|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$126.74 |
| Max. Negotiated Rate |
$606.49 |
| Rate for Payer: Aetna Commercial |
$261.61
|
| Rate for Payer: Aetna Medicare |
$195.23
|
| Rate for Payer: BCBS Complete |
$133.08
|
| Rate for Payer: BCBS MAPPO |
$195.23
|
| Rate for Payer: BCBS Trust/PPO |
$606.49
|
| Rate for Payer: BCN Commercial |
$517.51
|
| Rate for Payer: BCN Medicare Advantage |
$195.23
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$261.61
|
| Rate for Payer: Cofinity Commercial |
$281.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.23
|
| Rate for Payer: Healthscope Commercial |
$234.28
|
| Rate for Payer: Healthscope Whirlpool |
$234.28
|
| Rate for Payer: Meridian Medicaid |
$133.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$204.99
|
| Rate for Payer: PACE SWMI |
$195.23
|
| Rate for Payer: PHP Medicare Advantage |
$195.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.74
|
| Rate for Payer: Priority Health Medicare |
$195.23
|
| Rate for Payer: Priority Health Narrow Network |
$317.74
|
| Rate for Payer: UHC Medicare Advantage |
$201.09
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$152.93 |
| Max. Negotiated Rate |
$1,479.24 |
| Rate for Payer: Aetna Commercial |
$317.16
|
| Rate for Payer: Aetna Medicare |
$236.69
|
| Rate for Payer: BCBS Complete |
$160.58
|
| Rate for Payer: BCBS MAPPO |
$236.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.24
|
| Rate for Payer: BCN Commercial |
$347.94
|
| Rate for Payer: BCN Medicare Advantage |
$236.69
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$317.16
|
| Rate for Payer: Cofinity Commercial |
$340.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.69
|
| Rate for Payer: Healthscope Commercial |
$284.03
|
| Rate for Payer: Healthscope Whirlpool |
$284.03
|
| Rate for Payer: Meridian Medicaid |
$160.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$248.52
|
| Rate for Payer: PACE SWMI |
$236.69
|
| Rate for Payer: PHP Medicare Advantage |
$236.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.74
|
| Rate for Payer: Priority Health Medicare |
$236.69
|
| Rate for Payer: Priority Health Narrow Network |
$384.74
|
| Rate for Payer: UHC Medicare Advantage |
$243.79
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$1,188.68 |
| Rate for Payer: Aetna Commercial |
$357.99
|
| Rate for Payer: Aetna Medicare |
$267.16
|
| Rate for Payer: BCBS Complete |
$180.94
|
| Rate for Payer: BCBS MAPPO |
$267.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.68
|
| Rate for Payer: BCN Commercial |
$686.59
|
| Rate for Payer: BCN Medicare Advantage |
$267.16
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$384.71
|
| Rate for Payer: Cofinity Commercial |
$357.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.16
|
| Rate for Payer: Healthscope Commercial |
$320.59
|
| Rate for Payer: Healthscope Whirlpool |
$320.59
|
| Rate for Payer: Meridian Medicaid |
$180.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$280.52
|
| Rate for Payer: PACE SWMI |
$267.16
|
| Rate for Payer: PHP Medicare Advantage |
$267.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.90
|
| Rate for Payer: Priority Health Medicare |
$267.16
|
| Rate for Payer: Priority Health Narrow Network |
$433.90
|
| Rate for Payer: UHC Medicare Advantage |
$275.17
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,770.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$2,177.12 |
| Rate for Payer: Aetna Commercial |
$229.09
|
| Rate for Payer: Aetna Medicare |
$170.96
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS MAPPO |
$170.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,177.12
|
| Rate for Payer: BCN Commercial |
$1,100.50
|
| Rate for Payer: BCN Medicare Advantage |
$170.96
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Commercial |
$229.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.96
|
| Rate for Payer: Healthscope Commercial |
$205.15
|
| Rate for Payer: Healthscope Whirlpool |
$205.15
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$179.51
|
| Rate for Payer: PACE SWMI |
$170.96
|
| Rate for Payer: PHP Medicare Advantage |
$170.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,939.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.66
|
