|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$460.71 |
| Rate for Payer: Aetna Commercial |
$428.72
|
| Rate for Payer: Aetna Medicare |
$332.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.72
|
| Rate for Payer: BCBS Complete |
$260.00
|
| Rate for Payer: BCBS MAPPO |
$319.94
|
| Rate for Payer: BCN Medicare Advantage |
$319.94
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$460.71
|
| Rate for Payer: Cofinity Commercial |
$428.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.94
|
| Rate for Payer: Nomi Health Commercial |
$383.93
|
| Rate for Payer: PACE SWMI |
$319.94
|
| Rate for Payer: PHP Commercial |
$447.92
|
| Rate for Payer: PHP Medicare Advantage |
$319.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health Medicare |
$319.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.94
|
| Rate for Payer: UHC Medicare Advantage |
$319.94
|
| Rate for Payer: UMR Bronson Commercial |
$299.00
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$326.91 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$236.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.21
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$227.02
|
| Rate for Payer: BCN Medicare Advantage |
$227.02
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$326.91
|
| Rate for Payer: Cofinity Commercial |
$304.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.37
|
| Rate for Payer: Nomi Health Commercial |
$272.42
|
| Rate for Payer: PACE SWMI |
$227.02
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: PHP Medicare Advantage |
$227.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$227.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.02
|
| Rate for Payer: UHC Medicare Advantage |
$227.02
|
| Rate for Payer: UMR Bronson Commercial |
$230.00
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$187.58 |
| Max. Negotiated Rate |
$415.35 |
| Rate for Payer: Aetna Commercial |
$251.36
|
| Rate for Payer: Aetna Medicare |
$195.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.36
|
| Rate for Payer: BCBS Complete |
$255.60
|
| Rate for Payer: BCBS MAPPO |
$187.58
|
| Rate for Payer: BCN Medicare Advantage |
$187.58
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cofinity Commercial |
$270.12
|
| Rate for Payer: Cofinity Commercial |
$251.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.96
|
| Rate for Payer: Nomi Health Commercial |
$225.10
|
| Rate for Payer: PACE SWMI |
$187.58
|
| Rate for Payer: PHP Commercial |
$262.61
|
| Rate for Payer: PHP Medicare Advantage |
$187.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.35
|
| Rate for Payer: Priority Health Medicare |
$187.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.58
|
| Rate for Payer: UHC Medicare Advantage |
$187.58
|
| Rate for Payer: UMR Bronson Commercial |
$293.94
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,167.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$273.12 |
| Max. Negotiated Rate |
$758.55 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Medicare |
$284.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.98
|
| Rate for Payer: BCBS Complete |
$466.80
|
| Rate for Payer: BCBS MAPPO |
$273.12
|
| Rate for Payer: BCN Medicare Advantage |
$273.12
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cash Price |
$933.60
|
| Rate for Payer: Cofinity Commercial |
$393.29
|
| Rate for Payer: Cofinity Commercial |
$365.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.78
|
| Rate for Payer: Nomi Health Commercial |
$327.74
|
| Rate for Payer: PACE SWMI |
$273.12
|
| Rate for Payer: PHP Commercial |
$382.37
|
| Rate for Payer: PHP Medicare Advantage |
$273.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.55
|
| Rate for Payer: Priority Health Medicare |
$273.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.12
|
| Rate for Payer: UHC Medicare Advantage |
$273.12
|
| Rate for Payer: UMR Bronson Commercial |
$536.82
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$370.96 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$385.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.09
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCN Medicare Advantage |
$370.96
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Cofinity Commercial |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$445.15
|
| Rate for Payer: PACE SWMI |
$370.96
|
| Rate for Payer: PHP Commercial |
$519.34
|
| Rate for Payer: PHP Medicare Advantage |
$370.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
| Rate for Payer: Priority Health Medicare |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.96
|
| Rate for Payer: UHC Medicare Advantage |
$370.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.78
