|
PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO
|
Professional
|
Both
|
$2,028.00
|
|
|
Service Code
|
HCPCS 51065
|
| Min. Negotiated Rate |
$338.03 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Aetna Commercial |
$698.35
|
| Rate for Payer: Aetna Medicare |
$521.16
|
| Rate for Payer: BCBS Complete |
$354.93
|
| Rate for Payer: BCBS MAPPO |
$521.16
|
| Rate for Payer: BCN Commercial |
$872.96
|
| Rate for Payer: BCN Medicare Advantage |
$521.16
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cash Price |
$1,622.40
|
| Rate for Payer: Cofinity Commercial |
$750.47
|
| Rate for Payer: Cofinity Commercial |
$698.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.16
|
| Rate for Payer: Healthscope Commercial |
$625.39
|
| Rate for Payer: Healthscope Whirlpool |
$625.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$547.22
|
| Rate for Payer: Meridian Medicaid |
$354.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$573.28
|
| Rate for Payer: Nomi Health Commercial |
$625.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,521.00
|
| Rate for Payer: PACE SWMI |
$521.16
|
| Rate for Payer: PHP Medicare Advantage |
$521.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$950.93
|
| Rate for Payer: Priority Health Medicare |
$521.16
|
| Rate for Payer: Priority Health Narrow Network |
$950.93
|
| Rate for Payer: Railroad Medicare Medicare |
$521.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,019.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$521.16
|
| Rate for Payer: UHC Exchange |
$1,019.83
|
| Rate for Payer: UHC Medicaid |
$338.03
|
| Rate for Payer: UHCCP DNSP |
$521.16
|
| Rate for Payer: UHCCP Medicaid |
$338.03
|
|
|
PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
HCPCS 51045
|
| Min. Negotiated Rate |
$291.17 |
| Max. Negotiated Rate |
$877.62 |
| Rate for Payer: Aetna Commercial |
$600.03
|
| Rate for Payer: Aetna Medicare |
$447.78
|
| Rate for Payer: BCBS Complete |
$305.73
|
| Rate for Payer: BCBS MAPPO |
$447.78
|
| Rate for Payer: BCN Commercial |
$740.00
|
| Rate for Payer: BCN Medicare Advantage |
$447.78
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Cofinity Commercial |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$600.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.78
|
| Rate for Payer: Healthscope Commercial |
$537.34
|
| Rate for Payer: Healthscope Whirlpool |
$537.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.17
|
| Rate for Payer: Meridian Medicaid |
$305.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.56
|
| Rate for Payer: Nomi Health Commercial |
$537.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$797.25
|
| Rate for Payer: PACE SWMI |
$447.78
|
| Rate for Payer: PHP Medicare Advantage |
$447.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$806.10
|
| Rate for Payer: Priority Health Medicare |
$447.78
|
| Rate for Payer: Priority Health Narrow Network |
$806.10
|
| Rate for Payer: Railroad Medicare Medicare |
$447.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$877.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.78
|
| Rate for Payer: UHC Exchange |
$877.62
|
| Rate for Payer: UHC Medicaid |
$291.17
|
| Rate for Payer: UHCCP DNSP |
$447.78
|
| Rate for Payer: UHCCP Medicaid |
$291.17
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$232.81 |
| Max. Negotiated Rate |
$735.79 |
| Rate for Payer: Aetna Commercial |
$486.88
|
| Rate for Payer: Aetna Medicare |
$363.34
|
| Rate for Payer: BCBS Complete |
$244.45
|
| Rate for Payer: BCBS MAPPO |
$363.34
|
| Rate for Payer: BCN Commercial |
$613.51
|
| Rate for Payer: BCN Medicare Advantage |
$363.34
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$523.21
|
| Rate for Payer: Cofinity Commercial |
$486.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.34
|
| Rate for Payer: Healthscope Commercial |
$436.01
|
| Rate for Payer: Healthscope Whirlpool |
$436.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.51
|
| Rate for Payer: Meridian Medicaid |
$244.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$399.67
|
| Rate for Payer: Nomi Health Commercial |
$436.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$654.75
