|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,326.25 |
| Rate for Payer: Aetna Commercial |
$1,234.15
|
| Rate for Payer: Aetna Medicare |
$957.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,234.15
|
| Rate for Payer: BCBS Complete |
$618.00
|
| Rate for Payer: BCBS MAPPO |
$921.01
|
| Rate for Payer: BCN Medicare Advantage |
$921.01
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cofinity Commercial |
$1,326.25
|
| Rate for Payer: Cofinity Commercial |
$1,234.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.06
|
| Rate for Payer: Nomi Health Commercial |
$1,105.21
|
| Rate for Payer: PACE SWMI |
$921.01
|
| Rate for Payer: PHP Commercial |
$1,289.41
|
| Rate for Payer: PHP Medicare Advantage |
$921.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.25
|
| Rate for Payer: Priority Health Medicare |
$921.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.01
|
| Rate for Payer: UHC Medicare Advantage |
$921.01
|
| Rate for Payer: UMR Bronson Commercial |
$710.70
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$3,796.00
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,518.40 |
| Max. Negotiated Rate |
$2,489.01 |
| Rate for Payer: Aetna Commercial |
$2,316.16
|
| Rate for Payer: Aetna Medicare |
$1,797.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,489.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,316.16
|
| Rate for Payer: BCBS Complete |
$1,518.40
|
| Rate for Payer: BCBS MAPPO |
$1,728.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,728.48
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cofinity Commercial |
$2,489.01
|
| Rate for Payer: Cofinity Commercial |
$2,316.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,728.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,814.90
|
| Rate for Payer: Nomi Health Commercial |
$2,074.18
|
| Rate for Payer: PACE SWMI |
$1,728.48
|
| Rate for Payer: PHP Commercial |
$2,419.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,728.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,467.40
|
| Rate for Payer: Priority Health Medicare |
$1,728.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,728.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,728.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,746.16
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$144.58 |
| Max. Negotiated Rate |
$502.45 |
| Rate for Payer: Aetna Commercial |
$193.74
|
| Rate for Payer: Aetna Medicare |
$150.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.74
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: BCBS MAPPO |
$144.58
|
| Rate for Payer: BCN Medicare Advantage |
$144.58
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$208.20
|
| Rate for Payer: Cofinity Commercial |
$193.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.81
|
| Rate for Payer: Nomi Health Commercial |
$173.50
|
| Rate for Payer: PACE SWMI |
$144.58
|
| Rate for Payer: PHP Commercial |
$202.41
|
| Rate for Payer: PHP Medicare Advantage |
$144.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health Medicare |
$144.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.58
|
| Rate for Payer: UHC Medicare Advantage |
$144.58
|
| Rate for Payer: UMR Bronson Commercial |
$355.58
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$406.46
|
| Rate for Payer: Aetna Medicare |
$315.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.46
|
| Rate for Payer: BCBS Complete |
$266.00
|
| Rate for Payer: BCBS MAPPO |
$303.33
|
| Rate for Payer: BCN Medicare Advantage |
$303.33
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.50
|
| Rate for Payer: Nomi Health Commercial |
$364.00
|
| Rate for Payer: PACE SWMI |
$303.33
|
| Rate for Payer: PHP Commercial |
$424.66
|
| Rate for Payer: PHP Medicare Advantage |
$303.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health Medicare |
$303.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.33
|
| Rate for Payer: UHC Medicare Advantage |
$303.33
|
| Rate for Payer: UMR Bronson Commercial |
$305.90
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$218.80 |
| Max. Negotiated Rate |
$379.31 |
| Rate for Payer: Aetna Commercial |
$352.97
|
| Rate for Payer: Aetna Medicare |
$273.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.97
|
| Rate for Payer: BCBS Complete |
$218.80
|
| Rate for Payer: BCBS MAPPO |
$263.41
|
| Rate for Payer: BCN Medicare Advantage |
$263.41
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$379.31
|
| Rate for Payer: Cofinity Commercial |
$352.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.58
|
| Rate for Payer: Nomi Health Commercial |
$316.09
|
| Rate for Payer: PACE SWMI |
$263.41
|
| Rate for Payer: PHP Commercial |
$368.77
|
| Rate for Payer: PHP Medicare Advantage |
$263.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health Medicare |
$263.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.41
|
| Rate for Payer: UHC Medicare Advantage |
$263.41
|
| Rate for Payer: UMR Bronson Commercial |
$251.62
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$1,118.00 |
