140.01
|
| Rate for Payer: BCBS MAPPO |
$199.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,421.13
|
| Rate for Payer: BCN Commercial |
$418.29
|
| 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: Mclaren Medicaid |
$133.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.96
|
| Rate for Payer: Meridian Medicaid |
$140.01
|
| 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 Choice Medicaid |
$133.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health HMO/PPO |
$331.28
|
| Rate for Payer: Priority Health Medicare |
$201.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.28
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$5,029.94 |
| Rate for Payer: Aetna Commercial |
$207.00
|
| Rate for Payer: Aetna Medicare |
$160.66
|
| Rate for Payer: BCBS Complete |
$108.24
|
| Rate for Payer: BCBS MAPPO |
$154.48
|
| Rate for Payer: BCBS Trust/PPO |
$5,029.94
|
| Rate for Payer: BCN Commercial |
$549.27
|
| 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: Mclaren Medicaid |
$103.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.20
|
| Rate for Payer: Meridian Medicaid |
$108.24
|
| 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 Choice Medicaid |
$103.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health HMO/PPO |
$256.18
|
| Rate for Payer: Priority Health Medicare |
$156.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.18
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$103.09
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$167.21 |
| Max. Negotiated Rate |
$2,759.84 |
| Rate for Payer: Aetna Commercial |
$336.03
|
| Rate for Payer: Aetna Medicare |
$260.80
|
| Rate for Payer: BCBS Complete |
$175.57
|
| Rate for Payer: BCBS MAPPO |
$250.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,759.84
|
| Rate for Payer: BCN Commercial |
$376.77
|
| 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: Mclaren Medicaid |
$167.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.31
|
| Rate for Payer: Meridian Medicaid |
$175.57
|
| 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 Choice Medicaid |
$167.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.65
|
| Rate for Payer: Priority Health HMO/PPO |
$414.90
|
| Rate for Payer: Priority Health Medicare |
$253.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$414.90
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$167.21
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$4,237.49 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$179.87
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS MAPPO |
$172.95
|
| Rate for Payer: BCBS Trust/PPO |
$4,237.49
|
| Rate for Payer: BCN Commercial |
$617.20
|
| 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: Mclaren Medicaid |
$115.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.60
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| 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 Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO |
$285.47
|
| Rate for Payer: Priority Health Medicare |
$174.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.47
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$5,563.53 |
| Rate for Payer: Aetna Commercial |
$316.48
|
| Rate for Payer: Aetna Medicare |
$245.63
|
| Rate for Payer: BCBS Complete |
$165.28
|
| Rate for Payer: BCBS MAPPO |
$236.18
|
| Rate for Payer: BCBS Trust/PPO |
$5,563.53
|
| Rate for Payer: BCN Commercial |
$790.68
|
| 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: Mclaren Medicaid |
$157.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.99
|
| Rate for Payer: Meridian Medicaid |
$165.28
|
| 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 Choice Medicaid |
$157.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health HMO/PPO |
$389.86
|
| Rate for Payer: Priority Health Medicare |
$238.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$389.86
|
| 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
|
| Rate for Payer: UHCCP Medicaid |
$157.41
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,981.65 |
| Rate for Payer: Aetna Commercial |
$179.64
|
| Rate for Payer: Aetna Medicare |
$139.42
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS MAPPO |
$134.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,981.65
|
| Rate for Payer: BCN Commercial |
$554.65
|
| Rate for Payer: BCN Medicare Advantage |
$134.06
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Cofinity Commercial |
$179.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.06
|
| Rate for Payer: Mclaren Medicaid |
$89.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.76
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Nomi Health Commercial |
$160.87
|
| Rate for Payer: PACE SWMI |
$134.06
|
| Rate for Payer: PHP Medicare Advantage |
$134.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.20
|
| Rate for Payer: Priority Health HMO/PPO |
$223.15
|
| Rate for Payer: Priority Health Medicare |
$135.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.06
|
| Rate for Payer: UHC Exchange |
$134.06
|
| Rate for Payer: UHC Medicare Advantage |
$134.06
|
| Rate for Payer: UHCCP Medicaid |
$89.67
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$926.90 |
| Rate for Payer: Aetna Commercial |
$313.72
|
| Rate for Payer: Aetna Medicare |
$243.48
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS MAPPO |
$234.12
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$234.12
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cofinity Commercial |
$337.13
|
| Rate for Payer: Cofinity Commercial |