|
| Rate for Payer: PACE SWMI |
$363.34
|
| Rate for Payer: PHP Medicare Advantage |
$363.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$668.32
|
| Rate for Payer: Priority Health Medicare |
$363.34
|
| Rate for Payer: Priority Health Narrow Network |
$668.32
|
| Rate for Payer: Railroad Medicare Medicare |
$363.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$735.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$363.34
|
| Rate for Payer: UHC Exchange |
$735.79
|
| Rate for Payer: UHC Medicaid |
$232.81
|
| Rate for Payer: UHCCP DNSP |
$363.34
|
| Rate for Payer: UHCCP Medicaid |
$232.81
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$94.78
|
| Rate for Payer: Aetna Medicare |
$70.73
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS MAPPO |
$70.73
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: BCN Medicare Advantage |
$70.73
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Commercial |
$101.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.73
|
| Rate for Payer: Healthscope Commercial |
$84.88
|
| Rate for Payer: Healthscope Whirlpool |
$84.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.27
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.80
|
| Rate for Payer: Nomi Health Commercial |
$84.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE SWMI |
$70.73
|
| Rate for Payer: PHP Medicare Advantage |
$70.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$129.65
|
| Rate for Payer: Priority Health Medicare |
$70.73
|
| Rate for Payer: Priority Health Narrow Network |
$129.65
|
| Rate for Payer: Railroad Medicare Medicare |
$70.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.73
|
| Rate for Payer: UHC Exchange |
$142.99
|
| Rate for Payer: UHC Medicaid |
$45.37
|
| Rate for Payer: UHCCP DNSP |
$70.73
|
| Rate for Payer: UHCCP Medicaid |
$45.37
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Aetna Commercial |
$198.56
|
| Rate for Payer: Aetna Medicare |
$148.18
|
| Rate for Payer: BCBS Complete |
$99.75
|
| Rate for Payer: BCBS MAPPO |
$148.18
|
| Rate for Payer: BCN Commercial |
$250.98
|
| Rate for Payer: BCN Medicare Advantage |
$148.18
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$213.38
|
| Rate for Payer: Cofinity Commercial |
$198.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.18
|
| Rate for Payer: Healthscope Commercial |
$177.82
|
| Rate for Payer: Healthscope Whirlpool |
$177.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.59
|
| Rate for Payer: Meridian Medicaid |
$99.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$163.00
|
| Rate for Payer: Nomi Health Commercial |
$177.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$544.50
|
| Rate for Payer: PACE SWMI |
$148.18
|
| Rate for Payer: PHP Medicare Advantage |
$148.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$273.41
|
| Rate for Payer: Priority Health Medicare |
$148.18
|
| Rate for Payer: Priority Health Narrow Network |
$273.41
|
| Rate for Payer: Railroad Medicare Medicare |
$148.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$300.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$148.18
|
| Rate for Payer: UHC Exchange |
$300.12
|
| Rate for Payer: UHC Medicaid |
$95.00
|
| Rate for Payer: UHCCP DNSP |
$148.18
|
| Rate for Payer: UHCCP Medicaid |
$95.00
|
|
|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$189.36 |
| Max. Negotiated Rate |
$597.92 |
| Rate for Payer: Aetna Commercial |
$395.76
|
| Rate for Payer: Aetna Medicare |
$295.34
|
| Rate for Payer: BCBS Complete |
$198.83
|
| Rate for Payer: BCBS MAPPO |
$295.34
|
| Rate for Payer: BCN Commercial |
$497.98
|
| Rate for Payer: BCN Medicare Advantage |
$295.34
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$425.29
|
| Rate for Payer: Cofinity Commercial |
$395.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.34
|
| Rate for Payer: Healthscope Commercial |
$354.41
|
| Rate for Payer: Healthscope Whirlpool |
$354.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.11
|
| Rate for Payer: Meridian Medicaid |
$198.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$324.87
|
| Rate for Payer: Nomi Health Commercial |
$354.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.50
