|
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 |
$1,175.72
|
| Rate for Payer: Aetna Medicare |
$877.40
|
| Rate for Payer: BCBS Complete |
$598.27
|
| Rate for Payer: BCBS MAPPO |
$877.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: BCN Commercial |
$1,294.51
|
| Rate for Payer: BCN Medicare Advantage |
$877.40
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cofinity Commercial |
$1,263.46
|
| Rate for Payer: Cofinity Commercial |
$1,175.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$877.40
|
| Rate for Payer: Healthscope Commercial |
$1,052.88
|
| Rate for Payer: Healthscope Whirlpool |
$1,052.88
|
| Rate for Payer: Meridian Medicaid |
$598.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$921.27
|
| Rate for Payer: PACE SWMI |
$877.40
|
| Rate for Payer: PHP Medicare Advantage |
$877.40
|
| 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 Medicare |
$877.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.40
|
| Rate for Payer: UHC Medicare Advantage |
$903.72
|
|
|
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 |
$980.28
|
| Rate for Payer: Aetna Medicare |
$731.55
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$731.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.46
|
| Rate for Payer: BCN Commercial |
$1,080.96
|
| Rate for Payer: BCN Medicare Advantage |
$731.55
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$980.28
|
| Rate for Payer: Cofinity Commercial |
$1,053.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$731.55
|
| Rate for Payer: Healthscope Commercial |
$877.86
|
| Rate for Payer: Healthscope Whirlpool |
$877.86
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$768.13
|
| Rate for Payer: PACE SWMI |
$731.55
|
| Rate for Payer: PHP Medicare Advantage |
$731.55
|
| 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 Medicare |
$731.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,195.26
|
| Rate for Payer: UHC Medicare Advantage |
$753.50
|
|
|
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 |
$379.61
|
| Rate for Payer: Aetna Medicare |
$283.29
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$283.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,051.99
|
| Rate for Payer: BCN Commercial |
$422.22
|
| Rate for Payer: BCN Medicare Advantage |
$283.29
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cofinity Commercial |
$379.61
|
| Rate for Payer: Cofinity Commercial |
$407.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.29
|
| Rate for Payer: Healthscope Commercial |
$339.95
|
| Rate for Payer: Healthscope Whirlpool |
$339.95
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$297.45
|
| Rate for Payer: PACE SWMI |
$283.29
|
| Rate for Payer: PHP Medicare Advantage |
$283.29
|
| 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 Medicare |
$283.29
|
| Rate for Payer: Priority Health Narrow Network |
$466.88
|
| Rate for Payer: UHC Medicare Advantage |
$291.79
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$2,402.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$301.61 |
| Max. Negotiated Rate |
$3,049.88 |
| Rate for Payer: Aetna Commercial |
$614.15
|
| Rate for Payer: Aetna Medicare |
$458.32
|
| Rate for Payer: BCBS Complete |
$316.69
|
| Rate for Payer: BCBS MAPPO |
$458.32
|
| Rate for Payer: BCBS Trust/PPO |
$3,049.88
|
| Rate for Payer: BCN Commercial |
$680.73
|
| Rate for Payer: BCN Medicare Advantage |
$458.32
|
| Rate for Payer: Cash Price |
$1,921.60
|
| Rate for Payer: Cash Price |
$1,921.60
|
| Rate for Payer: Cofinity Commercial |
$659.98
|
| Rate for Payer: Cofinity Commercial |
$614.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.32
|
| Rate for Payer: Healthscope Commercial |
$549.98
|
| Rate for Payer: Healthscope Whirlpool |
$549.98
|
| Rate for Payer: Meridian Medicaid |
$316.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$481.24
|
| Rate for Payer: PACE SWMI |
$458.32
|
| Rate for Payer: PHP Medicare Advantage |
$458.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$752.72
|
| Rate for Payer: Priority Health Medicare |
$458.32
|
| Rate for Payer: Priority Health Narrow Network |
$752.72
|
| Rate for Payer: UHC Medicare Advantage |
$472.07
|
|
|
PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE
|
Professional
|
Both
|
$1,963.00
|
|
|
Service Code
|
HCPCS 51525
|
| Min. Negotiated Rate |
$544.85 |
| Max. Negotiated Rate |
$3,181.95 |
| Rate for Payer: Aetna Commercial |
$1,125.79
|
| Rate for Payer: Aetna Medicare |
$840.14
|
| Rate for Payer: BCBS Complete |
$572.09
|
| Rate for Payer: BCBS MAPPO |
$840.14
|
| Rate for Payer: BCBS Trust/PPO |