| Rate for Payer: Aetna Commercial |
$65.00
|
| Rate for Payer: Aetna Medicare |
$50.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: BCBS Complete |
$688.00
|
| Rate for Payer: BCBS MAPPO |
$48.51
|
| Rate for Payer: BCN Medicare Advantage |
$48.51
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$69.85
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.94
|
| Rate for Payer: Nomi Health Commercial |
$58.21
|
| Rate for Payer: PACE SWMI |
$48.51
|
| Rate for Payer: PHP Commercial |
$67.91
|
| Rate for Payer: PHP Medicare Advantage |
$48.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.00
|
| Rate for Payer: Priority Health Medicare |
$48.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.51
|
| Rate for Payer: UHC Medicare Advantage |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$791.20
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$199.63 |
| Max. Negotiated Rate |
$1,461.20 |
| Rate for Payer: Aetna Commercial |
$267.50
|
| Rate for Payer: Aetna Medicare |
$207.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.50
|
| Rate for Payer: BCBS Complete |
$899.20
|
| Rate for Payer: BCBS MAPPO |
$199.63
|
| Rate for Payer: BCN Medicare Advantage |
$199.63
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cofinity Commercial |
$287.47
|
| Rate for Payer: Cofinity Commercial |
$267.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.61
|
| Rate for Payer: Nomi Health Commercial |
$239.56
|
| Rate for Payer: PACE SWMI |
$199.63
|
| Rate for Payer: PHP Commercial |
$279.48
|
| Rate for Payer: PHP Medicare Advantage |
$199.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,461.20
|
| Rate for Payer: Priority Health Medicare |
$199.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.63
|
| Rate for Payer: UHC Medicare Advantage |
$199.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,034.08
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$174.15 |
| Max. Negotiated Rate |
$613.60 |
| Rate for Payer: Aetna Commercial |
$233.36
|
| Rate for Payer: Aetna Medicare |
$181.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.36
|
| Rate for Payer: BCBS Complete |
$377.60
|
| Rate for Payer: BCBS MAPPO |
$174.15
|
| Rate for Payer: BCN Medicare Advantage |
$174.15
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$250.78
|
| Rate for Payer: Cofinity Commercial |
$233.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.86
|
| Rate for Payer: Nomi Health Commercial |
$208.98
|
| Rate for Payer: PACE SWMI |
$174.15
|
| Rate for Payer: PHP Commercial |
$243.81
|
| Rate for Payer: PHP Medicare Advantage |
$174.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health Medicare |
$174.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.15
|
| Rate for Payer: UHC Medicare Advantage |
$174.15
|
| Rate for Payer: UMR Bronson Commercial |
$434.24
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$415.20 |
| Max. Negotiated Rate |
$674.70 |
| Rate for Payer: Aetna Commercial |
$606.54
|
| Rate for Payer: Aetna Medicare |
$470.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.54
|
| Rate for Payer: BCBS Complete |
$415.20
|
| Rate for Payer: BCBS MAPPO |
$452.64
|
| Rate for Payer: BCN Medicare Advantage |
$452.64
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$651.80
|
| Rate for Payer: Cofinity Commercial |
$606.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.27
|
| Rate for Payer: Nomi Health Commercial |
$543.17
|
| Rate for Payer: PACE SWMI |
$452.64
|
| Rate for Payer: PHP Commercial |
$633.70
|
| Rate for Payer: PHP Medicare Advantage |
$452.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health Medicare |
$452.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.64
|
| Rate for Payer: UHC Medicare Advantage |
$452.64
|
| Rate for Payer: UMR Bronson Commercial |
$477.48
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$249.79 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$334.72
|
| Rate for Payer: Aetna Medicare |
$259.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.72
|
| Rate for Payer: BCBS Complete |
$420.00
|
| Rate for Payer: BCBS MAPPO |
$249.79
|
| Rate for Payer: BCN Medicare Advantage |
$249.79
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$359.70
|
| Rate for Payer: Cofinity Commercial |
$334.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.28
|
| Rate for Payer: Nomi Health Commercial |
$299.75
|
| Rate for Payer: PACE SWMI |
$249.79
|
| Rate for Payer: PHP Commercial |
$349.71
|
| Rate for Payer: PHP Medicare Advantage |
$249.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health Medicare |
$249.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.79
|
| Rate for Payer: UHC Medicare Advantage |
$249.79
|
| Rate for Payer: UMR Bronson Commercial |
$483.00
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$570.02 |
| Rate for Payer: Aetna Commercial |
$530.44
|
| Rate for Payer: Aetna Medicare |
$411.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.44
|
| Rate for Payer: BCBS Complete |