|
| Rate for Payer: PACE SWMI |
$295.34
|
| Rate for Payer: PHP Medicare Advantage |
$295.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$189.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$542.47
|
| Rate for Payer: Priority Health Medicare |
$295.34
|
| Rate for Payer: Priority Health Narrow Network |
$542.47
|
| Rate for Payer: Railroad Medicare Medicare |
$295.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$295.34
|
| Rate for Payer: UHC Exchange |
$597.92
|
| Rate for Payer: UHC Medicaid |
$189.36
|
| Rate for Payer: UHCCP DNSP |
$295.34
|
| Rate for Payer: UHCCP Medicaid |
$189.36
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$423.17 |
| Rate for Payer: Aetna Commercial |
$281.55
|
| Rate for Payer: Aetna Medicare |
$210.11
|
| Rate for Payer: BCBS Complete |
$141.79
|
| Rate for Payer: BCBS MAPPO |
$210.11
|
| Rate for Payer: BCN Commercial |
$354.07
|
| Rate for Payer: BCN Medicare Advantage |
$210.11
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cofinity Commercial |
$302.56
|
| Rate for Payer: Cofinity Commercial |
$281.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.11
|
| Rate for Payer: Healthscope Commercial |
$252.13
|
| Rate for Payer: Healthscope Whirlpool |
$252.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.62
|
| Rate for Payer: Meridian Medicaid |
$141.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$231.12
|
| Rate for Payer: Nomi Health Commercial |
$252.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.25
|
| Rate for Payer: PACE SWMI |
$210.11
|
| Rate for Payer: PHP Medicare Advantage |
$210.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$385.69
|
| Rate for Payer: Priority Health Medicare |
$210.11
|
| Rate for Payer: Priority Health Narrow Network |
$385.69
|
| Rate for Payer: Railroad Medicare Medicare |
$210.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$423.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$210.11
|
| Rate for Payer: UHC Exchange |
$423.17
|
| Rate for Payer: UHC Medicaid |
$135.04
|
| Rate for Payer: UHCCP DNSP |
$210.11
|
| Rate for Payer: UHCCP Medicaid |
$135.04
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$658.00
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna Commercial |
$230.48
|
| Rate for Payer: Aetna Medicare |
$172.00
|
| Rate for Payer: BCBS Complete |
$116.08
|
| Rate for Payer: BCBS MAPPO |
$172.00
|
| Rate for Payer: BCN Commercial |
$292.32
|
| Rate for Payer: BCN Medicare Advantage |
$172.00
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cash Price |
$526.40
|
| Rate for Payer: Cofinity Commercial |
$247.68
|
| Rate for Payer: Cofinity Commercial |
$230.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$206.40
|
| Rate for Payer: Healthscope Whirlpool |
$206.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.60
|
| Rate for Payer: Meridian Medicaid |
$116.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.20
|
| Rate for Payer: Nomi Health Commercial |
$206.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.50
|
| Rate for Payer: PACE SWMI |
$172.00
|
| Rate for Payer: PHP Medicare Advantage |
$172.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$318.42
|
| Rate for Payer: Priority Health Medicare |
$172.00
|
| Rate for Payer: Priority Health Narrow Network |
$318.42
|
| Rate for Payer: Railroad Medicare Medicare |
$172.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$172.00
|
| Rate for Payer: UHC Exchange |
$345.60
|
| Rate for Payer: UHC Medicaid |
$110.55
|
| Rate for Payer: UHCCP DNSP |
$172.00
|
| Rate for Payer: UHCCP Medicaid |
$110.55
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$162.31 |
| Max. Negotiated Rate |
$901.50 |
| Rate for Payer: Aetna Commercial |
$338.59
|
| Rate for Payer: Aetna Medicare |
$252.68
|
| Rate for Payer: BCBS Complete |
$170.43
|
| Rate for Payer: BCBS MAPPO |
$252.68
|
| Rate for Payer: BCN Commercial |
$425.77
|
| Rate for Payer: BCN Medicare Advantage |
$252.68
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cofinity Commercial |
$363.86
|
| Rate for Payer: Cofinity Commercial |
$338.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.68
|