| Rate for Payer: Priority Health Medicare |
$170.96
|
| Rate for Payer: Priority Health Narrow Network |
$276.66
|
| Rate for Payer: UHC Medicare Advantage |
$176.09
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$2,268.52 |
| Rate for Payer: Aetna Commercial |
$202.25
|
| Rate for Payer: Aetna Medicare |
$150.93
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCBS MAPPO |
$150.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,268.52
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: BCN Medicare Advantage |
$150.93
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$217.34
|
| Rate for Payer: Cofinity Commercial |
$202.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.93
|
| Rate for Payer: Healthscope Commercial |
$181.12
|
| Rate for Payer: Healthscope Whirlpool |
$181.12
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.48
|
| Rate for Payer: PACE SWMI |
$150.93
|
| Rate for Payer: PHP Medicare Advantage |
$150.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.87
|
| Rate for Payer: Priority Health Medicare |
$150.93
|
| Rate for Payer: Priority Health Narrow Network |
$245.87
|
| Rate for Payer: UHC Medicare Advantage |
$155.46
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$180.41 |
| Max. Negotiated Rate |
$1,930.41 |
| Rate for Payer: Aetna Commercial |
$373.51
|
| Rate for Payer: Aetna Medicare |
$278.74
|
| Rate for Payer: BCBS Complete |
$189.43
|
| Rate for Payer: BCBS MAPPO |
$278.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.41
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$278.74
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cofinity Commercial |
$373.51
|
| Rate for Payer: Cofinity Commercial |
$401.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.74
|
| Rate for Payer: Healthscope Commercial |
$334.49
|
| Rate for Payer: Healthscope Whirlpool |
$334.49
|
| Rate for Payer: Meridian Medicaid |
$189.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.68
|
| Rate for Payer: PACE SWMI |
$278.74
|
| Rate for Payer: PHP Medicare Advantage |
$278.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.81
|
| Rate for Payer: Priority Health Medicare |
$278.74
|
| Rate for Payer: Priority Health Narrow Network |
$452.81
|
| Rate for Payer: UHC Medicare Advantage |
$287.10
|
|
|
PR CYSTO W/REMOVAL OF LESIONS MINOR
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$2,846.48 |
| Rate for Payer: Aetna Commercial |
$265.35
|
| Rate for Payer: Aetna Medicare |
$198.02
|
| Rate for Payer: BCBS Complete |
$133.30
|
| Rate for Payer: BCBS MAPPO |
$198.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.48
|
| Rate for Payer: BCN Commercial |
$1,149.37
|
| Rate for Payer: BCN Medicare Advantage |
$198.02
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$285.15
|
| Rate for Payer: Cofinity Commercial |
$265.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.02
|
| Rate for Payer: Healthscope Commercial |
$237.62
|
| Rate for Payer: Healthscope Whirlpool |
$237.62
|
| Rate for Payer: Meridian Medicaid |
$133.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$207.92
|
| Rate for Payer: PACE SWMI |
$198.02
|
| Rate for Payer: PHP Medicare Advantage |
$198.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,596.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.43
|
| Rate for Payer: Priority Health Medicare |
$198.02
|
| Rate for Payer: Priority Health Narrow Network |
$320.43
|
| Rate for Payer: UHC Medicare Advantage |
$203.96
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$5,244.96 |
| Rate for Payer: Aetna Commercial |
$319.80
|
| Rate for Payer: Aetna Medicare |
$238.66
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS MAPPO |
$238.66
|
| Rate for Payer: BCBS Trust/PPO |
$5,244.96
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$238.66
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$343.67
|
| Rate for Payer: Cofinity Commercial |
$319.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.66
|
| Rate for Payer: Healthscope Commercial |
$286.39
|
| Rate for Payer: Healthscope Whirlpool |
$286.39
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.59
|
| Rate for Payer: PACE SWMI |
$238.66
|
| Rate for Payer: PHP Medicare Advantage |
$238.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.98
|