$304.80
|
| Rate for Payer: BCBS MAPPO |
$395.85
|
| Rate for Payer: BCN Medicare Advantage |
$395.85
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$570.02
|
| Rate for Payer: Cofinity Commercial |
$530.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.64
|
| Rate for Payer: Nomi Health Commercial |
$475.02
|
| Rate for Payer: PACE SWMI |
$395.85
|
| Rate for Payer: PHP Commercial |
$554.19
|
| Rate for Payer: PHP Medicare Advantage |
$395.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health Medicare |
$395.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.85
|
| Rate for Payer: UHC Medicare Advantage |
$395.85
|
| Rate for Payer: UMR Bronson Commercial |
$350.52
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$443.65 |
| Max. Negotiated Rate |
$943.80 |
| Rate for Payer: Aetna Commercial |
$594.49
|
| Rate for Payer: Aetna Medicare |
$461.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.49
|
| Rate for Payer: BCBS Complete |
$580.80
|
| Rate for Payer: BCBS MAPPO |
$443.65
|
| Rate for Payer: BCN Medicare Advantage |
$443.65
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cofinity Commercial |
$638.86
|
| Rate for Payer: Cofinity Commercial |
$594.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.83
|
| Rate for Payer: Nomi Health Commercial |
$532.38
|
| Rate for Payer: PACE SWMI |
$443.65
|
| Rate for Payer: PHP Commercial |
$621.11
|
| Rate for Payer: PHP Medicare Advantage |
$443.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.80
|
| Rate for Payer: Priority Health Medicare |
$443.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.65
|
| Rate for Payer: UHC Medicare Advantage |
$443.65
|
| Rate for Payer: UMR Bronson Commercial |
$667.92
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,197.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$854.74 |
| Max. Negotiated Rate |
$2,078.05 |
| Rate for Payer: Aetna Commercial |
$1,145.35
|
| Rate for Payer: Aetna Medicare |
$888.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,145.35
|
| Rate for Payer: BCBS Complete |
$1,278.80
|
| Rate for Payer: BCBS MAPPO |
$854.74
|
| Rate for Payer: BCN Medicare Advantage |
$854.74
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cofinity Commercial |
$1,230.83
|
| Rate for Payer: Cofinity Commercial |
$1,145.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$897.48
|
| Rate for Payer: Nomi Health Commercial |
$1,025.69
|
| Rate for Payer: PACE SWMI |
$854.74
|
| Rate for Payer: PHP Commercial |
$1,196.64
|
| Rate for Payer: PHP Medicare Advantage |
$854.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,078.05
|
| Rate for Payer: Priority Health Medicare |
$854.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.74
|
| Rate for Payer: UHC Medicare Advantage |
$854.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.62
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$712.24 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Aetna Commercial |
$954.40
|
| Rate for Payer: Aetna Medicare |
$740.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.63
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$712.24
|
| Rate for Payer: BCN Medicare Advantage |
$712.24
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$954.40
|
| Rate for Payer: Cofinity Commercial |
$1,025.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.85
|
| Rate for Payer: Nomi Health Commercial |
$854.69
|
| Rate for Payer: PACE SWMI |
$712.24
|
| Rate for Payer: PHP Commercial |
$997.14
|
| Rate for Payer: PHP Medicare Advantage |
$712.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$712.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.24
|
| Rate for Payer: UHC Medicare Advantage |
$712.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.08
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$373.42
|
| Rate for Payer: Aetna Medicare |
$289.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.42
|
| Rate for Payer: BCBS Complete |
$218.40
|
| Rate for Payer: BCBS MAPPO |
$278.67
|
| Rate for Payer: BCN Medicare Advantage |
$278.67
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$401.28
|
| Rate for Payer: Cofinity Commercial |
$373.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.60
|
| Rate for Payer: Nomi Health Commercial |
$334.40
|
| Rate for Payer: PACE SWMI |
$278.67
|
| Rate for Payer: PHP Commercial |
$390.14
|
| Rate for Payer: PHP Medicare Advantage |
$278.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health Medicare |
$278.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.67
|
| Rate for Payer: UHC Medicare Advantage |
$278.67
|
| Rate for Payer: UMR Bronson Commercial |
$251.16
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$449.18 |
| Max. Negotiated Rate |
$1,592.50 |
| Rate for Payer: Aetna Commercial |
$601.90
|
| Rate for Payer: Aetna Medicare |
$467.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.90
|
| Rate for Payer: BCBS Complete |
$980.00
|
| Rate for Payer: BCBS MAPPO |
$449.18
|
| Rate for Payer: BCN Medicare Advantage |
