|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCN Commercial |
$339.45
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCN Commercial |
$299.03
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$720.85 |
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: BCBS Complete |
$488.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.00
|
|
|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$2,683.76 |
| Rate for Payer: Aetna Commercial |
$389.89
|
| Rate for Payer: Aetna Medicare |
$302.60
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS MAPPO |
$290.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.76
|
| Rate for Payer: BCN Commercial |
$546.34
|
| Rate for Payer: BCN Medicare Advantage |
$290.96
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$418.98
|
| Rate for Payer: Cofinity Commercial |
$389.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.96
|
| Rate for Payer: Mclaren Medicaid |
$193.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.51
|
| Rate for Payer: Meridian Medicaid |
$203.52
|
| Rate for Payer: Nomi Health Commercial |
$349.15
|
| Rate for Payer: PACE SWMI |
$290.96
|
| Rate for Payer: PHP Medicare Advantage |
$290.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health HMO/PPO |
$482.00
|
| Rate for Payer: Priority Health Medicare |
$293.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.96
|
| Rate for Payer: UHC Exchange |
$290.96
|
| Rate for Payer: UHC Medicare Advantage |
$290.96
|
| Rate for Payer: UHCCP Medicaid |
$193.83
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$2,814.78 |
| Rate for Payer: Aetna Commercial |
$400.57
|
| Rate for Payer: Aetna Medicare |
$310.89
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$298.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,814.78
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$298.93
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$400.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.93
|
| Rate for Payer: Mclaren Medicaid |
$199.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.88
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Nomi Health Commercial |
$358.72
|
| Rate for Payer: PACE SWMI |
$298.93
|
| Rate for Payer: PHP Medicare Advantage |
$298.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health HMO/PPO |
$497.98
|
| Rate for Payer: Priority Health Medicare |
$301.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.93
|
| Rate for Payer: UHC Exchange |
$298.93
|
| Rate for Payer: UHC Medicare Advantage |
$298.93
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$836.88 |
| Max. Negotiated Rate |
$3,097.95 |
| Rate for Payer: Aetna Commercial |
$1,679.38
|
| Rate for Payer: Aetna Medicare |
$1,303.40
|
| Rate for Payer: BCBS Complete |
$878.72
|
| Rate for Payer: BCBS MAPPO |
$1,253.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.95
|
| Rate for Payer: BCN Commercial |
$1,888.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,253.27
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,804.71
|
| Rate for Payer: Cofinity Commercial |
$1,679.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,253.27
|
| Rate for Payer: Mclaren Medicaid |
$836.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.93
|
| Rate for Payer: Meridian Medicaid |
$878.72
|
| Rate for Payer: Nomi Health Commercial |
$1,503.92
|
| Rate for Payer: PACE SWMI |
$1,253.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,253.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2,078.74
|
| Rate for Payer: Priority Health Medicare |
$1,265.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,078.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.27
|
| Rate for Payer: UHC Exchange |
$1,253.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.27
|
| Rate for Payer: UHCCP Medicaid |
$836.88
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$652.63 |
| Max. Negotiated Rate |
$4,734.10 |
| Rate for Payer: Aetna Commercial |
$1,313.19
|
| Rate for Payer: Aetna Medicare |
$1,019.19
|
| Rate for Payer: BCBS Complete |
$685.26
|
| Rate for Payer: BCBS MAPPO |
$979.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,734.10
|
| Rate for Payer: BCN Commercial |
$1,489.49
|
| Rate for Payer: BCN Medicare Advantage |
$979.99
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,411.19
|
| Rate for Payer: Cofinity Commercial |
$1,313.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.99
|
| Rate for Payer: Mclaren Medicaid |
$652.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.99
|
| Rate for Payer: Meridian Medicaid |
$685.26
|
| Rate for Payer: Nomi Health Commercial |
$1,175.99
|
| Rate for Payer: PACE SWMI |
$979.99
|
| Rate for Payer: PHP Medicare Advantage |
$979.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,631.36
|
| Rate for Payer: Priority Health Medicare |
$989.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,631.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.99
|
| Rate for Payer: UHC Exchange |
$979.99
|
| Rate for Payer: UHC Medicare Advantage |
$979.99
|
| Rate for Payer: UHCCP Medicaid |
$652.63
