|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$908.00 |
| Max. Negotiated Rate |
$1,675.18 |
| Rate for Payer: Aetna Commercial |
$1,558.85
|
| Rate for Payer: Aetna Medicare |
$1,209.85
|
| Rate for Payer: BCBS Complete |
$908.00
|
| Rate for Payer: BCBS MAPPO |
$1,163.32
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.49
|
| 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 Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health Medicare |
$1,174.95
|
| 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
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$837.20 |
| Max. Negotiated Rate |
$1,535.31 |
| Rate for Payer: Aetna Commercial |
$1,428.69
|
| Rate for Payer: Aetna Medicare |
$1,108.84
|
| Rate for Payer: BCBS Complete |
$837.20
|
| Rate for Payer: BCBS MAPPO |
$1,066.19
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,119.50
|
| 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 Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health Medicare |
$1,076.85
|
| 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
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$894.40 |
| Max. Negotiated Rate |
$1,476.06 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Aetna Medicare |
$1,066.04
|
| Rate for Payer: BCBS Complete |
$894.40
|
| Rate for Payer: BCBS MAPPO |
$1,025.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,076.29
|
| 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 Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health Medicare |
$1,035.29
|
| 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
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$1,546.08 |
| Rate for Payer: Aetna Commercial |
$1,438.72
|
| Rate for Payer: Aetna Medicare |
$1,116.62
|
| Rate for Payer: BCBS Complete |
$938.00
|
| Rate for Payer: BCBS MAPPO |
$1,073.67
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.35
|
| 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 Cigna Priority Health |
$1,524.25
|
| Rate for Payer: Priority Health Medicare |
$1,084.41
|
| 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
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$1,716.87 |
| Rate for Payer: Aetna Commercial |
$1,597.64
|
| Rate for Payer: Aetna Medicare |
$1,239.96
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: BCBS MAPPO |
$1,192.27
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.88
|
| 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 Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health Medicare |
$1,204.19
|
| 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
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$707.60 |
| Max. Negotiated Rate |
$1,158.72 |
| Rate for Payer: Aetna Commercial |
$1,078.26
|
| Rate for Payer: Aetna Medicare |
$836.86
|
| Rate for Payer: BCBS Complete |
$707.60
|
| Rate for Payer: BCBS MAPPO |
$804.67
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$844.90
|
| 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 Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health Medicare |
$812.72
|
| 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
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$1,402.73 |
| Rate for Payer: Aetna Commercial |
$1,305.32
|
| Rate for Payer: Aetna Medicare |
$1,013.08
|
| Rate for Payer: BCBS Complete |
$813.60
|
| Rate for Payer: BCBS MAPPO |
$974.12
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.83
|
| 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 Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health Medicare |
$983.86
|
| 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
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$844.00 |
| Max. Negotiated Rate |
$1,556.99 |
| Rate for Payer: Aetna Commercial |
$1,448.86
|
| Rate for Payer: Aetna Medicare |
$1,124.49
|
| Rate for Payer: BCBS Complete |
$844.00
|
| Rate for Payer: BCBS MAPPO |
$1,081.24
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.30
|
| 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 Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health Medicare |
$1,092.05
|
| 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
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$771.20 |
| Max. Negotiated Rate |
$1,275.49 |
| Rate for Payer: Aetna Commercial |
$1,186.92
|
| Rate for Payer: Aetna Medicare |
$921.19
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$885.76
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.05
|
| 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 Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health Medicare |
$894.62
|
| 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
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$545.20 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Aetna Commercial |
$960.06
|
| Rate for Payer: Aetna Medicare |
$745.12
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$716.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.28
|
| 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 Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$723.62
|
| 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
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$564.67 |