$3,181.95
|
| Rate for Payer: BCN Commercial |
$1,239.29
|
| Rate for Payer: BCN Medicare Advantage |
$840.14
|
| Rate for Payer: Cash Price |
$1,570.40
|
| Rate for Payer: Cash Price |
$1,570.40
|
| Rate for Payer: Cofinity Commercial |
$1,209.80
|
| Rate for Payer: Cofinity Commercial |
$1,125.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.14
|
| Rate for Payer: Healthscope Commercial |
$1,008.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,008.17
|
| Rate for Payer: Meridian Medicaid |
$572.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$882.15
|
| Rate for Payer: PACE SWMI |
$840.14
|
| Rate for Payer: PHP Medicare Advantage |
$840.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$544.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,370.35
|
| Rate for Payer: Priority Health Medicare |
$840.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,370.35
|
| Rate for Payer: UHC Medicare Advantage |
$865.34
|
|
|
PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE
|
Professional
|
Both
|
$1,695.00
|
|
|
Service Code
|
HCPCS 51535
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$3,177.20 |
| Rate for Payer: Aetna Commercial |
$1,020.48
|
| Rate for Payer: Aetna Medicare |
$761.55
|
| Rate for Payer: BCBS Complete |
$520.65
|
| Rate for Payer: BCBS MAPPO |
$761.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,177.20
|
| Rate for Payer: BCN Commercial |
$1,124.45
|
| Rate for Payer: BCN Medicare Advantage |
$761.55
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cofinity Commercial |
$1,096.63
|
| Rate for Payer: Cofinity Commercial |
$1,020.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.55
|
| Rate for Payer: Healthscope Commercial |
$913.86
|
| Rate for Payer: Healthscope Whirlpool |
$913.86
|
| Rate for Payer: Meridian Medicaid |
$520.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$799.63
|
| Rate for Payer: PACE SWMI |
$761.55
|
| Rate for Payer: PHP Medicare Advantage |
$761.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$495.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.36
|
| Rate for Payer: Priority Health Medicare |
$761.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,243.36
|
| Rate for Payer: UHC Medicare Advantage |
$784.40
|
|
|
PR CYSTOTOMY EXCISION BLADDER TUMOR
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 51530
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$2,404.29 |
| Rate for Payer: Aetna Commercial |
$1,007.49
|
| Rate for Payer: Aetna Medicare |
$751.86
|
| Rate for Payer: BCBS Complete |
$514.40
|
| Rate for Payer: BCBS MAPPO |
$751.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,404.29
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$751.86
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$1,007.49
|
| Rate for Payer: Cofinity Commercial |
$1,082.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.86
|
| Rate for Payer: Healthscope Commercial |
$902.23
|
| Rate for Payer: Healthscope Whirlpool |
$902.23
|
| Rate for Payer: Meridian Medicaid |
$514.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$789.45
|
| Rate for Payer: PACE SWMI |
$751.86
|
| Rate for Payer: PHP Medicare Advantage |
$751.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,227.70
|
| Rate for Payer: Priority Health Medicare |
$751.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,227.70
|
| Rate for Payer: UHC Medicare Advantage |
$774.42
|
|
|
PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 51520
|
| Min. Negotiated Rate |
$380.42 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$779.22
|
| Rate for Payer: Aetna Medicare |
$581.51
|
| Rate for Payer: BCBS Complete |
$399.44
|
| Rate for Payer: BCBS MAPPO |
$581.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$861.05
|
| Rate for Payer: BCN Medicare Advantage |
$581.51
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$779.22
|
| Rate for Payer: Cofinity Commercial |
$837.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.51
|
| Rate for Payer: Healthscope Commercial |
$697.81
|
| Rate for Payer: Healthscope Whirlpool |
$697.81
|
| Rate for Payer: Meridian Medicaid |
$399.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$610.59
|
| Rate for Payer: PACE SWMI |
$581.51
|
| Rate for Payer: PHP Medicare Advantage |
$581.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$380.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.11
|
| Rate for Payer: Priority Health Medicare |
$581.51
|
| Rate for Payer: Priority Health Narrow Network |
$952.11
|
| Rate for Payer: UHC Medicare Advantage |
$598.96
|
|
