|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 95928
|
| Min. Negotiated Rate |
$99.85 |
| Max. Negotiated Rate |
$344.03 |
| Rate for Payer: Aetna Commercial |
$297.96
|
| Rate for Payer: Aetna Commercial |
$297.96
|
| Rate for Payer: Aetna Medicare |
$222.36
|
| Rate for Payer: Aetna Medicare |
$222.36
|
| Rate for Payer: BCBS Complete |
$194.80
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$222.36
|
| Rate for Payer: BCBS MAPPO |
$222.36
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: BCN Commercial |
$344.03
|
| Rate for Payer: BCN Commercial |
$344.03
|
| Rate for Payer: BCN Medicare Advantage |
$222.36
|
| Rate for Payer: BCN Medicare Advantage |
$222.36
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cofinity Commercial |
$297.96
|
| Rate for Payer: Cofinity Commercial |
$320.20
|
| Rate for Payer: Cofinity Commercial |
$297.96
|
| Rate for Payer: Cofinity Commercial |
$320.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.36
|
| Rate for Payer: Healthscope Commercial |
$266.83
|
| Rate for Payer: Healthscope Commercial |
$266.83
|
| Rate for Payer: Healthscope Whirlpool |
$266.83
|
| Rate for Payer: Healthscope Whirlpool |
$266.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$233.48
|
| Rate for Payer: PACE SWMI |
$222.36
|
| Rate for Payer: PACE SWMI |
$222.36
|
| Rate for Payer: PHP Medicare Advantage |
$222.36
|
| Rate for Payer: PHP Medicare Advantage |
$222.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.20
|
| Rate for Payer: Priority Health Medicare |
$222.36
|
| Rate for Payer: Priority Health Medicare |
$222.36
|
| Rate for Payer: Priority Health Narrow Network |
$316.20
|
| Rate for Payer: Priority Health Narrow Network |
$316.20
|
| Rate for Payer: UHC Medicare Advantage |
$229.03
|
| Rate for Payer: UHC Medicare Advantage |
$229.03
|
|
|
PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 95939
|
| Min. Negotiated Rate |
$128.80 |
| Max. Negotiated Rate |
$797.04 |
| Rate for Payer: Aetna Commercial |
$684.85
|
| Rate for Payer: Aetna Medicare |
$511.08
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$511.08
|
| Rate for Payer: BCBS Trust/PPO |
$596.45
|
| Rate for Payer: BCN Commercial |
$797.04
|
| Rate for Payer: BCN Medicare Advantage |
$511.08
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$735.96
|
| Rate for Payer: Cofinity Commercial |
$684.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.08
|
| Rate for Payer: Healthscope Commercial |
$613.30
|
| Rate for Payer: Healthscope Whirlpool |
$613.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$536.63
|
| Rate for Payer: PACE SWMI |
$511.08
|
| Rate for Payer: PHP Medicare Advantage |
$511.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.55
|
| Rate for Payer: Priority Health Medicare |
$511.08
|
| Rate for Payer: Priority Health Narrow Network |
$732.55
|
| Rate for Payer: UHC Medicare Advantage |
$526.41
|
|
|
PR CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 59160
|
| Min. Negotiated Rate |
$121.84 |
| Max. Negotiated Rate |
$516.15 |
| Rate for Payer: Aetna Commercial |
$253.10
|
| Rate for Payer: Aetna Medicare |
$188.88
|
| Rate for Payer: BCBS Complete |
$127.93
|
| Rate for Payer: BCBS MAPPO |
$188.88
|
| Rate for Payer: BCBS Trust/PPO |
$516.15
|
| Rate for Payer: BCN Commercial |
$405.60
|
| Rate for Payer: BCN Medicare Advantage |
$188.88
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$253.10
|
| Rate for Payer: Cofinity Commercial |
$271.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.88
|
| Rate for Payer: Healthscope Commercial |
$226.66
|
| Rate for Payer: Healthscope Whirlpool |
$226.66
|
| Rate for Payer: Meridian Medicaid |
$127.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.32
|
| Rate for Payer: PACE SWMI |
$188.88
|
| Rate for Payer: PHP Medicare Advantage |
$188.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.14
|
| Rate for Payer: Priority Health Medicare |
$188.88
|
| Rate for Payer: Priority Health Narrow Network |
$269.14
|
| Rate for Payer: UHC Medicare Advantage |
$194.55
|
|
|
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 |
$171.45
|
| Rate for Payer: Aetna Medicare |
$127.95
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$127.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.83
|
| Rate for Payer: BCN Commercial |
$373.84
|
| Rate for Payer: BCN Medicare Advantage |
$127.95
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$184.25
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.95
|
| Rate for Payer: Healthscope Commercial |
$153.54
|
| Rate for Payer: Healthscope Whirlpool |
$153.54
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.35
|
| Rate for Payer: PACE SWMI |
$127.95
|
| Rate for Payer: PHP Medicare Advantage |
$127.95
|
| 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 Medicare |
$127.95
|
| Rate for Payer: Priority Health Narrow Network |
$228.72
|
| Rate for Payer: UHC Medicare Advantage |
$131.79
|
|
|
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