| Rate for Payer: Aetna Commercial |
$525.45
|
| Rate for Payer: Aetna Medicare |
$407.82
|
| Rate for Payer: BCBS Complete |
$309.60
|
| Rate for Payer: BCBS MAPPO |
$392.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.74
|
| 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 Cigna Priority Health |
$503.10
|
| Rate for Payer: Priority Health Medicare |
$396.05
|
| 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
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$437.65 |
| 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 |
$630.00
|
| Rate for Payer: BCBS MAPPO |
$437.65
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.53
|
| 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 Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health Medicare |
$442.03
|
| 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
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$813.20 |
| Max. Negotiated Rate |
$1,344.83 |
| Rate for Payer: Aetna Commercial |
$1,251.44
|
| Rate for Payer: Aetna Medicare |
$971.27
|
| Rate for Payer: BCBS Complete |
$813.20
|
| Rate for Payer: BCBS MAPPO |
$933.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.61
|
| 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 Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health Medicare |
$943.25
|
| 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
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,103.00 |
| Rate for Payer: Aetna Commercial |
$1,026.40
|
| Rate for Payer: Aetna Medicare |
$796.61
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$765.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.27
|
| 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 Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$773.63
|
| 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
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$1,201.13 |
| Rate for Payer: Aetna Commercial |
$1,117.72
|
| Rate for Payer: Aetna Medicare |
$867.48
|
| Rate for Payer: BCBS Complete |
$725.60
|
| Rate for Payer: BCBS MAPPO |
$834.12
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.83
|
| 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 Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health Medicare |
$842.46
|
| 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
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$705.60 |
| Max. Negotiated Rate |
$1,340.65 |
| Rate for Payer: Aetna Commercial |
$1,247.55
|
| Rate for Payer: Aetna Medicare |
$968.25
|
| Rate for Payer: BCBS Complete |
$705.60
|
| Rate for Payer: BCBS MAPPO |
$931.01
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.56
|
| 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 Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health Medicare |
$940.32
|
| 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
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$624.19
|
| Rate for Payer: Aetna Medicare |
$484.44
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS MAPPO |
$465.81
|
| Rate for Payer: BCN Medicare Advantage |
$465.81
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$670.77
|
| Rate for Payer: Cofinity Commercial |
$624.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.10
|
| Rate for Payer: Nomi Health Commercial |
$558.97
|
| Rate for Payer: PACE SWMI |
$465.81
|
| Rate for Payer: PHP Medicare Advantage |
$465.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health Medicare |
$470.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.81
|
| Rate for Payer: UHC Exchange |
$465.81
|
| Rate for Payer: UHC Medicare Advantage |
$465.81
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$670.33 |
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna Medicare |
$484.13
|
| Rate for Payer: BCBS Complete |
$369.20
|
| Rate for Payer: BCBS MAPPO |
$465.51
|
| Rate for Payer: BCN Medicare Advantage |
$465.51
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$670.33
|
| Rate for Payer: Cofinity Commercial |
$623.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.79
|
| Rate for Payer: Nomi Health Commercial |
$558.61
|
| Rate for Payer: PACE SWMI |
$465.51
|
| Rate for Payer: PHP Medicare Advantage |
$465.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.95
|
| Rate for Payer: Priority Health Medicare |
$470.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.51
|
| Rate for Payer: UHC Exchange |
$465.51
|
| Rate for Payer: UHC Medicare Advantage |
$465.51
|
|
|
PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 53010
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$409.61 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna Medicare |
$295.83
|
| Rate for Payer: BCBS Complete |
$221.20
|
| Rate for Payer: BCBS MAPPO |
$284.45
|
| Rate for Payer: BCN Medicare Advantage |
$284.45
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cofinity Commercial |
$409.61
|
| Rate for Payer: Cofinity Commercial |
$381.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.67
|
| Rate for Payer: Nomi Health Commercial |
$341.34
|
| Rate for Payer: PACE SWMI |
$284.45
|
| Rate for Payer: PHP Medicare Advantage |
$284.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.45
|
| Rate for Payer: Priority Health Medicare |