| Rate for Payer: Priority Health Medicare |
$238.66
|
| Rate for Payer: Priority Health Narrow Network |
$387.98
|
| Rate for Payer: UHC Medicare Advantage |
$245.82
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$175.73 |
| Max. Negotiated Rate |
$1,512.52 |
| Rate for Payer: Aetna Commercial |
$365.08
|
| Rate for Payer: Aetna Medicare |
$272.45
|
| Rate for Payer: BCBS Complete |
$184.52
|
| Rate for Payer: BCBS MAPPO |
$272.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.52
|
| Rate for Payer: BCN Commercial |
$400.23
|
| Rate for Payer: BCN Medicare Advantage |
$272.45
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$365.08
|
| Rate for Payer: Cofinity Commercial |
$392.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.45
|
| Rate for Payer: Healthscope Commercial |
$326.94
|
| Rate for Payer: Healthscope Whirlpool |
$326.94
|
| Rate for Payer: Meridian Medicaid |
$184.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$286.07
|
| Rate for Payer: PACE SWMI |
$272.45
|
| Rate for Payer: PHP Medicare Advantage |
$272.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.56
|
| Rate for Payer: Priority Health Medicare |
$272.45
|
| Rate for Payer: Priority Health Narrow Network |
$442.56
|
| Rate for Payer: UHC Medicare Advantage |
$280.62
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$571.22
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$182.12 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$377.06
|
| Rate for Payer: Aetna Medicare |
$281.39
|
| Rate for Payer: BCBS Complete |
$191.23
|
| Rate for Payer: BCBS MAPPO |
$281.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$281.39
|
| Rate for Payer: Cash Price |
$456.98
|
| Rate for Payer: Cash Price |
$456.98
|
| Rate for Payer: Cofinity Commercial |
$377.06
|
| Rate for Payer: Cofinity Commercial |
$405.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.39
|
| Rate for Payer: Healthscope Commercial |
$337.67
|
| Rate for Payer: Healthscope Whirlpool |
$337.67
|
| Rate for Payer: Meridian Medicaid |
$191.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$295.46
|
| Rate for Payer: PACE SWMI |
$281.39
|
| Rate for Payer: PHP Medicare Advantage |
$281.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.15
|
| Rate for Payer: Priority Health Medicare |
$281.39
|
| Rate for Payer: Priority Health Narrow Network |
$457.15
|
| Rate for Payer: UHC Medicare Advantage |
$289.83
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$197.23
|
| Rate for Payer: Aetna Medicare |
$147.19
|
| Rate for Payer: BCBS Complete |
$100.19
|
| Rate for Payer: BCBS MAPPO |
$147.19
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$466.69
|
| Rate for Payer: BCN Medicare Advantage |
$147.19
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cofinity Commercial |
$211.95
|
| Rate for Payer: Cofinity Commercial |
$197.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.19
|
| Rate for Payer: Healthscope Commercial |
$176.63
|
| Rate for Payer: Healthscope Whirlpool |
$176.63
|
| Rate for Payer: Meridian Medicaid |
$100.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$154.55
|
| Rate for Payer: PACE SWMI |
$147.19
|
| Rate for Payer: PHP Medicare Advantage |
$147.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.38
|
| Rate for Payer: Priority Health Medicare |
$147.19
|
| Rate for Payer: Priority Health Narrow Network |
$239.38
|
| Rate for Payer: UHC Medicare Advantage |
$151.61
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$2,129.58 |
| Rate for Payer: Aetna Commercial |
$338.16
|
| Rate for Payer: Aetna Medicare |
$252.36
|
| Rate for Payer: BCBS Complete |
$170.43
|
| Rate for Payer: BCBS MAPPO |
$252.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,129.58
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: BCN Medicare Advantage |
$252.36
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cofinity Commercial |
$363.40
|
| Rate for Payer: Cofinity Commercial |
$338.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.36
|
| Rate for Payer: Healthscope Commercial |
$302.83
|
| Rate for Payer: Healthscope Whirlpool |
$302.83
|
| Rate for Payer: Meridian Medicaid |
$170.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$264.98
|
| Rate for Payer: PACE SWMI |
$252.36
|
| Rate for Payer: PHP Medicare Advantage |