$313.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.12
|
| Rate for Payer: Mclaren Medicaid |
$155.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.83
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Nomi Health Commercial |
$280.94
|
| Rate for Payer: PACE SWMI |
$234.12
|
| Rate for Payer: PHP Medicare Advantage |
$234.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$926.90
|
| Rate for Payer: Priority Health HMO/PPO |
$386.13
|
| Rate for Payer: Priority Health Medicare |
$236.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.12
|
| Rate for Payer: UHC Exchange |
$234.12
|
| Rate for Payer: UHC Medicare Advantage |
$234.12
|
| Rate for Payer: UHCCP Medicaid |
$155.92
|
|
|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$606.49 |
| Rate for Payer: Aetna Commercial |
$257.55
|
| Rate for Payer: Aetna Medicare |
$199.89
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$192.20
|
| Rate for Payer: BCBS Trust/PPO |
$606.49
|
| Rate for Payer: BCN Commercial |
$517.51
|
| Rate for Payer: BCN Medicare Advantage |
$192.20
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$276.77
|
| Rate for Payer: Cofinity Commercial |
$257.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.20
|
| Rate for Payer: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.81
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$230.64
|
| Rate for Payer: PACE SWMI |
$192.20
|
| Rate for Payer: PHP Medicare Advantage |
$192.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO |
$316.90
|
| Rate for Payer: Priority Health Medicare |
$194.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.20
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicare Advantage |
$192.20
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$2,077.80 |
| Rate for Payer: Aetna Commercial |
$169.59
|
| Rate for Payer: Aetna Medicare |
$131.62
|
| Rate for Payer: BCBS Complete |
$89.01
|
| Rate for Payer: BCBS MAPPO |
$126.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.80
|
| Rate for Payer: BCN Commercial |
$489.65
|
| Rate for Payer: BCN Medicare Advantage |
$126.56
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cofinity Commercial |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$169.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.56
|
| Rate for Payer: Mclaren Medicaid |
$84.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.89
|
| Rate for Payer: Meridian Medicaid |
$89.01
|
| Rate for Payer: Nomi Health Commercial |
$151.87
|
| Rate for Payer: PACE SWMI |
$126.56
|
| Rate for Payer: PHP Medicare Advantage |
$126.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health HMO/PPO |
$210.38
|
| Rate for Payer: Priority Health Medicare |
$127.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.56
|
| Rate for Payer: UHC Exchange |
$126.56
|
| Rate for Payer: UHC Medicare Advantage |
$126.56
|
| Rate for Payer: UHCCP Medicaid |
$84.77
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$154.21 |
| Max. Negotiated Rate |
$1,479.24 |
| Rate for Payer: Aetna Commercial |
$309.79
|
| Rate for Payer: Aetna Medicare |
$240.44
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS MAPPO |
$231.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.24
|
| Rate for Payer: BCN Commercial |
$347.94
|
| Rate for Payer: BCN Medicare Advantage |
$231.19
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$332.91
|
| Rate for Payer: Cofinity Commercial |
$309.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.19
|
| Rate for Payer: Mclaren Medicaid |
$154.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.75
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Nomi Health Commercial |
$277.43
|
| Rate for Payer: PACE SWMI |
$231.19
|
| Rate for Payer: PHP Medicare Advantage |
$231.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health HMO/PPO |
$382.40
|
| Rate for Payer: Priority Health Medicare |
$233.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$382.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.19
|
| Rate for Payer: UHC Exchange |
$231.19
|
| Rate for Payer: UHC Medicare Advantage |
$231.19
|
| Rate for Payer: UHCCP Medicaid |
$154.21
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$1,188.68 |
| Rate for Payer: Aetna Commercial |
$348.64
|
| Rate for Payer: Aetna Medicare |
$270.59
|
| Rate for Payer: BCBS Complete |
$182.05
|
| Rate for Payer: BCBS MAPPO |
$260.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.68
|
| Rate for Payer: BCN Commercial |
$686.59
|
| Rate for Payer: BCN Medicare Advantage |
$260.18
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$374.66
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.18
|
| Rate for Payer: Mclaren Medicaid |
$173.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.19
|
| Rate for Payer: Meridian Medicaid |
$182.05
|
| Rate for Payer: Nomi Health Commercial |
$312.22
|
| Rate for Payer: PACE SWMI |
$260.18
|
| Rate for Payer: PHP Medicare Advantage |
$260.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health HMO/PPO |
$430.88
|
| Rate for Payer: Priority Health Medicare |
$262.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$430.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.18
|
| Rate for Payer: UHC Exchange |
$260.18
|
| Rate for Payer: UHC Medicare Advantage |
$260.18
|
| Rate for Payer: UHCCP Medicaid |
$173.38
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$2,177.12 |
| Rate for Payer: Aetna Commercial |
$223.71
|
| Rate for Payer: Aetna Medicare |
$173.63
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS MAPPO |