|
PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO
|
Professional
|
Both
|
$1,930.00
|
|
|
Service Code
|
HCPCS 51065
|
| Min. Negotiated Rate |
$370.83 |
| Max. Negotiated Rate |
$2,864.97 |
| Rate for Payer: Aetna Commercial |
$759.40
|
| Rate for Payer: Aetna Medicare |
$566.72
|
| Rate for Payer: BCBS Complete |
$389.37
|
| Rate for Payer: BCBS MAPPO |
$566.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,864.97
|
| Rate for Payer: BCN Commercial |
$839.06
|
| Rate for Payer: BCN Medicare Advantage |
$566.72
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cash Price |
$1,544.00
|
| Rate for Payer: Cofinity Commercial |
$816.08
|
| Rate for Payer: Cofinity Commercial |
$759.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.72
|
| Rate for Payer: Healthscope Commercial |
$680.06
|
| Rate for Payer: Healthscope Whirlpool |
$680.06
|
| Rate for Payer: Meridian Medicaid |
$389.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$595.06
|
| Rate for Payer: PACE SWMI |
$566.72
|
| Rate for Payer: PHP Medicare Advantage |
$566.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,351.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$927.79
|
| Rate for Payer: Priority Health Medicare |
$566.72
|
| Rate for Payer: Priority Health Narrow Network |
$927.79
|
| Rate for Payer: UHC Medicare Advantage |
$583.72
|
|
|
PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX
|
Professional
|
Both
|
$1,012.00
|
|
|
Service Code
|
HCPCS 51045
|
| Min. Negotiated Rate |
$319.07 |
| Max. Negotiated Rate |
$3,133.88 |
| Rate for Payer: Aetna Commercial |
$657.83
|
| Rate for Payer: Aetna Medicare |
$490.92
|
| Rate for Payer: BCBS Complete |
$335.02
|
| Rate for Payer: BCBS MAPPO |
$490.92
|
| Rate for Payer: BCBS Trust/PPO |
$3,133.88
|
| Rate for Payer: BCN Commercial |
$728.13
|
| Rate for Payer: BCN Medicare Advantage |
$490.92
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cash Price |
$809.60
|
| Rate for Payer: Cofinity Commercial |
$657.83
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.92
|
| Rate for Payer: Healthscope Commercial |
$589.10
|
| Rate for Payer: Healthscope Whirlpool |
$589.10
|
| Rate for Payer: Meridian Medicaid |
$335.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.47
|
| Rate for Payer: PACE SWMI |
$490.92
|
| Rate for Payer: PHP Medicare Advantage |
$490.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$708.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.13
|
| Rate for Payer: Priority Health Medicare |
$490.92
|
| Rate for Payer: Priority Health Narrow Network |
$805.13
|
| Rate for Payer: UHC Medicare Advantage |
$505.65
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$260.71 |
| Max. Negotiated Rate |
$654.37 |
| Rate for Payer: Aetna Commercial |
$540.41
|
| Rate for Payer: Aetna Medicare |
$403.29
|
| Rate for Payer: BCBS Complete |
$273.75
|
| Rate for Payer: BCBS MAPPO |
$403.29
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: BCN Commercial |
$591.79
|
| Rate for Payer: BCN Medicare Advantage |
$403.29
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cofinity Commercial |
$580.74
|
| Rate for Payer: Cofinity Commercial |
$540.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.29
|
| Rate for Payer: Healthscope Commercial |
$483.95
|
| Rate for Payer: Healthscope Whirlpool |
$483.95
|
| Rate for Payer: Meridian Medicaid |
$273.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$423.45
|
| Rate for Payer: PACE SWMI |
$403.29
|
| Rate for Payer: PHP Medicare Advantage |
$403.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.37
|
| Rate for Payer: Priority Health Medicare |
$403.29
|
| Rate for Payer: Priority Health Narrow Network |
$654.37
|
| Rate for Payer: UHC Medicare Advantage |
$415.39
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$50.69 |
| Max. Negotiated Rate |
$1,840.07 |
| Rate for Payer: Aetna Commercial |
$105.23
|
| Rate for Payer: Aetna Medicare |
$78.53
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$78.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.07
|
| Rate for Payer: BCN Commercial |
$352.33
|
| Rate for Payer: BCN Medicare Advantage |
$78.53
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$105.23
|
| Rate for Payer: Cofinity Commercial |
$113.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.53
|
| Rate for Payer: Healthscope Commercial |
$94.24
|
| Rate for Payer: Healthscope Whirlpool |
$94.24
|
| Rate for Payer: Meridian Medicaid |
$53.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.46
|
| Rate for Payer: PACE SWMI |
$78.53
|
| Rate for Payer: PHP Medicare Advantage |