$252.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.51
|
| Rate for Payer: Priority Health Medicare |
$252.36
|
| Rate for Payer: Priority Health Narrow Network |
$408.51
|
| Rate for Payer: UHC Medicare Advantage |
$259.93
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$664.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$215.77 |
| Max. Negotiated Rate |
$2,659.46 |
| Rate for Payer: Aetna Commercial |
$447.64
|
| Rate for Payer: Aetna Medicare |
$334.06
|
| Rate for Payer: BCBS Complete |
$226.56
|
| Rate for Payer: BCBS MAPPO |
$334.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.46
|
| Rate for Payer: BCN Commercial |
$490.63
|
| Rate for Payer: BCN Medicare Advantage |
$334.06
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cash Price |
$531.20
|
| Rate for Payer: Cofinity Commercial |
$447.64
|
| Rate for Payer: Cofinity Commercial |
$481.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.06
|
| Rate for Payer: Healthscope Commercial |
$400.87
|
| Rate for Payer: Healthscope Whirlpool |
$400.87
|
| Rate for Payer: Meridian Medicaid |
$226.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$350.76
|
| Rate for Payer: PACE SWMI |
$334.06
|
| Rate for Payer: PHP Medicare Advantage |
$334.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$542.52
|
| Rate for Payer: Priority Health Medicare |
$334.06
|
| Rate for Payer: Priority Health Narrow Network |
$542.52
|
| Rate for Payer: UHC Medicare Advantage |
$344.08
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$2,160.75 |
| Rate for Payer: Aetna Commercial |
$369.84
|
| Rate for Payer: Aetna Medicare |
$276.00
|
| Rate for Payer: BCBS Complete |
$187.41
|
| Rate for Payer: BCBS MAPPO |
$276.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.75
|
| Rate for Payer: BCN Commercial |
$405.60
|
| Rate for Payer: BCN Medicare Advantage |
$276.00
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Cofinity Commercial |
$397.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.00
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Healthscope Whirlpool |
$331.20
|
| Rate for Payer: Meridian Medicaid |
$187.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.80
|
| Rate for Payer: PACE SWMI |
$276.00
|
| Rate for Payer: PHP Medicare Advantage |
$276.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.49
|
| Rate for Payer: Priority Health Medicare |
$276.00
|
| Rate for Payer: Priority Health Narrow Network |
$448.49
|
| Rate for Payer: UHC Medicare Advantage |
$284.28
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$194.26 |
| Max. Negotiated Rate |
$1,174.60 |
| Rate for Payer: Aetna Commercial |
$401.53
|
| Rate for Payer: Aetna Medicare |
$299.65
|
| Rate for Payer: BCBS Complete |
$203.97
|
| Rate for Payer: BCBS MAPPO |
$299.65
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$440.30
|
| Rate for Payer: BCN Medicare Advantage |
$299.65
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cofinity Commercial |
$431.50
|
| Rate for Payer: Cofinity Commercial |
$401.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.65
|
| Rate for Payer: Healthscope Commercial |
$359.58
|
| Rate for Payer: Healthscope Whirlpool |
$359.58
|
| Rate for Payer: Meridian Medicaid |
$203.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$314.63
|
| Rate for Payer: PACE SWMI |
$299.65
|
| Rate for Payer: PHP Medicare Advantage |
$299.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,174.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.86
|
| Rate for Payer: Priority Health Medicare |
$299.65
|
| Rate for Payer: Priority Health Narrow Network |
$486.86
|
| Rate for Payer: UHC Medicare Advantage |
$308.64
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$245.80 |
| Max. Negotiated Rate |
$7,607.52 |
| Rate for Payer: Aetna Commercial |
$509.88
|
| Rate for Payer: Aetna Medicare |
$380.51
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS MAPPO |
$380.51
|
| Rate for Payer: BCBS Trust/PPO |
$7,607.52
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$380.51
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$509.88
|
| Rate for Payer: Cofinity Commercial |
$547.93
|
| 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 |
$258.09
|