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$287.94 |
| Rate for Payer: Aetna Commercial |
$267.95
|
| Rate for Payer: Aetna Medicare |
$207.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.95
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$199.96
|
| Rate for Payer: BCN Medicare Advantage |
$199.96
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$287.94
|
| Rate for Payer: Cofinity Commercial |
$267.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.96
|
| Rate for Payer: Nomi Health Commercial |
$239.95
|
| Rate for Payer: PACE SWMI |
$199.96
|
| Rate for Payer: PHP Commercial |
$279.94
|
| Rate for Payer: PHP Medicare Advantage |
$199.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$199.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.96
|
| Rate for Payer: UHC Medicare Advantage |
$199.96
|
| Rate for Payer: UMR Bronson Commercial |
$181.70
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$414.70 |
| Rate for Payer: Aetna Commercial |
$207.00
|
| Rate for Payer: Aetna Medicare |
$160.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.00
|
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCBS MAPPO |
$154.48
|
| Rate for Payer: BCN Medicare Advantage |
$154.48
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$222.45
|
| Rate for Payer: Cofinity Commercial |
$207.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.20
|
| Rate for Payer: Nomi Health Commercial |
$185.38
|
| Rate for Payer: PACE SWMI |
$154.48
|
| Rate for Payer: PHP Commercial |
$216.27
|
| Rate for Payer: PHP Medicare Advantage |
$154.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health Medicare |
$154.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.48
|
| Rate for Payer: UHC Medicare Advantage |
$154.48
|
| Rate for Payer: UMR Bronson Commercial |
$293.48
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$250.77 |
| Max. Negotiated Rate |
$728.65 |
| Rate for Payer: Aetna Commercial |
$336.03
|
| Rate for Payer: Aetna Medicare |
$260.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$361.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.03
|
| Rate for Payer: BCBS Complete |
$448.40
|
| Rate for Payer: BCBS MAPPO |
$250.77
|
| Rate for Payer: BCN Medicare Advantage |
$250.77
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Cofinity Commercial |
$336.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.31
|
| Rate for Payer: Nomi Health Commercial |
$300.92
|
| Rate for Payer: PACE SWMI |
$250.77
|
| Rate for Payer: PHP Commercial |
$351.08
|
| Rate for Payer: PHP Medicare Advantage |
$250.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.65
|
| Rate for Payer: Priority Health Medicare |
$250.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.77
|
| Rate for Payer: UHC Medicare Advantage |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$515.66
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$172.95 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$179.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.75
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$172.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.95
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$249.05
|
| Rate for Payer: Cofinity Commercial |
$231.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.60
|
| Rate for Payer: Nomi Health Commercial |
$207.54
|
| Rate for Payer: PACE SWMI |
$172.95
|
| Rate for Payer: PHP Commercial |
$242.13
|
| Rate for Payer: PHP Medicare Advantage |
$172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$172.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.95
|
| Rate for Payer: UHC Medicare Advantage |
$172.95
|
| Rate for Payer: UMR Bronson Commercial |
$329.36
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$635.05 |
| Rate for Payer: Aetna Commercial |
$316.48
|
| Rate for Payer: Aetna Medicare |
$245.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.48
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS MAPPO |
$236.18
|
| Rate for Payer: BCN Medicare Advantage |
$236.18
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$340.10
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.99
|
| Rate for Payer: Nomi Health Commercial |
$283.42
|
| Rate for Payer: PACE SWMI |
$236.18
|
| Rate for Payer: PHP Commercial |
$330.65
|
| Rate for Payer: PHP Medicare Advantage |
$236.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health Medicare |
$236.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.18
|
| Rate for Payer: UHC Medicare Advantage |
$236.18
|
| Rate for Payer: UMR Bronson Commercial |
$449.42
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$486.20 |
| Rate for Payer: Aetna Commercial |
$179.64
|
| Rate for Payer: Aetna Medicare |