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$774.89 |
| Max. Negotiated Rate |
$4,058.93 |
| Rate for Payer: Aetna Commercial |
$1,558.85
|
| Rate for Payer: Aetna Medicare |
$1,209.85
|
| Rate for Payer: BCBS Complete |
$813.63
|
| Rate for Payer: BCBS MAPPO |
$1,163.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,058.93
|
| Rate for Payer: BCN Commercial |
$1,749.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,163.32
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cofinity Commercial |
$1,675.18
|
| Rate for Payer: Cofinity Commercial |
$1,558.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,163.32
|
| Rate for Payer: Mclaren Medicaid |
$774.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.49
|
| Rate for Payer: Meridian Medicaid |
$813.63
|
| Rate for Payer: Nomi Health Commercial |
$1,395.98
|
| Rate for Payer: PACE SWMI |
$1,163.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,925.89
|
| Rate for Payer: Priority Health Medicare |
$1,174.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,925.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,163.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,163.32
|
| Rate for Payer: UHC Exchange |
$1,163.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.32
|
| Rate for Payer: UHCCP Medicaid |
$774.89
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$711.21 |
| Max. Negotiated Rate |
$2,795.76 |
| Rate for Payer: Aetna Commercial |
$1,428.69
|
| Rate for Payer: Aetna Medicare |
$1,108.84
|
| Rate for Payer: BCBS Complete |
$746.77
|
| Rate for Payer: BCBS MAPPO |
$1,066.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,795.76
|
| Rate for Payer: BCN Commercial |
$1,600.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,066.19
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$1,535.31
|
| Rate for Payer: Cofinity Commercial |
$1,428.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,066.19
|
| Rate for Payer: Mclaren Medicaid |
$711.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,119.50
|
| Rate for Payer: Meridian Medicaid |
$746.77
|
| Rate for Payer: Nomi Health Commercial |
$1,279.43
|
| Rate for Payer: PACE SWMI |
$1,066.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,066.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.17
|
| Rate for Payer: Priority Health Medicare |
$1,076.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,767.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,066.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,066.19
|
| Rate for Payer: UHC Exchange |
$1,066.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,066.19
|
| Rate for Payer: UHCCP Medicaid |
$711.21
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$685.43 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Aetna Medicare |
$1,066.04
|
| Rate for Payer: BCBS Complete |
$719.70
|
| Rate for Payer: BCBS MAPPO |
$1,025.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.25
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.04
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.06
|
| Rate for Payer: Cofinity Commercial |
$1,373.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.04
|
| Rate for Payer: Mclaren Medicaid |
$685.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,076.29
|
| Rate for Payer: Meridian Medicaid |
$719.70
|
| Rate for Payer: Nomi Health Commercial |
$1,230.05
|
| Rate for Payer: PACE SWMI |
$1,025.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,702.72
|
| Rate for Payer: Priority Health Medicare |
$1,035.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,702.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.04
|
| Rate for Payer: UHC Exchange |
$1,025.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.04
|
| Rate for Payer: UHCCP Medicaid |
$685.43
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$717.81 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$1,438.72
|
| Rate for Payer: Aetna Medicare |
$1,116.62
|
| Rate for Payer: BCBS Complete |
$753.70
|
| Rate for Payer: BCBS MAPPO |
$1,073.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$1,618.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,073.67
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cofinity Commercial |
$1,546.08
|
| Rate for Payer: Cofinity Commercial |
$1,438.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,073.67
|
| Rate for Payer: Mclaren Medicaid |
$717.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.35
|
| Rate for Payer: Meridian Medicaid |
$753.70
|
| Rate for Payer: Nomi Health Commercial |
$1,288.40
|
| Rate for Payer: PACE SWMI |
$1,073.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,073.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$717.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,784.74
|
| Rate for Payer: Priority Health Medicare |
$1,084.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,784.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,073.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,073.67
|
| Rate for Payer: UHC Exchange |
$1,073.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.67
