|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$681.51 |
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$681.51
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$300.97 |
| Max. Negotiated Rate |
$1,455.47 |
| Rate for Payer: Aetna Commercial |
$630.12
|
| Rate for Payer: Aetna Medicare |
$489.05
|
| Rate for Payer: BCBS Complete |
$316.02
|
| Rate for Payer: BCBS MAPPO |
$470.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.47
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: BCN Medicare Advantage |
$470.24
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cofinity Commercial |
$630.12
|
| Rate for Payer: Cofinity Commercial |
$677.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.24
|
| Rate for Payer: Mclaren Medicaid |
$300.97
|
| Rate for Payer: Meridian Medicaid |
$316.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$493.75
|
| Rate for Payer: PACE SWMI |
$470.24
|
| Rate for Payer: PHP Medicare Advantage |
$470.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.85
|
| Rate for Payer: Priority Health Medicare |
$470.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$754.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.24
|
| Rate for Payer: UHC Medicare Advantage |
$484.35
|
|
|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$215.32
|
| Rate for Payer: BCBS Complete |
$137.20
|
| Rate for Payer: BCN Commercial |
$339.45
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.10
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: Aetna Commercial |
$189.68
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCN Commercial |
$299.03
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$760.90 |
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.90
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: BCBS Complete |
$478.40
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.20
|
|
|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: BCBS Complete |
$720.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.00
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$192.77 |
| Max. Negotiated Rate |
$2,683.76 |
| Rate for Payer: Aetna Commercial |
$398.56
|
| Rate for Payer: Aetna Medicare |
$309.33
|
| Rate for Payer: BCBS Complete |
$202.41
|
| Rate for Payer: BCBS MAPPO |
$297.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.76
|
| Rate for Payer: BCN Commercial |
$546.34
|
| Rate for Payer: BCN Medicare Advantage |
$297.43
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Cofinity Commercial |
$428.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.43
|
| Rate for Payer: Mclaren Medicaid |
$192.77
|
| Rate for Payer: Meridian Medicaid |
$202.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.30
|
| Rate for Payer: PACE SWMI |
$297.43
|
| Rate for Payer: PHP Medicare Advantage |
$297.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.08
|
| Rate for Payer: Priority Health Medicare |
$297.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$483.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.43
|
| Rate for Payer: UHC Medicare Advantage |
$306.35
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$2,814.78 |
| Rate for Payer: Aetna Commercial |
$412.45
|
| Rate for Payer: Aetna Medicare |
$320.11
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$307.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,814.78
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$307.80
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$443.23
|
| Rate for Payer: Cofinity Commercial |
$412.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.80
|
| Rate for Payer: Mclaren Medicaid |
$199.16
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$323.19
|
| Rate for Payer: PACE SWMI |
$307.80
|
| Rate for Payer: PHP Medicare Advantage |
$307.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.84
|
| Rate for Payer: Priority Health Medicare |
$307.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$499.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$307.80
|
| Rate for Payer: UHC Medicare Advantage |
$317.03
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$831.34 |
| Max. Negotiated Rate |
$3,097.95 |
| Rate for Payer: Aetna Commercial |
$1,718.83
|
| Rate for Payer: Aetna Medicare |
$1,334.02
|
| Rate for Payer: BCBS Complete |
$872.91
|
| Rate for Payer: BCBS MAPPO |
$1,282.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.95
|
| Rate for Payer: BCN Commercial |
$1,888.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,282.71
|
| Rate for Payer: Cash Price |
$2,711.20
|
| Rate for Payer: Cash Price |
$2,711.20
|
| Rate for Payer: Cofinity Commercial |
$1,847.10
|
| Rate for Payer: Cofinity Commercial |
$1,718.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,282.71
|
| Rate for Payer: Mclaren Medicaid |
$831.34
|
| Rate for Payer: Meridian Medicaid |
$872.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,346.85
|
| Rate for Payer: PACE SWMI |
$1,282.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,282.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,088.48
|
| Rate for Payer: Priority Health Medicare |
$1,282.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,088.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,282.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,282.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,321.19