| Rate for Payer: Healthscope Commercial |
$303.22
|
| Rate for Payer: Healthscope Whirlpool |
$303.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.31
|
| Rate for Payer: Meridian Medicaid |
$170.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$277.95
|
| Rate for Payer: Nomi Health Commercial |
$303.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$901.50
|
| Rate for Payer: PACE SWMI |
$252.68
|
| Rate for Payer: PHP Medicare Advantage |
$252.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$463.80
|
| Rate for Payer: Priority Health Medicare |
$252.68
|
| Rate for Payer: Priority Health Narrow Network |
$463.80
|
| Rate for Payer: Railroad Medicare Medicare |
$252.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$509.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$252.68
|
| Rate for Payer: UHC Exchange |
$509.79
|
| Rate for Payer: UHC Medicaid |
$162.31
|
| Rate for Payer: UHCCP DNSP |
$252.68
|
| Rate for Payer: UHCCP Medicaid |
$162.31
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$2,310.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: Aetna Commercial |
$458.95
|
| Rate for Payer: Aetna Medicare |
$342.50
|
| Rate for Payer: BCBS Complete |
$230.58
|
| Rate for Payer: BCBS MAPPO |
$342.50
|
| Rate for Payer: BCN Commercial |
$577.66
|
| Rate for Payer: BCN Medicare Advantage |
$342.50
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cash Price |
$1,848.00
|
| Rate for Payer: Cofinity Commercial |
$493.20
|
| Rate for Payer: Cofinity Commercial |
$458.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.50
|
| Rate for Payer: Healthscope Commercial |
$411.00
|
| Rate for Payer: Healthscope Whirlpool |
$411.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.62
|
| Rate for Payer: Meridian Medicaid |
$230.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$376.75
|
| Rate for Payer: Nomi Health Commercial |
$411.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,732.50
|
| Rate for Payer: PACE SWMI |
$342.50
|
| Rate for Payer: PHP Medicare Advantage |
$342.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$629.26
|
| Rate for Payer: Priority Health Medicare |
$342.50
|
| Rate for Payer: Priority Health Narrow Network |
$629.26
|
| Rate for Payer: Railroad Medicare Medicare |
$342.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$342.50
|
| Rate for Payer: UHC Exchange |
$694.42
|
| Rate for Payer: UHC Medicaid |
$219.60
|
| Rate for Payer: UHCCP DNSP |
$342.50
|
| Rate for Payer: UHCCP Medicaid |
$219.60
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$430.67 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$184.30
|
| Rate for Payer: BCBS Complete |
$124.35
|
| Rate for Payer: BCBS MAPPO |
$184.30
|
| Rate for Payer: BCN Commercial |
$430.67
|
| Rate for Payer: BCN Medicare Advantage |
$184.30
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cash Price |
$325.60
|
| Rate for Payer: Cofinity Commercial |
$265.39
|
| Rate for Payer: Cofinity Commercial |
$246.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.30
|
| Rate for Payer: Healthscope Commercial |
$221.16
|
| Rate for Payer: Healthscope Whirlpool |
$221.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.51
|
| Rate for Payer: Meridian Medicaid |
$124.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.73
|
| Rate for Payer: Nomi Health Commercial |
$221.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.25
|
| Rate for Payer: PACE SWMI |
$184.30
|
| Rate for Payer: PHP Medicare Advantage |
$184.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$339.58
|
| Rate for Payer: Priority Health Medicare |
$184.30
|
| Rate for Payer: Priority Health Narrow Network |
$339.58
|
| Rate for Payer: Railroad Medicare Medicare |
$184.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.30
|
| Rate for Payer: UHC Exchange |
$372.74
|
| Rate for Payer: UHC Medicaid |
$118.43
|
| Rate for Payer: UHCCP DNSP |
$184.30
|
| Rate for Payer: UHCCP Medicaid |
$118.43
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Aetna Commercial |
$191.77
|
| Rate for Payer: Aetna Medicare |
$143.11
|
| Rate for Payer: BCBS Complete |
$96.62
|
| Rate for Payer: BCBS MAPPO |
$143.11
|
| Rate for Payer: BCN Commercial |