$287.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.45
|
| Rate for Payer: UHC Exchange |
$284.45
|
| Rate for Payer: UHC Medicare Advantage |
$284.45
|
|
|
PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 50650
|
| Min. Negotiated Rate |
$990.46 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Aetna Medicare |
$1,030.08
|
| Rate for Payer: BCBS Complete |
$1,340.00
|
| Rate for Payer: BCBS MAPPO |
$990.46
|
| Rate for Payer: BCN Medicare Advantage |
$990.46
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cofinity Commercial |
$1,426.26
|
| Rate for Payer: Cofinity Commercial |
$1,327.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$990.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.98
|
| Rate for Payer: Nomi Health Commercial |
$1,188.55
|
| Rate for Payer: PACE SWMI |
$990.46
|
| Rate for Payer: PHP Medicare Advantage |
$990.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.50
|
| Rate for Payer: Priority Health Medicare |
$1,000.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$990.46
|
| Rate for Payer: UHC Exchange |
$990.46
|
| Rate for Payer: UHC Medicare Advantage |
$990.46
|
|
|
PR URINARY LEG OR ABDOMEN BAG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4358
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$11.79 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Nomi Health Commercial |
$9.83
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$8.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Exchange |
$8.19
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
|
|
PR URINARY SUSPENSORY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS A5105
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$82.04 |
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Medicare |
$59.25
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$56.97
|
| Rate for Payer: BCN Medicare Advantage |
$56.97
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Cofinity Commercial |
$76.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$68.36
|
| Rate for Payer: PACE SWMI |
$56.97
|
| Rate for Payer: PHP Medicare Advantage |
$56.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$57.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.97
|
| Rate for Payer: UHC Exchange |
$56.97
|
| Rate for Payer: UHC Medicare Advantage |
$56.97
|
|
|
PR URTP W/TUBULARIZATION POST URT&/LWR BLDR
|
Professional
|
Both
|
$2,206.00
|
|
|
Service Code
|
HCPCS 53431
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,582.57 |
| Rate for Payer: Aetna Commercial |
$1,472.67
|
| Rate for Payer: Aetna Medicare |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: BCBS MAPPO |
$1,099.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.01
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cofinity Commercial |
$1,582.57
|
| Rate for Payer: Cofinity Commercial |
$1,472.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.96
|
| Rate for Payer: Nomi Health Commercial |
$1,318.81
|
| Rate for Payer: PACE SWMI |
$1,099.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.90
|
| Rate for Payer: Priority Health Medicare |
$1,110.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.01
|
| Rate for Payer: UHC Exchange |
$1,099.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.01
|
|
|
PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 50620
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,240.95 |
| Rate for Payer: Aetna Commercial |
$1,154.77
|
| Rate for Payer: Aetna Medicare |
$896.24
|
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: BCBS MAPPO |
$861.77
|
| Rate for Payer: BCN Medicare Advantage |
$861.77
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,240.95
|
| Rate for Payer: Cofinity Commercial |
$1,154.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$861.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$904.86
|
| Rate for Payer: Nomi Health Commercial |
$1,034.12
|
| Rate for Payer: PACE SWMI |
$861.77
|
| Rate for Payer: PHP Medicare Advantage |
$861.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.90
|
| Rate for Payer: Priority Health Medicare |
$870.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$861.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$861.77
|
| Rate for Payer: UHC Exchange |
$861.77
|
| Rate for Payer: UHC Medicare Advantage |
$861.77
|
|
|
PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 50785
|
| Min. Negotiated Rate |
$1,161.58 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$1,556.52
|
| Rate for Payer: Aetna Medicare |
$1,208.04
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,161.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.58
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,672.68
|
| Rate for Payer: Cofinity Commercial |
$1,556.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,219.66
|
| Rate for Payer: Nomi Health Commercial |
$1,393.90
|
| Rate for Payer: PACE SWMI |
$1,161.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,173.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,161.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,161.58
|
| Rate for Payer: UHC Exchange |
$1,161.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,161.58
|
|