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$652.42 |
| Max. Negotiated Rate |
$4,734.10 |
| Rate for Payer: Aetna Commercial |
$1,355.60
|
| Rate for Payer: Aetna Medicare |
$1,052.11
|
| Rate for Payer: BCBS Complete |
$685.04
|
| Rate for Payer: BCBS MAPPO |
$1,011.64
|
| Rate for Payer: BCBS Trust/PPO |
$4,734.10
|
| Rate for Payer: BCN Commercial |
$1,489.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,011.64
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$1,355.60
|
| Rate for Payer: Cofinity Commercial |
$1,456.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,011.64
|
| Rate for Payer: Mclaren Medicaid |
$652.42
|
| Rate for Payer: Meridian Medicaid |
$685.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,062.22
|
| Rate for Payer: PACE SWMI |
$1,011.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,011.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,647.01
|
| Rate for Payer: Priority Health Medicare |
$1,011.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,011.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,011.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.99
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$770.21 |
| Max. Negotiated Rate |
$4,058.93 |
| Rate for Payer: Aetna Commercial |
$1,591.24
|
| Rate for Payer: Aetna Medicare |
$1,234.99
|
| Rate for Payer: BCBS Complete |
$808.72
|
| Rate for Payer: BCBS MAPPO |
$1,187.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,058.93
|
| Rate for Payer: BCN Commercial |
$1,749.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.49
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Commercial |
$1,709.99
|
| Rate for Payer: Cofinity Commercial |
$1,591.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.49
|
| Rate for Payer: Mclaren Medicaid |
$770.21
|
| Rate for Payer: Meridian Medicaid |
$808.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,246.86
|
| Rate for Payer: PACE SWMI |
$1,187.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,557.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.02
|
| Rate for Payer: Priority Health Medicare |
$1,187.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,935.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,223.11
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$706.73 |
| Max. Negotiated Rate |
$2,795.76 |
| Rate for Payer: Aetna Commercial |
$1,456.62
|
| Rate for Payer: Aetna Medicare |
$1,130.51
|
| Rate for Payer: BCBS Complete |
$742.07
|
| Rate for Payer: BCBS MAPPO |
$1,087.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,795.76
|
| Rate for Payer: BCN Commercial |
$1,600.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,087.03
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$1,565.32
|
| Rate for Payer: Cofinity Commercial |
$1,456.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,087.03
|
| Rate for Payer: Mclaren Medicaid |
$706.73
|
| Rate for Payer: Meridian Medicaid |
$742.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,141.38
|
| Rate for Payer: PACE SWMI |
$1,087.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,087.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$706.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,769.68
|
| Rate for Payer: Priority Health Medicare |
$1,087.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,769.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,087.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,087.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,119.64
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$680.96 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Aetna Commercial |
$1,404.61
|
| Rate for Payer: Aetna Medicare |
$1,090.15
|
| Rate for Payer: BCBS Complete |
$715.01
|
| Rate for Payer: BCBS MAPPO |
$1,048.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.25
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.22
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,404.61
|
| Rate for Payer: Cofinity Commercial |
$1,509.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.22
|
| Rate for Payer: Mclaren Medicaid |
$680.96
|
| Rate for Payer: Meridian Medicaid |
$715.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,100.63
|
| Rate for Payer: PACE SWMI |
$1,048.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.06
|
| Rate for Payer: Priority Health Medicare |
$1,048.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,708.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,048.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.67
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$713.76 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$1,472.59
|
| Rate for Payer: Aetna Medicare |
$1,142.91
|
| Rate for Payer: BCBS Complete |
$749.45
|
| Rate for Payer: BCBS MAPPO |
$1,098.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$1,618.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.95
|
| Rate for Payer: Cash Price |
$1,839.20
|
| Rate for Payer: Cash Price |
$1,839.20
|
| Rate for Payer: Cofinity Commercial |
$1,472.59
|
| Rate for Payer: Cofinity Commercial |
$1,582.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.95