$241.02
|
| Rate for Payer: BCN Medicare Advantage |
$143.11
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$206.08
|
| Rate for Payer: Cofinity Commercial |
$191.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.11
|
| Rate for Payer: Healthscope Commercial |
$171.73
|
| Rate for Payer: Healthscope Whirlpool |
$171.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.27
|
| Rate for Payer: Meridian Medicaid |
$96.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.42
|
| Rate for Payer: Nomi Health Commercial |
$171.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.75
|
| Rate for Payer: PACE SWMI |
$143.11
|
| Rate for Payer: PHP Medicare Advantage |
$143.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.56
|
| Rate for Payer: Priority Health Medicare |
$143.11
|
| Rate for Payer: Priority Health Narrow Network |
$262.56
|
| Rate for Payer: Railroad Medicare Medicare |
$143.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$287.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$143.11
|
| Rate for Payer: UHC Exchange |
$287.80
|
| Rate for Payer: UHC Medicaid |
$92.02
|
| Rate for Payer: UHCCP DNSP |
$143.11
|
| Rate for Payer: UHCCP Medicaid |
$92.02
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: Aetna Commercial |
$310.59
|
| Rate for Payer: Aetna Medicare |
$231.78
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS MAPPO |
$231.78
|
| Rate for Payer: BCN Commercial |
$390.91
|
| Rate for Payer: BCN Medicare Advantage |
$231.78
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$333.76
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.78
|
| Rate for Payer: Healthscope Commercial |
$278.14
|
| Rate for Payer: Healthscope Whirlpool |
$278.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.37
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$254.96
|
| Rate for Payer: Nomi Health Commercial |
$278.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$866.25
|
| Rate for Payer: PACE SWMI |
$231.78
|
| Rate for Payer: PHP Medicare Advantage |
$231.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$425.83
|
| Rate for Payer: Priority Health Medicare |
$231.78
|
| Rate for Payer: Priority Health Narrow Network |
$425.83
|
| Rate for Payer: Railroad Medicare Medicare |
$231.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$467.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$231.78
|
| Rate for Payer: UHC Exchange |
$467.47
|
| Rate for Payer: UHC Medicaid |
$148.89
|
| Rate for Payer: UHCCP DNSP |
$231.78
|
| Rate for Payer: UHCCP Medicaid |
$148.89
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$552.75 |
| Rate for Payer: Aetna Commercial |
$215.11
|
| Rate for Payer: Aetna Medicare |
$160.53
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS MAPPO |
$160.53
|
| Rate for Payer: BCN Commercial |
$269.91
|
| Rate for Payer: BCN Medicare Advantage |
$160.53
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$231.16
|
| Rate for Payer: Cofinity Commercial |
$215.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.53
|
| Rate for Payer: Healthscope Commercial |
$192.64
|
| Rate for Payer: Healthscope Whirlpool |
$192.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.56
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.58
|
| Rate for Payer: Nomi Health Commercial |
$192.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PACE SWMI |
$160.53
|
| Rate for Payer: PHP Medicare Advantage |
$160.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.02
|
| Rate for Payer: Priority Health Medicare |
$160.53
|
| Rate for Payer: Priority Health Narrow Network |
$294.02
|
| Rate for Payer: Railroad Medicare Medicare |
$160.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.53
|
| Rate for Payer: UHC Exchange |
$320.49
|
| Rate for Payer: UHC Medicaid |
$103.31
|
| Rate for Payer: UHCCP DNSP |
$160.53
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$139.73 |
| Max. Negotiated Rate |
$754.50 |
| Rate for Payer: Aetna Commercial |
$291.46
|
| Rate for Payer: Aetna Medicare |
$217.51
|
| Rate for Payer: BCBS Complete |
$146.72
|
| Rate for Payer: BCBS MAPPO |
$217.51
|
| Rate for Payer: BCN Commercial |
$368.01
|