$78.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.52
|
| Rate for Payer: Priority Health Medicare |
$78.53
|
| Rate for Payer: Priority Health Narrow Network |
$127.52
|
| Rate for Payer: UHC Medicare Advantage |
$80.89
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,222.49 |
| Rate for Payer: Aetna Commercial |
$221.18
|
| Rate for Payer: Aetna Medicare |
$165.06
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$165.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,222.49
|
| Rate for Payer: BCN Commercial |
$570.29
|
| Rate for Payer: BCN Medicare Advantage |
$165.06
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$237.69
|
| Rate for Payer: Cofinity Commercial |
$221.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.06
|
| Rate for Payer: Healthscope Commercial |
$198.07
|
| Rate for Payer: Healthscope Whirlpool |
$198.07
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$173.31
|
| Rate for Payer: PACE SWMI |
$165.06
|
| Rate for Payer: PHP Medicare Advantage |
$165.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.02
|
| Rate for Payer: Priority Health Medicare |
$165.06
|
| Rate for Payer: Priority Health Narrow Network |
$268.02
|
| Rate for Payer: UHC Medicare Advantage |
$170.01
|
|
|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$211.72 |
| Max. Negotiated Rate |
$1,714.86 |
| Rate for Payer: Aetna Commercial |
$437.90
|
| Rate for Payer: Aetna Medicare |
$326.79
|
| Rate for Payer: BCBS Complete |
$222.31
|
| Rate for Payer: BCBS MAPPO |
$326.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,714.86
|
| Rate for Payer: BCN Commercial |
$479.88
|
| Rate for Payer: BCN Medicare Advantage |
$326.79
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cofinity Commercial |
$470.58
|
| Rate for Payer: Cofinity Commercial |
$437.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.79
|
| Rate for Payer: Healthscope Commercial |
$392.15
|
| Rate for Payer: Healthscope Whirlpool |
$392.15
|
| Rate for Payer: Meridian Medicaid |
$222.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.13
|
| Rate for Payer: PACE SWMI |
$326.79
|
| Rate for Payer: PHP Medicare Advantage |
$326.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.63
|
| Rate for Payer: Priority Health Medicare |
$326.79
|
| Rate for Payer: Priority Health Narrow Network |
$530.63
|
| Rate for Payer: UHC Medicare Advantage |
$336.59
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$4,966.55 |
| Rate for Payer: Aetna Commercial |
$311.35
|
| Rate for Payer: Aetna Medicare |
$232.35
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$232.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,966.55
|
| Rate for Payer: BCN Commercial |
$341.58
|
| Rate for Payer: BCN Medicare Advantage |
$232.35
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$311.35
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.35
|
| Rate for Payer: Healthscope Commercial |
$278.82
|
| Rate for Payer: Healthscope Whirlpool |
$278.82
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$243.97
|
| Rate for Payer: PACE SWMI |
$232.35
|
| Rate for Payer: PHP Medicare Advantage |
$232.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.71
|
| Rate for Payer: Priority Health Medicare |
$232.35
|
| Rate for Payer: Priority Health Narrow Network |
$377.71
|
| Rate for Payer: UHC Medicare Advantage |
$239.32
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$123.54 |
| Max. Negotiated Rate |
$1,483.99 |
| Rate for Payer: Aetna Commercial |
$254.47
|
| Rate for Payer: Aetna Medicare |
$189.90
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$189.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,483.99
|
| Rate for Payer: BCN Commercial |
$513.12
|
| Rate for Payer: BCN Medicare Advantage |
$189.90
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$273.46
|
| Rate for Payer: Cofinity Commercial |
$254.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.90
|
| Rate for Payer: Healthscope Commercial |
$227.88
|
| Rate for Payer: Healthscope Whirlpool |
$227.88
|
| Rate for Payer: Meridian Medicaid |
$129.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.40
|
| Rate for Payer: PACE SWMI |
$189.90
|
| Rate for Payer: PHP Medicare Advantage |
$189.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.08
|
| Rate for Payer: Priority Health Medicare |
$189.90
|
| Rate for Payer: Priority Health Narrow Network |
$309.08
|
| Rate for Payer: UHC Medicare Advantage |
$195.60
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$3,767.31 |
| Rate for Payer: Aetna Commercial |