|
| Rate for Payer: Mclaren Medicaid |
$713.76
|
| Rate for Payer: Meridian Medicaid |
$749.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,153.90
|
| Rate for Payer: PACE SWMI |
$1,098.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,790.20
|
| Rate for Payer: Priority Health Medicare |
$1,098.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,790.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,131.92
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$784.48 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$1,632.28
|
| Rate for Payer: Aetna Medicare |
$1,266.84
|
| Rate for Payer: BCBS Complete |
$823.70
|
| Rate for Payer: BCBS MAPPO |
$1,218.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,670.03
|
| Rate for Payer: BCN Commercial |
$1,788.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.12
|
| Rate for Payer: Cash Price |
$2,010.40
|
| Rate for Payer: Cash Price |
$2,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,754.09
|
| Rate for Payer: Cofinity Commercial |
$1,632.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.12
|
| Rate for Payer: Mclaren Medicaid |
$784.48
|
| Rate for Payer: Meridian Medicaid |
$823.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,279.03
|
| Rate for Payer: PACE SWMI |
$1,218.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.17
|
| Rate for Payer: Priority Health Medicare |
$1,218.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,977.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,218.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,254.66
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$535.91 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,102.10
|
| Rate for Payer: Aetna Medicare |
$855.36
|
| Rate for Payer: BCBS Complete |
$562.71
|
| Rate for Payer: BCBS MAPPO |
$822.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$1,214.37
|
| Rate for Payer: BCN Medicare Advantage |
$822.46
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$1,184.34
|
| Rate for Payer: Cofinity Commercial |
$1,102.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$822.46
|
| Rate for Payer: Mclaren Medicaid |
$535.91
|
| Rate for Payer: Meridian Medicaid |
$562.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$863.58
|
| Rate for Payer: PACE SWMI |
$822.46
|
| Rate for Payer: PHP Medicare Advantage |
$822.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,342.79
|
| Rate for Payer: Priority Health Medicare |
$822.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,342.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$822.46
|
| Rate for Payer: UHC Medicare Advantage |
$847.13
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$643.69 |
| Max. Negotiated Rate |
$1,619.45 |
| Rate for Payer: Aetna Commercial |
$1,335.74
|
| Rate for Payer: Aetna Medicare |
$1,036.69
|
| Rate for Payer: BCBS Complete |
$675.87
|
| Rate for Payer: BCBS MAPPO |
$996.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$996.82
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cofinity Commercial |
$1,435.42
|
| Rate for Payer: Cofinity Commercial |
$1,335.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.82
|
| Rate for Payer: Mclaren Medicaid |
$643.69
|
| Rate for Payer: Meridian Medicaid |
$675.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,046.66
|
| Rate for Payer: PACE SWMI |
$996.82
|
| Rate for Payer: PHP Medicare Advantage |
$996.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,619.45
|
| Rate for Payer: Priority Health Medicare |
$996.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,619.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.72
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,069.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$718.24 |
| Max. Negotiated Rate |
$2,592.37 |
| Rate for Payer: Aetna Commercial |
$1,491.54
|
| Rate for Payer: Aetna Medicare |
$1,157.61
|
| Rate for Payer: BCBS Complete |
$754.15
|
| Rate for Payer: BCBS MAPPO |
$1,113.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.37
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,113.09
|
| Rate for Payer: Cash Price |
$1,655.20
|
| Rate for Payer: Cash Price |
$1,655.20
|
| Rate for Payer: Cofinity Commercial |
$1,602.85
|
| Rate for Payer: Cofinity Commercial |
$1,491.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,113.09
|
| Rate for Payer: Mclaren Medicaid |
$718.24
|
| Rate for Payer: Meridian Medicaid |
$754.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,168.74
|
| Rate for Payer: PACE SWMI |
$1,113.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,113.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,810.74
|
| Rate for Payer: Priority Health Medicare |
$1,113.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,810.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,113.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,113.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,146.48
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$397.81 |
| Max. Negotiated Rate |
$1,476.80 |
| Rate for Payer: Aetna Commercial |
$1,213.80
|
| Rate for Payer: Aetna Medicare |
$942.05
|
| Rate for Payer: BCBS Complete |
$617.27
|
| Rate for Payer: BCBS MAPPO |
$905.82