| Rate for Payer: BCN Medicare Advantage |
$217.51
|
| Rate for Payer: Cash Price |
$804.80
|
| Rate for Payer: Cash Price |
$804.80
|
| Rate for Payer: Cofinity Commercial |
$313.21
|
| Rate for Payer: Cofinity Commercial |
$291.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.51
|
| Rate for Payer: Healthscope Commercial |
$261.01
|
| Rate for Payer: Healthscope Whirlpool |
$261.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$228.39
|
| Rate for Payer: Meridian Medicaid |
$146.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$239.26
|
| Rate for Payer: Nomi Health Commercial |
$261.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$754.50
|
| Rate for Payer: PACE SWMI |
$217.51
|
| Rate for Payer: PHP Medicare Advantage |
$217.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$400.88
|
| Rate for Payer: Priority Health Medicare |
$217.51
|
| Rate for Payer: Priority Health Narrow Network |
$400.88
|
| Rate for Payer: Railroad Medicare Medicare |
$217.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$217.51
|
| Rate for Payer: UHC Exchange |
$439.28
|
| Rate for Payer: UHC Medicaid |
$139.73
|
| Rate for Payer: UHCCP DNSP |
$217.51
|
| Rate for Payer: UHCCP Medicaid |
$139.73
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$80.94 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$168.42
|
| Rate for Payer: Aetna Medicare |
$125.69
|
| Rate for Payer: BCBS Complete |
$84.99
|
| Rate for Payer: BCBS MAPPO |
$125.69
|
| Rate for Payer: BCN Commercial |
$209.65
|
| Rate for Payer: BCN Medicare Advantage |
$125.69
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$180.99
|
| Rate for Payer: Cofinity Commercial |
$168.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.69
|
| Rate for Payer: Healthscope Commercial |
$150.83
|
| Rate for Payer: Healthscope Whirlpool |
$150.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.97
|
| Rate for Payer: Meridian Medicaid |
$84.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.26
|
| Rate for Payer: Nomi Health Commercial |
$150.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$577.50
|
| Rate for Payer: PACE SWMI |
$125.69
|
| Rate for Payer: PHP Medicare Advantage |
$125.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$228.38
|
| Rate for Payer: Priority Health Medicare |
$125.69
|
| Rate for Payer: Priority Health Narrow Network |
$228.38
|
| Rate for Payer: Railroad Medicare Medicare |
$125.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.69
|
| Rate for Payer: UHC Exchange |
$249.26
|
| Rate for Payer: UHC Medicaid |
$80.94
|
| Rate for Payer: UHCCP DNSP |
$125.69
|
| Rate for Payer: UHCCP Medicaid |
$80.94
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,469.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$138.02 |
| Max. Negotiated Rate |
$1,101.75 |
| Rate for Payer: Aetna Commercial |
$288.19
|
| Rate for Payer: Aetna Medicare |
$215.07
|
| Rate for Payer: BCBS Complete |
$144.92
|
| Rate for Payer: BCBS MAPPO |
$215.07
|
| Rate for Payer: BCN Commercial |
$364.52
|
| Rate for Payer: BCN Medicare Advantage |
$215.07
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cofinity Commercial |
$309.70
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.07
|
| Rate for Payer: Healthscope Commercial |
$258.08
|
| Rate for Payer: Healthscope Whirlpool |
$258.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.82
|
| Rate for Payer: Meridian Medicaid |
$144.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.58
|
| Rate for Payer: Nomi Health Commercial |
$258.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,101.75
|
| Rate for Payer: PACE SWMI |
$215.07
|
| Rate for Payer: PHP Medicare Advantage |
$215.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$397.09
|
| Rate for Payer: Priority Health Medicare |
$215.07
|
| Rate for Payer: Priority Health Narrow Network |
$397.09
|
| Rate for Payer: Railroad Medicare Medicare |
$215.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.07
|
| Rate for Payer: UHC Exchange |
$436.41
|
| Rate for Payer: UHC Medicaid |
$138.02
|
| Rate for Payer: UHCCP DNSP |
$215.07
|
| Rate for Payer: UHCCP Medicaid |
$138.02
|
|
|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$356.06 |