|
|
|
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 |
$934.14
|
| Rate for Payer: Aetna Medicare |
$697.12
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS MAPPO |
$697.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,370.48
|
| Rate for Payer: BCN Commercial |
$1,030.14
|
| Rate for Payer: BCN Medicare Advantage |
$697.12
|
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Cash Price |
$1,144.80
|
| Rate for Payer: Cofinity Commercial |
$1,003.85
|
| Rate for Payer: Cofinity Commercial |
$934.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.12
|
| Rate for Payer: Healthscope Commercial |
$836.54
|
| Rate for Payer: Healthscope Whirlpool |
$836.54
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$731.98
|
| Rate for Payer: PACE SWMI |
$697.12
|
| Rate for Payer: PHP Medicare Advantage |
$697.12
|
| 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 Medicare |
$697.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.07
|
| Rate for Payer: UHC Medicare Advantage |
$718.03
|
|
|
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 |
$18.25
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS MAPPO |
$13.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$20.04
|
| Rate for Payer: BCN Medicare Advantage |
$13.62
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.62
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Healthscope Whirlpool |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.30
|
| Rate for Payer: PACE SWMI |
$13.62
|
| Rate for Payer: PHP Medicare Advantage |
$13.62
|
| 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 Medicare |
$13.62
|
| Rate for Payer: Priority Health Narrow Network |
$19.38
|
| Rate for Payer: UHC Medicare Advantage |
$14.03
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$1,426.94 |
| Rate for Payer: Aetna Commercial |
$44.41
|
| Rate for Payer: Aetna Medicare |
$33.14
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$33.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.94
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: BCN Medicare Advantage |
$33.14
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$47.72
|
| Rate for Payer: Cofinity Commercial |
$44.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.14
|
| Rate for Payer: Healthscope Commercial |
$39.77
|
| Rate for Payer: Healthscope Whirlpool |
$39.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.80
|
| Rate for Payer: PACE SWMI |
$33.14
|
| Rate for Payer: PHP Medicare Advantage |
$33.14
|
| 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 Medicare |
$33.14
|
| Rate for Payer: Priority Health Narrow Network |
$50.60
|
| Rate for Payer: UHC Medicare Advantage |
$34.13
|
|
|
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 |
$27.54
|
| Rate for Payer: Aetna Medicare |
$20.55
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$20.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.90
|
| Rate for Payer: BCN Commercial |
$30.29
|
| Rate for Payer: BCN Medicare Advantage |
$20.55
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$29.59
|
| Rate for Payer: Cofinity Commercial |
$27.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$24.66
|
| Rate for Payer: Healthscope Whirlpool |
$24.66
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.58
|
| Rate for Payer: PACE SWMI |
$20.55
|
| Rate for Payer: PHP Medicare Advantage |
$20.55
|
| 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 Medicare |
$20.55
|
| Rate for Payer: Priority Health Narrow Network |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$21.17
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$2,485.65 |
| Rate for Payer: Aetna Commercial |
$90.21
|
| Rate for Payer: Aetna Medicare |
$67.32
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS MAPPO |
$67.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,485.65
|
| Rate for Payer: BCN Commercial |
$102.62
|
| Rate for Payer: BCN Medicare Advantage |
$67.32
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$96.94
|
| Rate for Payer: Cofinity Commercial |
$90.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.32
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Healthscope Whirlpool |
$80.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.69
|
| Rate for Payer: PACE SWMI |
$67.32
|
| Rate for Payer: PHP Medicare Advantage |
$67.32
|
| 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 Medicare |
$67.32
|
| Rate for Payer: Priority Health Narrow Network |
$99.30
|
| Rate for Payer: UHC Medicare Advantage |
$69.34
|
|
|
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 |
$1,927.74
|
| Rate for Payer: Aetna Medicare |
$1,438.61
|
| Rate for Payer: BCBS Complete |
$977.80
|
| Rate for Payer: BCBS MAPPO |
$1,438.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,145.50
|
| Rate for Payer: BCN Commercial |
$2,115.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,438.61
|
| Rate for Payer: Cash Price |
$2,204.80
|
| Rate for Payer: Cash Price |