|
| Rate for Payer: UHCCP Medicaid |
$717.81
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$788.74 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$1,597.64
|
| Rate for Payer: Aetna Medicare |
$1,239.96
|
| Rate for Payer: BCBS Complete |
$828.18
|
| Rate for Payer: BCBS MAPPO |
$1,192.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,670.03
|
| Rate for Payer: BCN Commercial |
$1,788.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.27
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,716.87
|
| Rate for Payer: Cofinity Commercial |
$1,597.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.27
|
| Rate for Payer: Mclaren Medicaid |
$788.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.88
|
| Rate for Payer: Meridian Medicaid |
$828.18
|
| Rate for Payer: Nomi Health Commercial |
$1,430.72
|
| Rate for Payer: PACE SWMI |
$1,192.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,961.57
|
| Rate for Payer: Priority Health Medicare |
$1,204.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,961.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,192.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.27
|
| Rate for Payer: UHC Exchange |
$1,192.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.27
|
| Rate for Payer: UHCCP Medicaid |
$788.74
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$539.32 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,078.26
|
| Rate for Payer: Aetna Medicare |
$836.86
|
| Rate for Payer: BCBS Complete |
$566.29
|
| Rate for Payer: BCBS MAPPO |
$804.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$1,214.37
|
| Rate for Payer: BCN Medicare Advantage |
$804.67
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cofinity Commercial |
$1,158.72
|
| Rate for Payer: Cofinity Commercial |
$1,078.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.67
|
| Rate for Payer: Mclaren Medicaid |
$539.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$844.90
|
| Rate for Payer: Meridian Medicaid |
$566.29
|
| Rate for Payer: Nomi Health Commercial |
$965.60
|
| Rate for Payer: PACE SWMI |
$804.67
|
| Rate for Payer: PHP Medicare Advantage |
$804.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,340.02
|
| Rate for Payer: Priority Health Medicare |
$812.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,340.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.67
|
| Rate for Payer: UHC Exchange |
$804.67
|
| Rate for Payer: UHC Medicare Advantage |
$804.67
|
| Rate for Payer: UHCCP Medicaid |
$539.32
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$646.03 |
| Max. Negotiated Rate |
$1,609.52 |
| Rate for Payer: Aetna Commercial |
$1,305.32
|
| Rate for Payer: Aetna Medicare |
$1,013.08
|
| Rate for Payer: BCBS Complete |
$678.33
|
| Rate for Payer: BCBS MAPPO |
$974.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$974.12
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,402.73
|
| Rate for Payer: Cofinity Commercial |
$1,305.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.12
|
| Rate for Payer: Mclaren Medicaid |
$646.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.83
|
| Rate for Payer: Meridian Medicaid |
$678.33
|
| Rate for Payer: Nomi Health Commercial |
$1,168.94
|
| Rate for Payer: PACE SWMI |
$974.12
|
| Rate for Payer: PHP Medicare Advantage |
$974.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$646.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,609.52
|
| Rate for Payer: Priority Health Medicare |
$983.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,609.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.12
|
| Rate for Payer: UHC Exchange |
$974.12
|
| Rate for Payer: UHC Medicare Advantage |
$974.12
|
| Rate for Payer: UHCCP Medicaid |
$646.03
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$720.79 |
| Max. Negotiated Rate |
$2,592.37 |
| Rate for Payer: Aetna Commercial |
$1,448.86
|
| Rate for Payer: Aetna Medicare |
$1,124.49
|
| Rate for Payer: BCBS Complete |
$756.83
|
| Rate for Payer: BCBS MAPPO |
$1,081.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.37
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,081.24
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,556.99
|
| Rate for Payer: Cofinity Commercial |
$1,448.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,081.24
|
| Rate for Payer: Mclaren Medicaid |
$720.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.30
|
| Rate for Payer: Meridian Medicaid |
$756.83
|
| Rate for Payer: Nomi Health Commercial |
$1,297.49
|
| Rate for Payer: PACE SWMI |
$1,081.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,081.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,795.92
|
| Rate for Payer: Priority Health Medicare |
$1,092.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,795.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,081.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,081.24
|
| Rate for Payer: UHC Exchange |
$1,081.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.24
|
| Rate for Payer: UHCCP Medicaid |
$720.79