| Rate for Payer: Aetna Commercial |
$237.34
|
| Rate for Payer: Aetna Medicare |
$177.12
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCN Commercial |
$299.79
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cofinity Commercial |
$255.05
|
| Rate for Payer: Cofinity Commercial |
$237.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Healthscope Whirlpool |
$212.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.83
|
| Rate for Payer: Nomi Health Commercial |
$212.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.00
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$326.57
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$326.57
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$177.12
|
| Rate for Payer: UHC Exchange |
$356.06
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP DNSP |
$177.12
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$158.09
|
| Rate for Payer: Aetna Medicare |
$117.98
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$117.98
|
| Rate for Payer: BCN Commercial |
$217.73
|
| Rate for Payer: BCN Medicare Advantage |
$117.98
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$169.89
|
| Rate for Payer: Cofinity Commercial |
$158.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.98
|
| Rate for Payer: Healthscope Commercial |
$141.58
|
| Rate for Payer: Healthscope Whirlpool |
$141.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.88
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.78
|
| Rate for Payer: Nomi Health Commercial |
$141.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.00
|
| Rate for Payer: PACE SWMI |
$117.98
|
| Rate for Payer: PHP Medicare Advantage |
$117.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$215.90
|
| Rate for Payer: Priority Health Medicare |
$117.98
|
| Rate for Payer: Priority Health Narrow Network |
$215.90
|
| Rate for Payer: Railroad Medicare Medicare |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.98
|
| Rate for Payer: UHC Exchange |
$232.99
|
| Rate for Payer: UHC Medicaid |
$76.25
|
| Rate for Payer: UHCCP DNSP |
$117.98
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$431.17 |
| Rate for Payer: Aetna Commercial |
$286.48
|
| Rate for Payer: Aetna Medicare |
$213.79
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$213.79
|
| Rate for Payer: BCN Commercial |
$360.54
|
| Rate for Payer: BCN Medicare Advantage |
$213.79
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cofinity Commercial |
$307.86
|
| Rate for Payer: Cofinity Commercial |
$286.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.79
|
| Rate for Payer: Healthscope Commercial |
$256.55
|
| Rate for Payer: Healthscope Whirlpool |
$256.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.48
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$235.17
|
| Rate for Payer: Nomi Health Commercial |
$256.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.00
|
| Rate for Payer: PACE SWMI |
$213.79
|
| Rate for Payer: PHP Medicare Advantage |
$213.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$392.75
|
| Rate for Payer: Priority Health Medicare |
$213.79
|
| Rate for Payer: Priority Health Narrow Network |
$392.75
|
| Rate for Payer: Railroad Medicare Medicare |
$213.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$213.79
|
| Rate for Payer: UHC Exchange |
$431.17
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP DNSP |
$213.79
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$154.64 |
| Max. Negotiated Rate |
$624.75 |
| Rate for Payer: Aetna Commercial |
$322.89
|
| Rate for Payer: Aetna Medicare |
$240.96
|
| Rate for Payer: BCBS Complete |
$162.37
|
| Rate for Payer: BCBS MAPPO |
$240.96
|
| Rate for Payer: BCN Commercial |
$405.36
|
| Rate for Payer: BCN Medicare Advantage |
$240.96
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$346.98
|
| Rate for Payer: Cofinity Commercial |
$322.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$289.15
|
| Rate for Payer: Healthscope Whirlpool |
$289.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.01
|
| Rate for Payer: Meridian Medicaid |
$162.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.06
|