$2,204.80
|
| Rate for Payer: Cofinity Commercial |
$2,071.60
|
| Rate for Payer: Cofinity Commercial |
$1,927.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,438.61
|
| Rate for Payer: Healthscope Commercial |
$1,726.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,726.33
|
| Rate for Payer: Meridian Medicaid |
$977.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,510.54
|
| Rate for Payer: PACE SWMI |
$1,438.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,438.61
|
| 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 Medicare |
$1,438.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,339.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,481.77
|
|
|
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 |
$1,648.41
|
| Rate for Payer: Aetna Medicare |
$1,230.16
|
| Rate for Payer: BCBS Complete |
$838.91
|
| Rate for Payer: BCBS MAPPO |
$1,230.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.69
|
| Rate for Payer: BCN Commercial |
$1,811.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,230.16
|
| Rate for Payer: Cash Price |
$6,080.00
|
| Rate for Payer: Cash Price |
$6,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,771.43
|
| Rate for Payer: Cofinity Commercial |
$1,648.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,230.16
|
| Rate for Payer: Healthscope Commercial |
$1,476.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,476.19
|
| Rate for Payer: Meridian Medicaid |
$838.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,291.67
|
| Rate for Payer: PACE SWMI |
$1,230.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,230.16
|
| 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 Medicare |
$1,230.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,002.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,267.06
|
|
|
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 |
$1,261.93
|
| Rate for Payer: Aetna Medicare |
$941.74
|
| Rate for Payer: BCBS Complete |
$643.00
|
| Rate for Payer: BCBS MAPPO |
$941.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.35
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: BCN Medicare Advantage |
$941.74
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$1,356.11
|
| Rate for Payer: Cofinity Commercial |
$1,261.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$941.74
|
| Rate for Payer: Healthscope Commercial |
$1,130.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,130.09
|
| Rate for Payer: Meridian Medicaid |
$643.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$988.83
|
| Rate for Payer: PACE SWMI |
$941.74
|
| Rate for Payer: PHP Medicare Advantage |
$941.74
|
| 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 Medicare |
$941.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.62
|
| Rate for Payer: UHC Medicare Advantage |
$969.99
|
|
|
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 |
$2,378.51
|
| Rate for Payer: Aetna Medicare |
$1,775.01
|
| Rate for Payer: BCBS Complete |
$1,203.69
|
| Rate for Payer: BCBS MAPPO |
$1,775.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,111.16
|
| Rate for Payer: BCN Commercial |
$2,610.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,775.01
|
| Rate for Payer: Cash Price |
$2,977.60
|
| Rate for Payer: Cash Price |
$2,977.60
|
| Rate for Payer: Cofinity Commercial |
$2,556.01
|
| Rate for Payer: Cofinity Commercial |
$2,378.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,775.01
|
| Rate for Payer: Healthscope Commercial |
$2,130.01
|
| Rate for Payer: Healthscope Whirlpool |
$2,130.01
|
| Rate for Payer: Meridian Medicaid |
$1,203.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,863.76
|
| Rate for Payer: PACE SWMI |
$1,775.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,775.01
|
| 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 Medicare |
$1,775.01
|
| Rate for Payer: Priority Health Narrow Network |
$2,886.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,828.26
|
|
|
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 |
$171.69
|
| Rate for Payer: Aetna Medicare |
$128.13
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$128.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,077.80
|
| Rate for Payer: BCN Commercial |
$489.65
|
| Rate for Payer: BCN Medicare Advantage |
$128.13
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cofinity Commercial |
$184.51
|
| Rate for Payer: Cofinity Commercial |
$171.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.13
|
| Rate for Payer: Healthscope Commercial |
$153.76
|
| Rate for Payer: Healthscope Whirlpool |
$153.76
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.54
|
| Rate for Payer: PACE SWMI |
$128.13
|
| Rate for Payer: PHP Medicare Advantage |
$128.13
|
| 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 Medicare |
$128.13
|
| Rate for Payer: Priority Health Narrow Network |
$209.11
|
| Rate for Payer: UHC Medicare Advantage |
$131.97
|
|
|
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 |