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$1,335.55
|
| Rate for Payer: BCN Medicare Advantage |
$905.82
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cofinity Commercial |
$1,304.38
|
| Rate for Payer: Cofinity Commercial |
$1,213.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.82
|
| Rate for Payer: Mclaren Medicaid |
$587.88
|
| Rate for Payer: Meridian Medicaid |
$617.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$951.11
|
| Rate for Payer: PACE SWMI |
$905.82
|
| Rate for Payer: PHP Medicare Advantage |
$905.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,323.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,476.80
|
| Rate for Payer: Priority Health Medicare |
$905.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$905.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$905.82
|
| Rate for Payer: UHC Medicare Advantage |
$932.99
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$477.55 |
| Max. Negotiated Rate |
$1,201.21 |
| Rate for Payer: Aetna Commercial |
$986.00
|
| Rate for Payer: Aetna Medicare |
$765.25
|
| Rate for Payer: BCBS Complete |
$501.43
|
| Rate for Payer: BCBS MAPPO |
$735.82
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,086.33
|
| Rate for Payer: BCN Medicare Advantage |
$735.82
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cofinity Commercial |
$1,059.58
|
| Rate for Payer: Cofinity Commercial |
$986.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.82
|
| Rate for Payer: Mclaren Medicaid |
$477.55
|
| Rate for Payer: Meridian Medicaid |
$501.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$772.61
|
| Rate for Payer: PACE SWMI |
$735.82
|
| Rate for Payer: PHP Medicare Advantage |
$735.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.21
|
| Rate for Payer: Priority Health Medicare |
$735.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,201.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.82
|
| Rate for Payer: UHC Medicare Advantage |
$757.89
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$261.99 |
| Max. Negotiated Rate |
$1,193.96 |
| Rate for Payer: Aetna Commercial |
$534.73
|
| Rate for Payer: Aetna Medicare |
$415.01
|
| Rate for Payer: BCBS Complete |
$275.09
|
| Rate for Payer: BCBS MAPPO |
$399.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.96
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: BCN Medicare Advantage |
$399.05
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cofinity Commercial |
$534.73
|
| Rate for Payer: Cofinity Commercial |
$574.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.05
|
| Rate for Payer: Mclaren Medicaid |
$261.99
|
| Rate for Payer: Meridian Medicaid |
$275.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.00
|
| Rate for Payer: PACE SWMI |
$399.05
|
| Rate for Payer: PHP Medicare Advantage |
$399.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.91
|
| Rate for Payer: Priority Health Medicare |
$399.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.05
|
| Rate for Payer: UHC Medicare Advantage |
$411.02
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,544.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$293.09 |
| Max. Negotiated Rate |
$1,080.80 |
| Rate for Payer: Aetna Commercial |
$598.26
|
| Rate for Payer: Aetna Medicare |
$464.32
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS MAPPO |
$446.46
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: BCN Medicare Advantage |
$446.46
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cofinity Commercial |
$642.90
|
| Rate for Payer: Cofinity Commercial |
$598.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$446.46
|
| Rate for Payer: Mclaren Medicaid |
$293.09
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$468.78
|
| Rate for Payer: PACE SWMI |
$446.46
|
| Rate for Payer: PHP Medicare Advantage |
$446.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.64
|
| Rate for Payer: Priority Health Medicare |
$446.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$446.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$446.46
|
| Rate for Payer: UHC Medicare Advantage |
$459.85
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$621.96 |
| Max. Negotiated Rate |
$1,732.82 |
| Rate for Payer: Aetna Commercial |
$1,280.22
|
| Rate for Payer: Aetna Medicare |
$993.61
|
| Rate for Payer: BCBS Complete |
$653.06
|
| Rate for Payer: BCBS MAPPO |
$955.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.82
|
| Rate for Payer: BCN Commercial |
$1,409.35
|
| Rate for Payer: BCN Medicare Advantage |
$955.39
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cofinity Commercial |
$1,280.22
|
| Rate for Payer: Cofinity Commercial |
$1,375.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$955.39
|
| Rate for Payer: Mclaren Medicaid |
$621.96
|
| Rate for Payer: Meridian Medicaid |
$653.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,003.16
|
| Rate for Payer: PACE SWMI |
$955.39
|
| Rate for Payer: PHP Medicare Advantage |
$955.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.40
|
| Rate for Payer: Priority Health Medicare |
$955.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$955.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$955.39
|
| Rate for Payer: UHC Medicare Advantage |
$984.05
|
|