$139.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.64
|
| Rate for Payer: BCBS Complete |
$299.20
|
| Rate for Payer: BCBS MAPPO |
$134.06
|
| Rate for Payer: BCN Medicare Advantage |
$134.06
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Cofinity Commercial |
$179.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.76
|
| Rate for Payer: Nomi Health Commercial |
$160.87
|
| Rate for Payer: PACE SWMI |
$134.06
|
| Rate for Payer: PHP Commercial |
$187.68
|
| Rate for Payer: PHP Medicare Advantage |
$134.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.20
|
| Rate for Payer: Priority Health Medicare |
$134.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.06
|
| Rate for Payer: UHC Medicare Advantage |
$134.06
|
| Rate for Payer: UMR Bronson Commercial |
$344.08
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$234.12 |
| Max. Negotiated Rate |
$926.90 |
| Rate for Payer: Aetna Commercial |
$313.72
|
| Rate for Payer: Aetna Medicare |
$243.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.72
|
| Rate for Payer: BCBS Complete |
$570.40
|
| Rate for Payer: BCBS MAPPO |
$234.12
|
| Rate for Payer: BCN Medicare Advantage |
$234.12
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cofinity Commercial |
$337.13
|
| Rate for Payer: Cofinity Commercial |
$313.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.83
|
| Rate for Payer: Nomi Health Commercial |
$280.94
|
| Rate for Payer: PACE SWMI |
$234.12
|
| Rate for Payer: PHP Commercial |
$327.77
|
| Rate for Payer: PHP Medicare Advantage |
$234.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$926.90
|
| Rate for Payer: Priority Health Medicare |
$234.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.12
|
| Rate for Payer: UHC Medicare Advantage |
$234.12
|
| Rate for Payer: UMR Bronson Commercial |
$655.96
|
|
|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$276.77 |
| Rate for Payer: Aetna Commercial |
$257.55
|
| Rate for Payer: Aetna Medicare |
$199.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.55
|
| Rate for Payer: BCBS Complete |
$166.40
|
| Rate for Payer: BCBS MAPPO |
$192.20
|
| Rate for Payer: BCN Medicare Advantage |
$192.20
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$276.77
|
| Rate for Payer: Cofinity Commercial |
$257.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.81
|
| Rate for Payer: Nomi Health Commercial |
$230.64
|
| Rate for Payer: PACE SWMI |
$192.20
|
| Rate for Payer: PHP Commercial |
$269.08
|
| Rate for Payer: PHP Medicare Advantage |
$192.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health Medicare |
$192.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.20
|
| Rate for Payer: UHC Medicare Advantage |
$192.20
|
| Rate for Payer: UMR Bronson Commercial |
$191.36
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$363.35 |
| Rate for Payer: Aetna Commercial |
$169.59
|
| Rate for Payer: Aetna Medicare |
$131.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.59
|
| Rate for Payer: BCBS Complete |
$223.60
|
| Rate for Payer: BCBS MAPPO |
$126.56
|
| Rate for Payer: BCN Medicare Advantage |
$126.56
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cofinity Commercial |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$169.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.89
|
| Rate for Payer: Nomi Health Commercial |
$151.87
|
| Rate for Payer: PACE SWMI |
$126.56
|
| Rate for Payer: PHP Commercial |
$177.18
|
| Rate for Payer: PHP Medicare Advantage |
$126.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health Medicare |
$126.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.56
|
| Rate for Payer: UHC Medicare Advantage |
$126.56
|
| Rate for Payer: UMR Bronson Commercial |
$257.14
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$332.91 |
| Rate for Payer: Aetna Commercial |
$309.79
|
| Rate for Payer: Aetna Medicare |
$240.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.79
|
| Rate for Payer: BCBS Complete |
$189.60
|
| Rate for Payer: BCBS MAPPO |
$231.19
|
| Rate for Payer: BCN Medicare Advantage |
$231.19
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$332.91
|
| Rate for Payer: Cofinity Commercial |
$309.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.75
|
| Rate for Payer: Nomi Health Commercial |
$277.43
|
| Rate for Payer: PACE SWMI |
$231.19
|
| Rate for Payer: PHP Commercial |
$323.67
|
| Rate for Payer: PHP Medicare Advantage |
$231.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health Medicare |
$231.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.19
|
| Rate for Payer: UHC Medicare Advantage |
$231.19
|
| Rate for Payer: UMR Bronson Commercial |
$218.04
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$260.18 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Aetna Commercial |