$166.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,177.12
|
| Rate for Payer: BCN Commercial |
$1,100.50
|
| Rate for Payer: BCN Medicare Advantage |
$166.95
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cofinity Commercial |
$223.71
|
| Rate for Payer: Cofinity Commercial |
$240.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.95
|
| Rate for Payer: Mclaren Medicaid |
$110.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.30
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: PACE SWMI |
$166.95
|
| Rate for Payer: PHP Medicare Advantage |
$166.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.25
|
| Rate for Payer: Priority Health HMO/PPO |
$274.29
|
| Rate for Payer: Priority Health Medicare |
$168.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.95
|
| Rate for Payer: UHC Exchange |
$166.95
|
| Rate for Payer: UHC Medicare Advantage |
$166.95
|
| Rate for Payer: UHCCP Medicaid |
$110.76
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,050.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna Commercial |
$210.27
|
| Rate for Payer: Aetna Medicare |
$163.20
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS MAPPO |
$156.92
|
| Rate for Payer: BCN Medicare Advantage |
$156.92
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cofinity Commercial |
$210.27
|
| Rate for Payer: Cofinity Commercial |
$225.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.92
|
| Rate for Payer: Mclaren Medicaid |
$104.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.77
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Nomi Health Commercial |
$188.30
|
| Rate for Payer: PACE SWMI |
$156.92
|
| Rate for Payer: PHP Medicare Advantage |
$156.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,632.50
|
| Rate for Payer: Priority Health HMO/PPO |
$258.85
|
| Rate for Payer: Priority Health Medicare |
$158.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.92
|
| Rate for Payer: UHC Exchange |
$156.92
|
| Rate for Payer: UHC Medicare Advantage |
$156.92
|
| Rate for Payer: UHCCP Medicaid |
$104.58
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$2,268.52 |
| Rate for Payer: Aetna Commercial |
$198.07
|
| Rate for Payer: Aetna Medicare |
$153.72
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS MAPPO |
$147.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,268.52
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: BCN Medicare Advantage |
$147.81
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$212.85
|
| Rate for Payer: Cofinity Commercial |
$198.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.81
|
| Rate for Payer: Mclaren Medicaid |
$98.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.20
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Nomi Health Commercial |
$177.37
|
| Rate for Payer: PACE SWMI |
$147.81
|
| Rate for Payer: PHP Medicare Advantage |
$147.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO |
$244.99
|
| Rate for Payer: Priority Health Medicare |
$149.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.81
|
| Rate for Payer: UHC Exchange |
$147.81
|
| Rate for Payer: UHC Medicare Advantage |
$147.81
|
| Rate for Payer: UHCCP Medicaid |
$98.83
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$1,930.41 |
| Rate for Payer: Aetna Commercial |
$364.40
|
| Rate for Payer: Aetna Medicare |
$282.82
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS MAPPO |
$271.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.41
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$271.94
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$391.59
|
| Rate for Payer: Cofinity Commercial |
$364.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.94
|
| Rate for Payer: Mclaren Medicaid |
$181.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.54
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Nomi Health Commercial |
$326.33
|
| Rate for Payer: PACE SWMI |
$271.94
|
| Rate for Payer: PHP Medicare Advantage |
$271.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health HMO/PPO |
$451.12
|
| Rate for Payer: Priority Health Medicare |
$274.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.94
|
| Rate for Payer: UHC Exchange |
$271.94
|
| Rate for Payer: UHC Medicare Advantage |
$271.94
|
| Rate for Payer: UHCCP Medicaid |
$181.26
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$2,846.48 |
| Rate for Payer: Aetna Commercial |
$258.62
|
| Rate for Payer: Aetna Medicare |
$200.72
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS MAPPO |
$193.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.48
|
| Rate for Payer: BCN Commercial |
$1,149.37
|
| Rate for Payer: BCN Medicare Advantage |
$193.00
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cofinity Commercial |
$277.92
|
| Rate for Payer: Cofinity Commercial |
$258.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.00
|
| Rate for Payer: Mclaren Medicaid |
$128.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.65
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Nomi Health Commercial |
$231.60
|
| Rate for Payer: PACE SWMI |
$193.00
|
| Rate for Payer: PHP Medicare Advantage |
$193.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.90
|
| Rate for Payer: Priority Health HMO/PPO |
$317.42
|
| Rate for Payer: Priority Health Medicare |
$194.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.00
|
| Rate for Payer: UHC Exchange |
$193.00
|
| Rate for Payer: UHC Medicare Advantage |
$193.00
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$155.49 |