$197.74
|
| Rate for Payer: Aetna Medicare |
$147.57
|
| Rate for Payer: BCBS Complete |
$100.64
|
| Rate for Payer: BCBS MAPPO |
$147.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.67
|
| Rate for Payer: BCN Commercial |
$478.42
|
| Rate for Payer: BCN Medicare Advantage |
$147.57
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$197.74
|
| Rate for Payer: Cofinity Commercial |
$212.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.57
|
| Rate for Payer: Healthscope Commercial |
$177.08
|
| Rate for Payer: Healthscope Whirlpool |
$177.08
|
| Rate for Payer: Meridian Medicaid |
$100.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$154.95
|
| Rate for Payer: PACE SWMI |
$147.57
|
| Rate for Payer: PHP Medicare Advantage |
$147.57
|
| 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 Medicare |
$147.57
|
| Rate for Payer: Priority Health Narrow Network |
$240.46
|
| Rate for Payer: UHC Medicare Advantage |
$152.00
|
|
|
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 |
$416.70
|
| Rate for Payer: Aetna Medicare |
$310.97
|
| Rate for Payer: BCBS Complete |
$210.68
|
| Rate for Payer: BCBS MAPPO |
$310.97
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.76
|
| Rate for Payer: BCN Commercial |
$456.42
|
| Rate for Payer: BCN Medicare Advantage |
$310.97
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cofinity Commercial |
$447.80
|
| Rate for Payer: Cofinity Commercial |
$416.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$373.16
|
| Rate for Payer: Healthscope Whirlpool |
$373.16
|
| Rate for Payer: Meridian Medicaid |
$210.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$326.52
|
| Rate for Payer: PACE SWMI |
$310.97
|
| Rate for Payer: PHP Medicare Advantage |
$310.97
|
| 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 Medicare |
$310.97
|
| Rate for Payer: Priority Health Narrow Network |
$504.70
|
| Rate for Payer: UHC Medicare Advantage |
$320.30
|
|
|
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 |
$363.02
|
| Rate for Payer: Aetna Medicare |
$270.91
|
| Rate for Payer: BCBS Complete |
$183.17
|
| Rate for Payer: BCBS MAPPO |
$270.91
|
| Rate for Payer: BCBS Trust/PPO |
$894.94
|
| Rate for Payer: BCN Commercial |
$397.79
|
| Rate for Payer: BCN Medicare Advantage |
$270.91
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cofinity Commercial |
$363.02
|
| Rate for Payer: Cofinity Commercial |
$390.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$325.09
|
| Rate for Payer: Healthscope Whirlpool |
$325.09
|
| Rate for Payer: Meridian Medicaid |
$183.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.46
|
| Rate for Payer: PACE SWMI |
$270.91
|
| Rate for Payer: PHP Medicare Advantage |
$270.91
|
| 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 Medicare |
$270.91
|
| Rate for Payer: Priority Health Narrow Network |
$439.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.04
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,686.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$1,276.43 |
| Rate for Payer: Aetna Commercial |
$66.21
|
| Rate for Payer: Aetna Medicare |
$49.41
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$49.41
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$1,276.43
|
| Rate for Payer: BCN Medicare Advantage |
$49.41
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cash Price |
$1,348.80
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Cofinity Commercial |
$71.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.41
|
| Rate for Payer: Healthscope Commercial |
$59.29
|
| Rate for Payer: Healthscope Whirlpool |
$59.29
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.88
|
| Rate for Payer: PACE SWMI |
$49.41
|
| Rate for Payer: PHP Medicare Advantage |
$49.41
|
| 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 Medicare |
$49.41
|
| Rate for Payer: Priority Health Narrow Network |
$79.97
|
| Rate for Payer: UHC Medicare Advantage |
$50.89
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$272.85
|
| Rate for Payer: Aetna Medicare |
$203.62
|
| Rate for Payer: BCBS Complete |
$138.21
|
| Rate for Payer: BCBS MAPPO |
$203.62
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: BCN Commercial |
$1,866.75
|
| Rate for Payer: BCN Medicare Advantage |
$203.62
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cofinity Commercial |
$272.85
|
| Rate for Payer: Cofinity Commercial |
$293.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.62
|
| Rate for Payer: Healthscope Commercial |
$244.34
|
| Rate for Payer: Healthscope Whirlpool |
$244.34
|
| Rate for Payer: Meridian Medicaid |
$138.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$213.80
|
| Rate for Payer: PACE SWMI |
$203.62
|
| Rate for Payer: PHP Medicare Advantage |
$203.62
|
| 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 Medicare |
$203.62
|
| Rate for Payer: Priority Health Narrow Network |
$330.70
|
| Rate for Payer: UHC Medicare Advantage |
$209.73
|
|
|