$348.64
|
| Rate for Payer: Aetna Medicare |
$270.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.64
|
| Rate for Payer: BCBS Complete |
$323.60
|
| Rate for Payer: BCBS MAPPO |
$260.18
|
| Rate for Payer: BCN Medicare Advantage |
$260.18
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$374.66
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.19
|
| Rate for Payer: Nomi Health Commercial |
$312.22
|
| Rate for Payer: PACE SWMI |
$260.18
|
| Rate for Payer: PHP Commercial |
$364.25
|
| Rate for Payer: PHP Medicare Advantage |
$260.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health Medicare |
$260.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.18
|
| Rate for Payer: UHC Medicare Advantage |
$260.18
|
| Rate for Payer: UMR Bronson Commercial |
$372.14
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$166.95 |
| Max. Negotiated Rate |
$1,836.25 |
| Rate for Payer: Aetna Commercial |
$223.71
|
| Rate for Payer: Aetna Medicare |
$173.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.71
|
| Rate for Payer: BCBS Complete |
$1,130.00
|
| Rate for Payer: BCBS MAPPO |
$166.95
|
| Rate for Payer: BCN Medicare Advantage |
$166.95
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cofinity Commercial |
$240.41
|
| Rate for Payer: Cofinity Commercial |
$223.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.30
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: PACE SWMI |
$166.95
|
| Rate for Payer: PHP Commercial |
$233.73
|
| Rate for Payer: PHP Medicare Advantage |
$166.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.25
|
| Rate for Payer: Priority Health Medicare |
$166.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.95
|
| Rate for Payer: UHC Medicare Advantage |
$166.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,299.50
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,050.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$156.92 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna Commercial |
$210.27
|
| Rate for Payer: Aetna Medicare |
$163.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.27
|
| Rate for Payer: BCBS Complete |
$1,620.00
|
| Rate for Payer: BCBS MAPPO |
$156.92
|
| Rate for Payer: BCN Medicare Advantage |
$156.92
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cofinity Commercial |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$210.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.77
|
| Rate for Payer: Nomi Health Commercial |
$188.30
|
| Rate for Payer: PACE SWMI |
$156.92
|
| Rate for Payer: PHP Commercial |
$219.69
|
| Rate for Payer: PHP Medicare Advantage |
$156.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,632.50
|
| Rate for Payer: Priority Health Medicare |
$156.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.92
|
| Rate for Payer: UHC Medicare Advantage |
$156.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,863.00
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$147.81 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Aetna Commercial |
$198.07
|
| Rate for Payer: Aetna Medicare |
$153.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.07
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$147.81
|
| Rate for Payer: BCN Medicare Advantage |
$147.81
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$212.85
|
| Rate for Payer: Cofinity Commercial |
$198.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.20
|
| Rate for Payer: Nomi Health Commercial |
$177.37
|
| Rate for Payer: PACE SWMI |
$147.81
|
| Rate for Payer: PHP Commercial |
$206.93
|
| Rate for Payer: PHP Medicare Advantage |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$147.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.81
|
| Rate for Payer: UHC Medicare Advantage |
$147.81
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$271.94 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna Commercial |
$364.40
|
| Rate for Payer: Aetna Medicare |
$282.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.40
|
| Rate for Payer: BCBS Complete |
$308.00
|
| Rate for Payer: BCBS MAPPO |
$271.94
|
| Rate for Payer: BCN Medicare Advantage |
$271.94
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$391.59
|
| Rate for Payer: Cofinity Commercial |
$364.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.54
|
| Rate for Payer: Nomi Health Commercial |
$326.33
|
| Rate for Payer: PACE SWMI |
$271.94
|
| Rate for Payer: PHP Commercial |
$380.72
|
| Rate for Payer: PHP Medicare Advantage |
$271.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health Medicare |
$271.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.94
|
| Rate for Payer: UHC Medicare Advantage |
$271.94