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$397.81 |
| Max. Negotiated Rate |
$1,469.98 |
| Rate for Payer: Aetna Commercial |
$1,186.92
|
| Rate for Payer: Aetna Medicare |
$921.19
|
| Rate for Payer: BCBS Complete |
$622.20
|
| Rate for Payer: BCBS MAPPO |
$885.76
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$1,335.55
|
| Rate for Payer: BCN Medicare Advantage |
$885.76
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,275.49
|
| Rate for Payer: Cofinity Commercial |
$1,186.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.76
|
| Rate for Payer: Mclaren Medicaid |
$592.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.05
|
| Rate for Payer: Meridian Medicaid |
$622.20
|
| Rate for Payer: Nomi Health Commercial |
$1,062.91
|
| Rate for Payer: PACE SWMI |
$885.76
|
| Rate for Payer: PHP Medicare Advantage |
$885.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,469.98
|
| Rate for Payer: Priority Health Medicare |
$894.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,469.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.76
|
| Rate for Payer: UHC Exchange |
$885.76
|
| Rate for Payer: UHC Medicare Advantage |
$885.76
|
| Rate for Payer: UHCCP Medicaid |
$592.57
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$479.25 |
| Max. Negotiated Rate |
$1,194.10 |
| Rate for Payer: Aetna Commercial |
$960.06
|
| Rate for Payer: Aetna Medicare |
$745.12
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS MAPPO |
$716.46
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,086.33
|
| Rate for Payer: BCN Medicare Advantage |
$716.46
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$960.06
|
| Rate for Payer: Cofinity Commercial |
$1,031.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.46
|
| Rate for Payer: Mclaren Medicaid |
$479.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.28
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| Rate for Payer: Nomi Health Commercial |
$859.75
|
| Rate for Payer: PACE SWMI |
$716.46
|
| Rate for Payer: PHP Medicare Advantage |
$716.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,194.10
|
| Rate for Payer: Priority Health Medicare |
$723.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,194.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.46
|
| Rate for Payer: UHC Exchange |
$716.46
|
| Rate for Payer: UHC Medicare Advantage |
$716.46
|
| Rate for Payer: UHCCP Medicaid |
$479.25
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$264.33 |
| Max. Negotiated Rate |
$1,193.96 |
| Rate for Payer: Aetna Commercial |
$525.45
|
| Rate for Payer: Aetna Medicare |
$407.82
|
| Rate for Payer: BCBS Complete |
$277.55
|
| Rate for Payer: BCBS MAPPO |
$392.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.96
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: BCN Medicare Advantage |
$392.13
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$564.67
|
| Rate for Payer: Cofinity Commercial |
$525.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.13
|
| Rate for Payer: Mclaren Medicaid |
$264.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.74
|
| Rate for Payer: Meridian Medicaid |
$277.55
|
| Rate for Payer: Nomi Health Commercial |
$470.56
|
| Rate for Payer: PACE SWMI |
$392.13
|
| Rate for Payer: PHP Medicare Advantage |
$392.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.10
|
| Rate for Payer: Priority Health HMO/PPO |
$655.10
|
| Rate for Payer: Priority Health Medicare |
$396.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$655.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.13
|
| Rate for Payer: UHC Exchange |
$392.13
|
| Rate for Payer: UHC Medicare Advantage |
$392.13
|
| Rate for Payer: UHCCP Medicaid |
$264.33
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$294.58 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$586.45
|
| Rate for Payer: Aetna Medicare |
$455.16
|
| Rate for Payer: BCBS Complete |
$309.31
|
| Rate for Payer: BCBS MAPPO |
$437.65
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: BCN Medicare Advantage |
$437.65
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cofinity Commercial |
$630.22
|
| Rate for Payer: Cofinity Commercial |
$586.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.65
|
| Rate for Payer: Mclaren Medicaid |
$294.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.53
|
| Rate for Payer: Meridian Medicaid |
$309.31
|
| Rate for Payer: Nomi Health Commercial |
$525.18
|
| Rate for Payer: PACE SWMI |
$437.65
|
| Rate for Payer: PHP Medicare Advantage |
$437.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health HMO/PPO |
$732.86
|
| Rate for Payer: Priority Health Medicare |
$442.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$732.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.65
|
| Rate for Payer: UHC Exchange |
$437.65
|
| Rate for Payer: UHC Medicare Advantage |
$437.65
|
| Rate for Payer: UHCCP Medicaid |
$294.58
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$625.16 |
| Max. Negotiated Rate |
$1,732.82 |
| Rate for Payer: Aetna Commercial |
$1,251.44
|