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 |
$238.01
|
| Rate for Payer: Aetna Medicare |
$177.62
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS MAPPO |
$177.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.39
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: BCN Medicare Advantage |
$177.62
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cofinity Commercial |
$255.77
|
| Rate for Payer: Cofinity Commercial |
$238.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.62
|
| Rate for Payer: Healthscope Commercial |
$213.14
|
| Rate for Payer: Healthscope Whirlpool |
$213.14
|
| Rate for Payer: Meridian Medicaid |
$120.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.50
|
| Rate for Payer: PACE SWMI |
$177.62
|
| Rate for Payer: PHP Medicare Advantage |
$177.62
|
| 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 Medicare |
$177.62
|
| Rate for Payer: Priority Health Narrow Network |
$289.10
|
| Rate for Payer: UHC Medicare Advantage |
$182.95
|
|
|
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 |
$616.82
|
| Rate for Payer: Aetna Medicare |
$460.31
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS MAPPO |
$460.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.27
|
| Rate for Payer: BCN Commercial |
$682.20
|
| Rate for Payer: BCN Medicare Advantage |
$460.31
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$616.82
|
| Rate for Payer: Cofinity Commercial |
$662.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.31
|
| Rate for Payer: Healthscope Commercial |
$552.37
|
| Rate for Payer: Healthscope Whirlpool |
$552.37
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$483.33
|
| Rate for Payer: PACE SWMI |
$460.31
|
| Rate for Payer: PHP Medicare Advantage |
$460.31
|
| 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 Medicare |
$460.31
|
| Rate for Payer: Priority Health Narrow Network |
$754.35
|
| Rate for Payer: UHC Medicare Advantage |
$474.12
|
|
|
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 |
$342.45
|
| Rate for Payer: Aetna Medicare |
$255.56
|
| Rate for Payer: BCBS Complete |
$173.55
|
| Rate for Payer: BCBS MAPPO |
$255.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,449.49
|
| Rate for Payer: BCN Commercial |
$884.01
|
| Rate for Payer: BCN Medicare Advantage |
$255.56
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$368.01
|
| Rate for Payer: Cofinity Commercial |
$342.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.56
|
| Rate for Payer: Healthscope Commercial |
$306.67
|
| Rate for Payer: Healthscope Whirlpool |
$306.67
|
| Rate for Payer: Meridian Medicaid |
$173.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.34
|
| Rate for Payer: PACE SWMI |
$255.56
|
| Rate for Payer: PHP Medicare Advantage |
$255.56
|
| 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 Medicare |
$255.56
|
| Rate for Payer: Priority Health Narrow Network |
$414.99
|
| Rate for Payer: UHC Medicare Advantage |
$263.23
|
|
|
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 |
$542.07
|
| Rate for Payer: Aetna Medicare |
$404.53
|
| Rate for Payer: BCBS Complete |
$274.64
|
| Rate for Payer: BCBS MAPPO |
$404.53
|
| Rate for Payer: BCBS Trust/PPO |
$475.77
|
| Rate for Payer: BCN Commercial |
$593.74
|
| Rate for Payer: BCN Medicare Advantage |
$404.53
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$582.52
|
| Rate for Payer: Cofinity Commercial |
$542.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.53
|
| Rate for Payer: Healthscope Commercial |
$485.44
|
| Rate for Payer: Healthscope Whirlpool |
$485.44
|
| Rate for Payer: Meridian Medicaid |
$274.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$424.76
|
| Rate for Payer: PACE SWMI |
$404.53
|
| Rate for Payer: PHP Medicare Advantage |
$404.53
|
| 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 Medicare |
$404.53
|
| Rate for Payer: Priority Health Narrow Network |
$656.54
|
| Rate for Payer: UHC Medicare Advantage |
$416.67
|
|
|
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 |
$607.33
|
| Rate for Payer: Aetna Medicare |
$453.23
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS MAPPO |
$453.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.58
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: BCN Medicare Advantage |
$453.23
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cash Price |
$1,139.20
|
| Rate for Payer: Cofinity Commercial |
$652.65
|
| Rate for Payer: Cofinity Commercial |
$607.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.23
|
| Rate for Payer: Healthscope Commercial |
$543.88
|
| Rate for Payer: Healthscope Whirlpool |
$543.88
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$475.89
|
| Rate for Payer: PACE SWMI |
$453.23
|
| Rate for Payer: PHP Medicare Advantage |
$453.23
|
| 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 Medicare |
$453.23
|
| Rate for Payer: Priority Health Narrow Network |
$735.42
|
| Rate for Payer: UHC Medicare Advantage |
$466.83
|
|