$375.17
|
| Rate for Payer: Aetna Medicare |
$279.98
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS MAPPO |
$279.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,767.31
|
| Rate for Payer: BCN Commercial |
$411.47
|
| Rate for Payer: BCN Medicare Advantage |
$279.98
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cash Price |
$915.20
|
| Rate for Payer: Cofinity Commercial |
$403.17
|
| Rate for Payer: Cofinity Commercial |
$375.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.98
|
| Rate for Payer: Healthscope Commercial |
$335.98
|
| Rate for Payer: Healthscope Whirlpool |
$335.98
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.98
|
| Rate for Payer: PACE SWMI |
$279.98
|
| Rate for Payer: PHP Medicare Advantage |
$279.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.98
|
| Rate for Payer: Priority Health Medicare |
$279.98
|
| Rate for Payer: Priority Health Narrow Network |
$454.98
|
| Rate for Payer: UHC Medicare Advantage |
$288.38
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$4,858.78 |
| Rate for Payer: Aetna Commercial |
$509.88
|
| Rate for Payer: Aetna Medicare |
$380.51
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS MAPPO |
$380.51
|
| Rate for Payer: BCBS Trust/PPO |
$4,858.78
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$380.51
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Cash Price |
$1,759.20
|
| Rate for Payer: Cofinity Commercial |
$547.93
|
| Rate for Payer: Cofinity Commercial |
$509.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.51
|
| Rate for Payer: Healthscope Commercial |
$456.61
|
| Rate for Payer: Healthscope Whirlpool |
$456.61
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.54
|
| Rate for Payer: PACE SWMI |
$380.51
|
| Rate for Payer: PHP Medicare Advantage |
$380.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,539.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.63
|
| Rate for Payer: Priority Health Medicare |
$380.51
|
| Rate for Payer: Priority Health Narrow Network |
$617.63
|
| Rate for Payer: UHC Medicare Advantage |
$391.93
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$132.49 |
| Max. Negotiated Rate |
$1,421.13 |
| Rate for Payer: Aetna Commercial |
$274.78
|
| Rate for Payer: Aetna Medicare |
$205.06
|
| Rate for Payer: BCBS Complete |
$139.11
|
| Rate for Payer: BCBS MAPPO |
$205.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,421.13
|
| Rate for Payer: BCN Commercial |
$418.29
|
| Rate for Payer: BCN Medicare Advantage |
$205.06
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$274.78
|
| Rate for Payer: Cofinity Commercial |
$295.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$246.07
|
| Rate for Payer: Healthscope Whirlpool |
$246.07
|
| Rate for Payer: Meridian Medicaid |
$139.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$215.31
|
| Rate for Payer: PACE SWMI |
$205.06
|
| Rate for Payer: PHP Medicare Advantage |
$205.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.39
|
| Rate for Payer: Priority Health Medicare |
$205.06
|
| Rate for Payer: Priority Health Narrow Network |
$333.39
|
| Rate for Payer: UHC Medicare Advantage |
$211.21
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$102.45 |
| Max. Negotiated Rate |
$5,029.94 |
| Rate for Payer: Aetna Commercial |
$211.64
|
| Rate for Payer: Aetna Medicare |
$157.94
|
| Rate for Payer: BCBS Complete |
$107.57
|
| Rate for Payer: BCBS MAPPO |
$157.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,029.94
|
| Rate for Payer: BCN Commercial |
$549.27
|
| Rate for Payer: BCN Medicare Advantage |
$157.94
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$211.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.94
|
| Rate for Payer: Healthscope Commercial |
$189.53
|
| Rate for Payer: Healthscope Whirlpool |
$189.53
|
| Rate for Payer: Meridian Medicaid |
$107.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.84
|
| Rate for Payer: PACE SWMI |
$157.94
|
| Rate for Payer: PHP Medicare Advantage |
$157.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.21
|
| Rate for Payer: Priority Health Medicare |
$157.94
|
| Rate for Payer: Priority Health Narrow Network |
$257.21
|
| Rate for Payer: UHC Medicare Advantage |
$162.68
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$165.93 |
| Max. Negotiated Rate |
$2,759.84 |
| Rate for Payer: Aetna Commercial |
$343.54
|
| Rate for Payer: Aetna Medicare |
$256.37
|
| Rate for Payer: BCBS Complete |
$174.23
|
| Rate for Payer: BCBS MAPPO |
$256.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,759.84
|
| Rate for Payer: BCN Commercial |
