|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 46942
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,144.83 |
| Rate for Payer: Aetna Commercial |
$172.65
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.83
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.72
|
| Rate for Payer: Priority Health Narrow Network |
$228.72
|
| Rate for Payer: Priority Health SBD |
$228.72
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR CUSTOM EAR PLUGS
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 00592
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$1,431.00
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$454.54 |
| Max. Negotiated Rate |
$2,370.48 |
| Rate for Payer: Aetna Commercial |
$916.03
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,370.48
|
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,139.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.07
|
| Rate for Payer: Priority Health SBD |
$1,139.07
|
| Rate for Payer: UMR Bronson Commercial |
$658.26
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.38
|
| Rate for Payer: Priority Health Narrow Network |
$19.38
|
| Rate for Payer: Priority Health SBD |
$19.38
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$1,426.94 |
| Rate for Payer: Aetna Commercial |
$43.41
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.94
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.60
|
| Rate for Payer: Priority Health Narrow Network |
$50.60
|
| Rate for Payer: Priority Health SBD |
$50.60
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$1,780.90 |
| Rate for Payer: Aetna Commercial |
$28.99
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.90
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.32
|
| Rate for Payer: Priority Health Narrow Network |
$29.32
|
| Rate for Payer: Priority Health SBD |
$29.32
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$91.71 |
| Max. Negotiated Rate |
$2,485.65 |
| Rate for Payer: Aetna Commercial |
$91.71
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,485.65
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.30
|
| Rate for Payer: Priority Health Narrow Network |
$99.30
|
| Rate for Payer: Priority Health SBD |
$99.30
|
| Rate for Payer: UMR Bronson Commercial |
$203.78
|
|
|
PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,756.00
|
|
|
Service Code
|
HCPCS 51570
|
| Min. Negotiated Rate |
$931.24 |
| Max. Negotiated Rate |
$3,145.50 |
| Rate for Payer: Aetna Commercial |
$1,887.68
|
| Rate for Payer: BCBS Complete |
$977.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,145.50
|
| Rate for Payer: Cash Price |
$2,204.80
|
| Rate for Payer: Cash Price |
$2,204.80
|
| Rate for Payer: Meridian Medicaid |
$977.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,929.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,339.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,339.76
|
| Rate for Payer: Priority Health SBD |
$2,339.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,267.76
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$7,600.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$798.96 |
| Max. Negotiated Rate |
$5,320.00 |
| Rate for Payer: Aetna Commercial |
$1,622.71
|
| Rate for Payer: BCBS Complete |
$838.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.69
|
| Rate for Payer: Cash Price |
$6,080.00
|
| Rate for Payer: Cash Price |
$6,080.00
|
| Rate for Payer: Meridian Medicaid |
$838.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,320.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,002.57
|
| Rate for Payer: Priority Health Narrow Network |
$2,002.57
|
| Rate for Payer: Priority Health SBD |
$2,002.57
|
| Rate for Payer: UMR Bronson Commercial |
$3,496.00
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$612.38 |
| Max. Negotiated Rate |
$2,405.35 |
| Rate for Payer: Aetna Commercial |
$1,235.96
|
| Rate for Payer: BCBS Complete |
$643.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.35
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Meridian Medicaid |
$643.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,060.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,534.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.62
|
| Rate for Payer: Priority Health SBD |
$1,534.62
|
| Rate for Payer: UMR Bronson Commercial |
$696.90
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$3,722.00
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,146.37 |
| Max. Negotiated Rate |
$3,111.16 |
| Rate for Payer: Aetna Commercial |
$2,337.60
|
| Rate for Payer: BCBS Complete |
$1,203.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,111.16
|
| Rate for Payer: Cash Price |
$2,977.60
|
| Rate for Payer: Cash Price |
$2,977.60
|
| Rate for Payer: Meridian Medicaid |
$1,203.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,146.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,605.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,886.06
|
| Rate for Payer: Priority Health Narrow Network |
$2,886.06
|
| Rate for Payer: Priority Health SBD |
$2,886.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,712.12
|
|
|
PR CYSTO BLADDER W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$2,077.80 |
| Rate for Payer: Aetna Commercial |
$169.08
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.80
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.11
|
| Rate for Payer: Priority Health Narrow Network |
$209.11
|
| Rate for Payer: Priority Health SBD |
$209.11
|
| Rate for Payer: UMR Bronson Commercial |
$252.08
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$2,364.67 |
| Rate for Payer: Aetna Commercial |
$193.91
|
| Rate for Payer: BCBS Complete |
$100.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.67