$449.18
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cofinity Commercial |
$646.82
|
| Rate for Payer: Cofinity Commercial |
$601.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.64
|
| Rate for Payer: Nomi Health Commercial |
$539.02
|
| Rate for Payer: PACE SWMI |
$449.18
|
| Rate for Payer: PHP Commercial |
$628.85
|
| Rate for Payer: PHP Medicare Advantage |
$449.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,592.50
|
| Rate for Payer: Priority Health Medicare |
$449.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.18
|
| Rate for Payer: UHC Medicare Advantage |
$449.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.00
|
|
|
PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
HCPCS 51525
|
| Min. Negotiated Rate |
$800.80 |
| Max. Negotiated Rate |
$1,301.30 |
| Rate for Payer: Aetna Commercial |
$1,097.85
|
| Rate for Payer: Aetna Medicare |
$852.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.85
|
| Rate for Payer: BCBS Complete |
$800.80
|
| Rate for Payer: BCBS MAPPO |
$819.29
|
| Rate for Payer: BCN Medicare Advantage |
$819.29
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.78
|
| Rate for Payer: Cofinity Commercial |
$1,097.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$860.25
|
| Rate for Payer: Nomi Health Commercial |
$983.15
|
| Rate for Payer: PACE SWMI |
$819.29
|
| Rate for Payer: PHP Commercial |
$1,147.01
|
| Rate for Payer: PHP Medicare Advantage |
$819.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.30
|
| Rate for Payer: Priority Health Medicare |
$819.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$819.29
|
| Rate for Payer: UHC Medicare Advantage |
$819.29
|
| Rate for Payer: UMR Bronson Commercial |
$920.92
|
|
|
PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 51535
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$1,123.85 |
| Rate for Payer: Aetna Commercial |
$998.77
|
| Rate for Payer: Aetna Medicare |
$775.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.30
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$745.35
|
| Rate for Payer: BCN Medicare Advantage |
$745.35
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$998.77
|
| Rate for Payer: Cofinity Commercial |
$1,073.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.62
|
| Rate for Payer: Nomi Health Commercial |
$894.42
|
| Rate for Payer: PACE SWMI |
$745.35
|
| Rate for Payer: PHP Commercial |
$1,043.49
|
| Rate for Payer: PHP Medicare Advantage |
$745.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$745.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.35
|
| Rate for Payer: UHC Medicare Advantage |
$745.35
|
| Rate for Payer: UMR Bronson Commercial |
$795.34
|
|
|
PR CYSTOTOMY EXCISION BLADDER TUMOR
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 51530
|
| Min. Negotiated Rate |
$556.00 |
| Max. Negotiated Rate |
$1,059.31 |
| Rate for Payer: Aetna Commercial |
$985.74
|
| Rate for Payer: Aetna Medicare |
$765.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$985.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.31
|
| Rate for Payer: BCBS Complete |
$556.00
|
| Rate for Payer: BCBS MAPPO |
$735.63
|
| Rate for Payer: BCN Medicare Advantage |
$735.63
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cash Price |
$1,112.00
|
| Rate for Payer: Cofinity Commercial |
$985.74
|
| Rate for Payer: Cofinity Commercial |
$1,059.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$772.41
|
| Rate for Payer: Nomi Health Commercial |
$882.76
|
| Rate for Payer: PACE SWMI |
$735.63
|
| Rate for Payer: PHP Commercial |
$1,029.88
|
| Rate for Payer: PHP Medicare Advantage |
$735.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.50
|
| Rate for Payer: Priority Health Medicare |
$735.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.63
|
| Rate for Payer: UHC Medicare Advantage |
$735.63
|
| Rate for Payer: UMR Bronson Commercial |
$639.40
|
|
|
PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 51520
|
| Min. Negotiated Rate |
$491.20 |
| Max. Negotiated Rate |
$820.83 |
| Rate for Payer: Aetna Commercial |
$763.83
|
| Rate for Payer: Aetna Medicare |
$592.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$820.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.83
|
| Rate for Payer: BCBS Complete |
$491.20
|
| Rate for Payer: BCBS MAPPO |
$570.02
|
| Rate for Payer: BCN Medicare Advantage |
$570.02
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cofinity Commercial |
$820.83
|
| Rate for Payer: Cofinity Commercial |
$763.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.52
|
| Rate for Payer: Nomi Health Commercial |
$684.02
|
| Rate for Payer: PACE SWMI |
$570.02
|
| Rate for Payer: PHP Commercial |
$798.03
|
| Rate for Payer: PHP Medicare Advantage |
$570.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.20
|
| Rate for Payer: Priority Health Medicare |
$570.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.02
|
| Rate for Payer: UHC Medicare Advantage |
$570.02
|
| Rate for Payer: UMR Bronson Commercial |