| 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 |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.60
|
| 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 CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$2,941.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$222.16 |
| Max. Negotiated Rate |
$2,058.70 |
| Rate for Payer: Aetna Commercial |
$460.60
|
| Rate for Payer: Aetna Medicare |
$343.73
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$343.73
|
| Rate for Payer: BCBS Trust/PPO |
$677.97
|
| Rate for Payer: BCN Commercial |
$504.80
|
| Rate for Payer: BCN Medicare Advantage |
$343.73
|
| Rate for Payer: Cash Price |
$2,352.80
|
| Rate for Payer: Cash Price |
$2,352.80
|
| Rate for Payer: Cofinity Commercial |
$494.97
|
| Rate for Payer: Cofinity Commercial |
$460.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.73
|
| Rate for Payer: Healthscope Commercial |
$412.48
|
| Rate for Payer: Healthscope Whirlpool |
$412.48
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$360.92
|
| Rate for Payer: PACE SWMI |
$343.73
|
| Rate for Payer: PHP Medicare Advantage |
$343.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,058.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.18
|
| Rate for Payer: Priority Health Medicare |
$343.73
|
| Rate for Payer: Priority Health Narrow Network |
$558.18
|
| Rate for Payer: UHC Medicare Advantage |
$354.04
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$190.21 |
| Max. Negotiated Rate |
$476.60 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Medicare |
$293.37
|
| Rate for Payer: BCBS Complete |
$199.72
|
| Rate for Payer: BCBS MAPPO |
$293.37
|
| Rate for Payer: BCBS Trust/PPO |
$393.43
|
| Rate for Payer: BCN Commercial |
$431.01
|
| Rate for Payer: BCN Medicare Advantage |
$293.37
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$422.45
|
| Rate for Payer: Cofinity Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.37
|
| Rate for Payer: Healthscope Commercial |
$352.04
|
| Rate for Payer: Healthscope Whirlpool |
$352.04
|
| Rate for Payer: Meridian Medicaid |
$199.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$308.04
|
| Rate for Payer: PACE SWMI |
$293.37
|
| Rate for Payer: PHP Medicare Advantage |
$293.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.60
|
| Rate for Payer: Priority Health Medicare |
$293.37
|
| Rate for Payer: Priority Health Narrow Network |
$476.60
|
| Rate for Payer: UHC Medicare Advantage |
$302.17
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$279.88 |
| Max. Negotiated Rate |
$2,753.98 |
| Rate for Payer: Aetna Commercial |
$580.10
|
| Rate for Payer: Aetna Medicare |
$432.91
|
| Rate for Payer: BCBS Complete |
$293.87
|
| Rate for Payer: BCBS MAPPO |
$432.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,753.98
|
| Rate for Payer: BCN Commercial |
$635.28
|
| Rate for Payer: BCN Medicare Advantage |
$432.91
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$580.10
|
| Rate for Payer: Cofinity Commercial |
$623.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.91
|
| Rate for Payer: Healthscope Commercial |
$519.49
|
| Rate for Payer: Healthscope Whirlpool |
$519.49
|
| Rate for Payer: Meridian Medicaid |
$293.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$454.56
|
| Rate for Payer: PACE SWMI |
$432.91
|
| Rate for Payer: PHP Medicare Advantage |
$432.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$702.46
|
| Rate for Payer: Priority Health Medicare |
$432.91
|
| Rate for Payer: Priority Health Narrow Network |
$702.46
|
| Rate for Payer: UHC Medicare Advantage |
$445.90
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$231.96 |
| Max. Negotiated Rate |
$3,736.67 |
| Rate for Payer: Aetna Commercial |
$479.41
|
| Rate for Payer: Aetna Medicare |
$357.77
|
| Rate for Payer: BCBS Complete |
$243.56
|
| Rate for Payer: BCBS MAPPO |
$357.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,736.67
|
| Rate for Payer: BCN Commercial |
$525.33
|
| Rate for Payer: BCN Medicare Advantage |
$357.77
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cofinity Commercial |
$515.19
|
| Rate for Payer: Cofinity Commercial |
$479.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.77
|
| Rate for Payer: Healthscope Commercial |
$429.32
|
| Rate for Payer: Healthscope Whirlpool |