$376.77
|
| Rate for Payer: BCN Medicare Advantage |
$256.37
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cofinity Commercial |
$369.17
|
| Rate for Payer: Cofinity Commercial |
$343.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.37
|
| Rate for Payer: Healthscope Commercial |
$307.64
|
| Rate for Payer: Healthscope Whirlpool |
$307.64
|
| Rate for Payer: Meridian Medicaid |
$174.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$269.19
|
| Rate for Payer: PACE SWMI |
$256.37
|
| Rate for Payer: PHP Medicare Advantage |
$256.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.62
|
| Rate for Payer: Priority Health Medicare |
$256.37
|
| Rate for Payer: Priority Health Narrow Network |
$416.62
|
| Rate for Payer: UHC Medicare Advantage |
$264.06
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$4,237.49 |
| Rate for Payer: Aetna Commercial |
$235.83
|
| Rate for Payer: Aetna Medicare |
$175.99
|
| Rate for Payer: BCBS Complete |
$119.88
|
| Rate for Payer: BCBS MAPPO |
$175.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,237.49
|
| Rate for Payer: BCN Commercial |
$617.20
|
| Rate for Payer: BCN Medicare Advantage |
$175.99
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$253.43
|
| Rate for Payer: Cofinity Commercial |
$235.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.99
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Healthscope Whirlpool |
$211.19
|
| Rate for Payer: Meridian Medicaid |
$119.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.79
|
| Rate for Payer: PACE SWMI |
$175.99
|
| Rate for Payer: PHP Medicare Advantage |
$175.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.39
|
| Rate for Payer: Priority Health Medicare |
$175.99
|
| Rate for Payer: Priority Health Narrow Network |
$286.39
|
| Rate for Payer: UHC Medicare Advantage |
$181.27
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$5,563.53 |
| Rate for Payer: Aetna Commercial |
$322.58
|
| Rate for Payer: Aetna Medicare |
$240.73
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS MAPPO |
$240.73
|
| Rate for Payer: BCBS Trust/PPO |
$5,563.53
|
| Rate for Payer: BCN Commercial |
$790.68
|
| Rate for Payer: BCN Medicare Advantage |
$240.73
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cofinity Commercial |
$322.58
|
| Rate for Payer: Cofinity Commercial |
$346.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.73
|
| Rate for Payer: Healthscope Commercial |
$288.88
|
| Rate for Payer: Healthscope Whirlpool |
$288.88
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$252.77
|
| Rate for Payer: PACE SWMI |
$240.73
|
| Rate for Payer: PHP Medicare Advantage |
$240.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.21
|
| Rate for Payer: Priority Health Medicare |
$240.73
|
| Rate for Payer: Priority Health Narrow Network |
$391.21
|
| Rate for Payer: UHC Medicare Advantage |
$247.95
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$1,981.65 |
| Rate for Payer: Aetna Commercial |
$183.15
|
| Rate for Payer: Aetna Medicare |
$136.68
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS MAPPO |
$136.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,981.65
|
| Rate for Payer: BCN Commercial |
$554.65
|
| Rate for Payer: BCN Medicare Advantage |
$136.68
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cash Price |
$586.40
|
| Rate for Payer: Cofinity Commercial |
$183.15
|
| Rate for Payer: Cofinity Commercial |
$196.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.68
|
| Rate for Payer: Healthscope Commercial |
$164.02
|
| Rate for Payer: Healthscope Whirlpool |
$164.02
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.51
|
| Rate for Payer: PACE SWMI |
$136.68
|
| Rate for Payer: PHP Medicare Advantage |
$136.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.63
|
| Rate for Payer: Priority Health Medicare |
$136.68
|
| Rate for Payer: Priority Health Narrow Network |
$222.63
|
| Rate for Payer: UHC Medicare Advantage |
$140.78
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$978.60 |
| Rate for Payer: Aetna Commercial |
$320.10
|
| Rate for Payer: Aetna Medicare |
$238.88
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cofinity Commercial |
$343.99
|
| Rate for Payer: Cofinity Commercial |
$320.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Healthscope Commercial |
$286.66
|
| Rate for Payer: Healthscope Whirlpool |
$286.66
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.98
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow Network |
$387.98
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
|