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Meridian Medicaid |
$100.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.46
|
| Rate for Payer: Priority Health Narrow Network |
$240.46
|
| Rate for Payer: Priority Health SBD |
$240.46
|
| Rate for Payer: UMR Bronson Commercial |
$348.68
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$200.65 |
| Max. Negotiated Rate |
$4,083.76 |
| Rate for Payer: Aetna Commercial |
$410.09
|
| Rate for Payer: BCBS Complete |
$210.68
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.76
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Meridian Medicaid |
$210.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.70
|
| Rate for Payer: Priority Health Narrow Network |
$504.70
|
| Rate for Payer: Priority Health SBD |
$504.70
|
| Rate for Payer: UMR Bronson Commercial |
$299.92
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$174.45 |
| Max. Negotiated Rate |
$894.94 |
| Rate for Payer: Aetna Commercial |
$356.38
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCBS Trust/PPO |
$894.94
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.85
|
| Rate for Payer: Priority Health Narrow Network |
$439.85
|
| Rate for Payer: Priority Health SBD |
$439.85
|
| Rate for Payer: UMR Bronson Commercial |
$246.56
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,180.20 |
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.97
|
| Rate for Payer: Priority Health Narrow Network |
$79.97
|
| Rate for Payer: Priority Health SBD |
$79.97
|
| Rate for Payer: UMR Bronson Commercial |
$775.56
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$1,542.80 |
| Rate for Payer: Aetna Commercial |
$268.82
|
| Rate for Payer: BCBS Complete |
$138.21
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Meridian Medicaid |
$138.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,542.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.70
|
| Rate for Payer: Priority Health Narrow Network |
$330.70
|
| Rate for Payer: Priority Health SBD |
$330.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,013.84
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$114.81 |
| Max. Negotiated Rate |
$2,807.39 |
| Rate for Payer: Aetna Commercial |
$233.82
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.39
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.10
|
| Rate for Payer: Priority Health Narrow Network |
$289.10
|
| Rate for Payer: Priority Health SBD |
$289.10
|
| Rate for Payer: UMR Bronson Commercial |
$425.50
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$3,253.27 |
| Rate for Payer: Aetna Commercial |
$604.90
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.27
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.35
|
| Rate for Payer: Priority Health Narrow Network |
$754.35
|
| Rate for Payer: Priority Health SBD |
$754.35
|
| Rate for Payer: UMR Bronson Commercial |
$468.28
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$6,449.49 |
| Rate for Payer: Aetna Commercial |
$337.43
|
| Rate for Payer: BCBS Complete |
$173.55
|
| Rate for Payer: BCBS Trust/PPO |
$6,449.49
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Meridian Medicaid |
$173.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.99
|
| Rate for Payer: Priority Health Narrow Network |
$414.99
|
| Rate for Payer: Priority Health SBD |
$414.99
|
| Rate for Payer: UMR Bronson Commercial |
$473.34
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$261.56 |
| Max. Negotiated Rate |
$656.54 |
| Rate for Payer: Aetna Commercial |
$534.36
|
| Rate for Payer: BCBS Complete |
$274.64
|
| Rate for Payer: BCBS Trust/PPO |
$475.77
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Meridian Medicaid |
$274.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$656.54
|
| Rate for Payer: Priority Health Narrow Network |
$656.54
|
| Rate for Payer: Priority Health SBD |
$656.54
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$293.09 |
| Max. Negotiated Rate |
$7,524.58 |
| Rate for Payer: Aetna Commercial |
$598.21
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.58
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$996.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.42
|
| Rate for Payer: Priority Health Narrow Network |
$735.42
|
| Rate for Payer: Priority Health SBD |
$735.42
|
| Rate for Payer: UMR Bronson Commercial |
$655.04
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$569.78 |
| Max. Negotiated Rate |
$2,193.80 |
| Rate for Payer: Aetna Commercial |
$1,154.60
|
| Rate for Payer: BCBS Complete |
$598.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Meridian Medicaid |
$598.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$569.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,193.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,431.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.40
|
| Rate for Payer: Priority Health SBD |
$1,431.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.64
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$2,379.46 |
| Rate for Payer: Aetna Commercial |
$958.23
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.46
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.26
|
| Rate for Payer: Priority Health SBD |
$1,195.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,104.00
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$3,051.99 |
| Rate for Payer: Aetna Commercial |
$370.57
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,051.99
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$466.88
|
| Rate for Payer: Priority Health Narrow Network |
$466.88
|
| Rate for Payer: Priority Health SBD |
$466.88
|
| Rate for Payer: UMR Bronson Commercial |
$246.10
|
|