$429.32
|
| Rate for Payer: Meridian Medicaid |
$243.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$375.66
|
| Rate for Payer: PACE SWMI |
$357.77
|
| Rate for Payer: PHP Medicare Advantage |
$357.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.89
|
| Rate for Payer: Priority Health Medicare |
$357.77
|
| Rate for Payer: Priority Health Narrow Network |
$580.89
|
| Rate for Payer: UHC Medicare Advantage |
$368.50
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$1,105.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$247.51 |
| Max. Negotiated Rate |
$3,934.25 |
| Rate for Payer: Aetna Commercial |
$512.56
|
| Rate for Payer: Aetna Medicare |
$382.51
|
| Rate for Payer: BCBS Complete |
$259.89
|
| Rate for Payer: BCBS MAPPO |
$382.51
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.25
|
| Rate for Payer: BCN Commercial |
$561.49
|
| Rate for Payer: BCN Medicare Advantage |
$382.51
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cash Price |
$884.00
|
| Rate for Payer: Cofinity Commercial |
$550.81
|
| Rate for Payer: Cofinity Commercial |
$512.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.51
|
| Rate for Payer: Healthscope Commercial |
$459.01
|
| Rate for Payer: Healthscope Whirlpool |
$459.01
|
| Rate for Payer: Meridian Medicaid |
$259.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$401.64
|
| Rate for Payer: PACE SWMI |
$382.51
|
| Rate for Payer: PHP Medicare Advantage |
$382.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$620.86
|
| Rate for Payer: Priority Health Medicare |
$382.51
|
| Rate for Payer: Priority Health Narrow Network |
$620.86
|
| Rate for Payer: UHC Medicare Advantage |
$393.99
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$245.66 |
| Max. Negotiated Rate |
$1,405.01 |
| Rate for Payer: Aetna Commercial |
$1,039.06
|
| Rate for Payer: Aetna Medicare |
$775.42
|
| Rate for Payer: BCBS Complete |
$539.89
|
| Rate for Payer: BCBS MAPPO |
$775.42
|
| Rate for Payer: BCBS Trust/PPO |
$245.66
|
| Rate for Payer: BCN Commercial |
$1,172.83
|
| Rate for Payer: BCN Medicare Advantage |
$775.42
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,116.60
|
| Rate for Payer: Cofinity Commercial |
$1,039.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.42
|
| Rate for Payer: Healthscope Commercial |
$930.50
|
| Rate for Payer: Healthscope Whirlpool |
$930.50
|
| Rate for Payer: Meridian Medicaid |
$539.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$814.19
|
| Rate for Payer: PACE SWMI |
$775.42
|
| Rate for Payer: PHP Medicare Advantage |
$775.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$514.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,405.01
|
| Rate for Payer: Priority Health Medicare |
$775.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.01
|
| Rate for Payer: UHC Medicare Advantage |
$798.68
|
|
|
PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01996
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.50
|
| Rate for Payer: Priority Health Narrow Network |
$133.50
|
|
|
PR DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: Aetna Medicare |
$26.73
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$26.73
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$26.73
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$38.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.73
|
| Rate for Payer: Healthscope Commercial |
$32.08
|
| Rate for Payer: Healthscope Whirlpool |
$32.08
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.07
|
| Rate for Payer: PACE SWMI |
$26.73
|
| Rate for Payer: PHP Medicare Advantage |
$26.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.88
|
| Rate for Payer: Priority Health Medicare |
$26.73
|
| Rate for Payer: Priority Health Narrow Network |
$32.88
|
| Rate for Payer: UHC Medicare Advantage |
$27.53
|
|
|
PR DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$19.71
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$32.20
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$21.18
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Whirlpool |
$17.65
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.09
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow Network |
$18.09
|
| Rate for Payer: UHC Medicare Advantage |
$15.15
|
|