| Max. Negotiated Rate |
$5,244.96 |
| Rate for Payer: Aetna Commercial |
$312.43
|
| Rate for Payer: Aetna Medicare |
$242.49
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS MAPPO |
$233.16
|
| Rate for Payer: BCBS Trust/PPO |
$5,244.96
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$233.16
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$335.75
|
| Rate for Payer: Cofinity Commercial |
$312.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.16
|
| Rate for Payer: Mclaren Medicaid |
$155.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.82
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Nomi Health Commercial |
$279.79
|
| Rate for Payer: PACE SWMI |
$233.16
|
| Rate for Payer: PHP Medicare Advantage |
$233.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health HMO/PPO |
$386.13
|
| Rate for Payer: Priority Health Medicare |
$235.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.16
|
| Rate for Payer: UHC Exchange |
$233.16
|
| Rate for Payer: UHC Medicare Advantage |
$233.16
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$176.79 |
| Max. Negotiated Rate |
$1,512.52 |
| Rate for Payer: Aetna Commercial |
$355.34
|
| Rate for Payer: Aetna Medicare |
$275.79
|
| Rate for Payer: BCBS Complete |
$185.63
|
| Rate for Payer: BCBS MAPPO |
$265.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.52
|
| Rate for Payer: BCN Commercial |
$400.23
|
| Rate for Payer: BCN Medicare Advantage |
$265.18
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$381.86
|
| Rate for Payer: Cofinity Commercial |
$355.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.18
|
| Rate for Payer: Mclaren Medicaid |
$176.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.44
|
| Rate for Payer: Meridian Medicaid |
$185.63
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PACE SWMI |
$265.18
|
| Rate for Payer: PHP Medicare Advantage |
$265.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health HMO/PPO |
$439.39
|
| Rate for Payer: Priority Health Medicare |
$267.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.18
|
| Rate for Payer: UHC Exchange |
$265.18
|
| Rate for Payer: UHC Medicare Advantage |
$265.18
|
| Rate for Payer: UHCCP Medicaid |
$176.79
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$368.30
|
| Rate for Payer: Aetna Medicare |
$285.84
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS MAPPO |
$274.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$274.85
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Cofinity Commercial |
$368.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.85
|
| Rate for Payer: Mclaren Medicaid |
$183.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.59
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Nomi Health Commercial |
$329.82
|
| Rate for Payer: PACE SWMI |
$274.85
|
| Rate for Payer: PHP Medicare Advantage |
$274.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO |
$455.38
|
| Rate for Payer: Priority Health Medicare |
$277.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.85
|
| Rate for Payer: UHC Exchange |
$274.85
|
| Rate for Payer: UHC Medicare Advantage |
$274.85
|
| Rate for Payer: UHCCP Medicaid |
$183.18
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$193.30
|
| Rate for Payer: Aetna Medicare |
$150.02
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS MAPPO |
$144.25
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$466.69
|
| Rate for Payer: BCN Medicare Advantage |
$144.25
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Cofinity Commercial |
$193.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.25
|
| Rate for Payer: Mclaren Medicaid |
$96.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.46
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Nomi Health Commercial |
$173.10
|
| Rate for Payer: PACE SWMI |
$144.25
|
| Rate for Payer: PHP Medicare Advantage |
$144.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.50
|
| Rate for Payer: Priority Health HMO/PPO |
$238.61
|
| Rate for Payer: Priority Health Medicare |
$145.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.25
|
| Rate for Payer: UHC Exchange |
$144.25
|
| Rate for Payer: UHC Medicare Advantage |
$144.25
|
| Rate for Payer: UHCCP Medicaid |
$96.28
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$2,129.58 |
| Rate for Payer: Aetna Commercial |
$330.00
|
| Rate for Payer: Aetna Medicare |
$256.12
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS MAPPO |
$246.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,129.58
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: BCN Medicare Advantage |
$246.27
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cofinity Commercial |
$354.63
|
| Rate for Payer: Cofinity Commercial |
$330.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.27
|
| Rate for Payer: Mclaren Medicaid |
$163.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.58
|
| Rate for Payer: Meridian Medicaid |
$171.54
|
| Rate for Payer: Nomi Health Commercial |
$295.52
|
| Rate for Payer: PACE SWMI |
$246.27
|
| Rate for Payer: PHP Medicare Advantage |
$246.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.45
|
| Rate for Payer: Priority Health HMO/PPO |
$405.84
|
| Rate for Payer: Priority Health Medicare |
$248.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$405.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.27
|
| Rate for Payer: UHC Exchange |
$246.27
|
| Rate for Payer: UHC Medicare Advantage |
$246.27
|
| Rate for Payer: UHCCP Medicaid |
$163.37
|
|