$564.88
|
|
|
PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO
|
Professional
|
Both
|
$1,969.00
|
|
|
Service Code
|
HCPCS 51065
|
| Min. Negotiated Rate |
$555.47 |
| Max. Negotiated Rate |
$1,279.85 |
| Rate for Payer: Aetna Commercial |
$744.33
|
| Rate for Payer: Aetna Medicare |
$577.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.33
|
| Rate for Payer: BCBS Complete |
$787.60
|
| Rate for Payer: BCBS MAPPO |
$555.47
|
| Rate for Payer: BCN Medicare Advantage |
$555.47
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$799.88
|
| Rate for Payer: Cofinity Commercial |
$744.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.24
|
| Rate for Payer: Nomi Health Commercial |
$666.56
|
| Rate for Payer: PACE SWMI |
$555.47
|
| Rate for Payer: PHP Commercial |
$777.66
|
| Rate for Payer: PHP Medicare Advantage |
$555.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.85
|
| Rate for Payer: Priority Health Medicare |
$555.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.47
|
| Rate for Payer: UHC Medicare Advantage |
$555.47
|
| Rate for Payer: UMR Bronson Commercial |
$905.74
|
|
|
PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
HCPCS 51045
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$677.33 |
| Rate for Payer: Aetna Commercial |
$630.30
|
| Rate for Payer: Aetna Medicare |
$489.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.30
|
| Rate for Payer: BCBS Complete |
$412.80
|
| Rate for Payer: BCBS MAPPO |
$470.37
|
| Rate for Payer: BCN Medicare Advantage |
$470.37
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cash Price |
$825.60
|
| Rate for Payer: Cofinity Commercial |
$677.33
|
| Rate for Payer: Cofinity Commercial |
$630.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.89
|
| Rate for Payer: Nomi Health Commercial |
$564.44
|
| Rate for Payer: PACE SWMI |
$470.37
|
| Rate for Payer: PHP Commercial |
$658.52
|
| Rate for Payer: PHP Medicare Advantage |
$470.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.80
|
| Rate for Payer: Priority Health Medicare |
$470.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.37
|
| Rate for Payer: UHC Medicare Advantage |
$470.37
|
| Rate for Payer: UMR Bronson Commercial |
$474.72
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$567.78 |
| Rate for Payer: Aetna Commercial |
$528.35
|
| Rate for Payer: Aetna Medicare |
$410.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.35
|
| Rate for Payer: BCBS Complete |
$339.20
|
| Rate for Payer: BCBS MAPPO |
$394.29
|
| Rate for Payer: BCN Medicare Advantage |
$394.29
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$567.78
|
| Rate for Payer: Cofinity Commercial |
$528.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.00
|
| Rate for Payer: Nomi Health Commercial |
$473.15
|
| Rate for Payer: PACE SWMI |
$394.29
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: PHP Medicare Advantage |
$394.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.20
|
| Rate for Payer: Priority Health Medicare |
$394.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.29
|
| Rate for Payer: UHC Medicare Advantage |
$394.29
|
| Rate for Payer: UMR Bronson Commercial |
$390.08
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$76.36 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$102.32
|
| Rate for Payer: Aetna Medicare |
$79.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.32
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$76.36
|
| Rate for Payer: BCN Medicare Advantage |
$76.36
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$109.96
|
| Rate for Payer: Cofinity Commercial |
$102.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.18
|
| Rate for Payer: Nomi Health Commercial |
$91.63
|
| Rate for Payer: PACE SWMI |
$76.36
|
| Rate for Payer: PHP Commercial |
$106.90
|
| Rate for Payer: PHP Medicare Advantage |
$76.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$76.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.36
|
| Rate for Payer: UHC Medicare Advantage |
$76.36
|
| Rate for Payer: UMR Bronson Commercial |
$216.20
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$161.29 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$216.13
|
| Rate for Payer: Aetna Medicare |
$167.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.13
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS MAPPO |
$161.29
|
| Rate for Payer: BCN Medicare Advantage |
$161.29
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$232.26
|
| Rate for Payer: Cofinity Commercial |
$216.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.35
|
| Rate for Payer: Nomi Health Commercial |
$193.55
|
| Rate for Payer: PACE SWMI |
$161.29
|
| Rate for Payer: PHP Commercial |
$225.81
|
| Rate for Payer: PHP Medicare Advantage |
$161.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Medicare |
$161.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.29
|
| Rate for Payer: UHC Medicare Advantage |
$161.29
|
| Rate for Payer: UMR Bronson Commercial |
$324.30
|
|