| Rate for Payer: Aetna Medicare |
$971.27
|
| Rate for Payer: BCBS Complete |
$656.42
|
| Rate for Payer: BCBS MAPPO |
$933.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.82
|
| Rate for Payer: BCN Commercial |
$1,409.35
|
| Rate for Payer: BCN Medicare Advantage |
$933.91
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,344.83
|
| Rate for Payer: Cofinity Commercial |
$1,251.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.91
|
| Rate for Payer: Mclaren Medicaid |
$625.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.61
|
| Rate for Payer: Meridian Medicaid |
$656.42
|
| Rate for Payer: Nomi Health Commercial |
$1,120.69
|
| Rate for Payer: PACE SWMI |
$933.91
|
| Rate for Payer: PHP Medicare Advantage |
$933.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,555.20
|
| Rate for Payer: Priority Health Medicare |
$943.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,555.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$933.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.91
|
| Rate for Payer: UHC Exchange |
$933.91
|
| Rate for Payer: UHC Medicare Advantage |
$933.91
|
| Rate for Payer: UHCCP Medicaid |
$625.16
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$513.54 |
| Max. Negotiated Rate |
$2,001.20 |
| Rate for Payer: Aetna Commercial |
$1,026.40
|
| Rate for Payer: Aetna Medicare |
$796.61
|
| Rate for Payer: BCBS Complete |
$539.22
|
| Rate for Payer: BCBS MAPPO |
$765.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,001.20
|
| Rate for Payer: BCN Commercial |
$1,154.25
|
| Rate for Payer: BCN Medicare Advantage |
$765.97
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,103.00
|
| Rate for Payer: Cofinity Commercial |
$1,026.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.97
|
| Rate for Payer: Mclaren Medicaid |
$513.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.27
|
| Rate for Payer: Meridian Medicaid |
$539.22
|
| Rate for Payer: Nomi Health Commercial |
$919.16
|
| Rate for Payer: PACE SWMI |
$765.97
|
| Rate for Payer: PHP Medicare Advantage |
$765.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,272.91
|
| Rate for Payer: Priority Health Medicare |
$773.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,272.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.97
|
| Rate for Payer: UHC Exchange |
$765.97
|
| Rate for Payer: UHC Medicare Advantage |
$765.97
|
| Rate for Payer: UHCCP Medicaid |
$513.54
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$558.70 |
| Max. Negotiated Rate |
$2,435.99 |
| Rate for Payer: Aetna Commercial |
$1,117.72
|
| Rate for Payer: Aetna Medicare |
$867.48
|
| Rate for Payer: BCBS Complete |
$586.64
|
| Rate for Payer: BCBS MAPPO |
$834.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.99
|
| Rate for Payer: BCN Commercial |
$1,258.34
|
| Rate for Payer: BCN Medicare Advantage |
$834.12
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,201.13
|
| Rate for Payer: Cofinity Commercial |
$1,117.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.12
|
| Rate for Payer: Mclaren Medicaid |
$558.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.83
|
| Rate for Payer: Meridian Medicaid |
$586.64
|
| Rate for Payer: Nomi Health Commercial |
$1,000.94
|
| Rate for Payer: PACE SWMI |
$834.12
|
| Rate for Payer: PHP Medicare Advantage |
$834.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,387.42
|
| Rate for Payer: Priority Health Medicare |
$842.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,387.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.12
|
| Rate for Payer: UHC Exchange |
$834.12
|
| Rate for Payer: UHC Medicare Advantage |
$834.12
|
| Rate for Payer: UHCCP Medicaid |
$558.70
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$622.17 |
| Max. Negotiated Rate |
$2,049.80 |
| Rate for Payer: Aetna Commercial |
$1,247.55
|
| Rate for Payer: Aetna Medicare |
$968.25
|
| Rate for Payer: BCBS Complete |
$653.28
|
| Rate for Payer: BCBS MAPPO |
$931.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.80
|
| Rate for Payer: BCN Commercial |
$1,406.42
|
| Rate for Payer: BCN Medicare Advantage |
$931.01
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cofinity Commercial |
$1,340.65
|
| Rate for Payer: Cofinity Commercial |
$1,247.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.01
|
| Rate for Payer: Mclaren Medicaid |
$622.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.56
|
| Rate for Payer: Meridian Medicaid |
$653.28
|
| Rate for Payer: Nomi Health Commercial |
$1,117.21
|
| Rate for Payer: PACE SWMI |
$931.01
|
| Rate for Payer: PHP Medicare Advantage |
$931.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$622.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,548.80
|
| Rate for Payer: Priority Health Medicare |
$940.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,548.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$931.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.01
|
| Rate for Payer: UHC Exchange |
$931.01
|
| Rate for Payer: UHC Medicare Advantage |
$931.01
|
| Rate for Payer: UHCCP Medicaid |
$622.17
|
|