|
| Rate for Payer: UMR Bronson Commercial |
$354.20
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$193.00 |
| Max. Negotiated Rate |
$1,511.90 |
| Rate for Payer: Aetna Commercial |
$258.62
|
| Rate for Payer: Aetna Medicare |
$200.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.62
|
| Rate for Payer: BCBS Complete |
$930.40
|
| Rate for Payer: BCBS MAPPO |
$193.00
|
| Rate for Payer: BCN Medicare Advantage |
$193.00
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cofinity Commercial |
$277.92
|
| Rate for Payer: Cofinity Commercial |
$258.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.65
|
| Rate for Payer: Nomi Health Commercial |
$231.60
|
| Rate for Payer: PACE SWMI |
$193.00
|
| Rate for Payer: PHP Commercial |
$270.20
|
| Rate for Payer: PHP Medicare Advantage |
$193.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.90
|
| Rate for Payer: Priority Health Medicare |
$193.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.00
|
| Rate for Payer: UHC Medicare Advantage |
$193.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,069.96
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$233.16 |
| Max. Negotiated Rate |
$700.05 |
| Rate for Payer: Aetna Commercial |
$312.43
|
| Rate for Payer: Aetna Medicare |
$242.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.43
|
| Rate for Payer: BCBS Complete |
$430.80
|
| Rate for Payer: BCBS MAPPO |
$233.16
|
| Rate for Payer: BCN Medicare Advantage |
$233.16
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$335.75
|
| Rate for Payer: Cofinity Commercial |
$312.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.82
|
| Rate for Payer: Nomi Health Commercial |
$279.79
|
| Rate for Payer: PACE SWMI |
$233.16
|
| Rate for Payer: PHP Commercial |
$326.42
|
| Rate for Payer: PHP Medicare Advantage |
$233.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health Medicare |
$233.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.16
|
| Rate for Payer: UHC Medicare Advantage |
$233.16
|
| Rate for Payer: UMR Bronson Commercial |
$495.42
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$381.86 |
| Rate for Payer: Aetna Commercial |
$355.34
|
| Rate for Payer: Aetna Medicare |
$275.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.34
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS MAPPO |
$265.18
|
| Rate for Payer: BCN Medicare Advantage |
$265.18
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$381.86
|
| Rate for Payer: Cofinity Commercial |
$355.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.44
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PACE SWMI |
$265.18
|
| Rate for Payer: PHP Commercial |
$371.25
|
| Rate for Payer: PHP Medicare Advantage |
$265.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health Medicare |
$265.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.18
|
| Rate for Payer: UHC Medicare Advantage |
$265.18
|
| Rate for Payer: UMR Bronson Commercial |
$253.00
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$395.78 |
| Rate for Payer: Aetna Commercial |
$368.30
|
| Rate for Payer: Aetna Medicare |
$285.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.30
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$274.85
|
| Rate for Payer: BCN Medicare Advantage |
$274.85
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Cofinity Commercial |
$368.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.59
|
| Rate for Payer: Nomi Health Commercial |
$329.82
|
| Rate for Payer: PACE SWMI |
$274.85
|
| Rate for Payer: PHP Commercial |
$384.79
|
| Rate for Payer: PHP Medicare Advantage |
$274.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$274.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.85
|
| Rate for Payer: UHC Medicare Advantage |
$274.85
|
| Rate for Payer: UMR Bronson Commercial |
$268.18
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: Aetna Commercial |
$193.29
|
| Rate for Payer: Aetna Medicare |
$150.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.29
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS MAPPO |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$144.25
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Cofinity Commercial |
$193.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.46
|
| Rate for Payer: Nomi Health Commercial |
$173.10
|
| Rate for Payer: PACE SWMI |
$144.25
|
| Rate for Payer: PHP Commercial |
$201.95
|
| Rate for Payer: PHP Medicare Advantage |
$144.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.50
|
| Rate for Payer: Priority Health Medicare |
$144.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.25
|
| Rate for Payer: UHC Medicare Advantage |
$144.25
|
| Rate for Payer: UMR Bronson Commercial |
$271.40
|
|