| Rate for Payer: Nomi Health Commercial |
$289.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.75
|
| Rate for Payer: PACE SWMI |
$240.96
|
| Rate for Payer: PHP Medicare Advantage |
$240.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$441.56
|
| Rate for Payer: Priority Health Medicare |
$240.96
|
| Rate for Payer: Priority Health Narrow Network |
$441.56
|
| Rate for Payer: Railroad Medicare Medicare |
$240.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$485.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.96
|
| Rate for Payer: UHC Exchange |
$485.41
|
| Rate for Payer: UHC Medicaid |
$154.64
|
| Rate for Payer: UHCCP DNSP |
$240.96
|
| Rate for Payer: UHCCP Medicaid |
$154.64
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,910.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Aetna Commercial |
$203.36
|
| Rate for Payer: Aetna Medicare |
$151.76
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$151.76
|
| Rate for Payer: BCN Commercial |
$258.95
|
| Rate for Payer: BCN Medicare Advantage |
$151.76
|
| Rate for Payer: Cash Price |
$2,328.00
|
| Rate for Payer: Cash Price |
$2,328.00
|
| Rate for Payer: Cofinity Commercial |
$218.53
|
| Rate for Payer: Cofinity Commercial |
$203.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.76
|
| Rate for Payer: Healthscope Commercial |
$182.11
|
| Rate for Payer: Healthscope Whirlpool |
$182.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.35
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.94
|
| Rate for Payer: Nomi Health Commercial |
$182.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,182.50
|
| Rate for Payer: PACE SWMI |
$151.76
|
| Rate for Payer: PHP Medicare Advantage |
$151.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.08
|
| Rate for Payer: Priority Health Medicare |
$151.76
|
| Rate for Payer: Priority Health Narrow Network |
$282.08
|
| Rate for Payer: Railroad Medicare Medicare |
$151.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.76
|
| Rate for Payer: UHC Exchange |
$313.30
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP DNSP |
$151.76
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,172.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$3,129.00 |
| Rate for Payer: Aetna Commercial |
$194.10
|
| Rate for Payer: Aetna Medicare |
$144.85
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS MAPPO |
$144.85
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: BCN Medicare Advantage |
$144.85
|
| Rate for Payer: Cash Price |
$3,337.60
|
| Rate for Payer: Cash Price |
$3,337.60
|
| Rate for Payer: Cofinity Commercial |
$208.58
|
| Rate for Payer: Cofinity Commercial |
$194.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.85
|
| Rate for Payer: Healthscope Commercial |
$173.82
|
| Rate for Payer: Healthscope Whirlpool |
$173.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.09
|
| Rate for Payer: Meridian Medicaid |
$97.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.34
|
| Rate for Payer: Nomi Health Commercial |
$173.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,129.00
|
| Rate for Payer: PACE SWMI |
$144.85
|
| Rate for Payer: PHP Medicare Advantage |
$144.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$266.35
|
| Rate for Payer: Priority Health Medicare |
$144.85
|
| Rate for Payer: Priority Health Narrow Network |
$266.35
|
| Rate for Payer: Railroad Medicare Medicare |
$144.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.85
|
| Rate for Payer: UHC Exchange |
$297.80
|
| Rate for Payer: UHC Medicaid |
$93.08
|
| Rate for Payer: UHCCP DNSP |
$144.85
|
| Rate for Payer: UHCCP Medicaid |
$93.08
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$669.75 |
| Rate for Payer: Aetna Commercial |
$185.00
|
| Rate for Payer: Aetna Medicare |
$138.06
|
| Rate for Payer: BCBS Complete |
$93.48
|
| Rate for Payer: BCBS MAPPO |
$138.06
|
| Rate for Payer: BCN Commercial |
$231.07
|
| Rate for Payer: BCN Medicare Advantage |
$138.06
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$198.81
|
| Rate for Payer: Cofinity Commercial |
$185.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.06
|
| Rate for Payer: Healthscope Commercial |
$165.67
|
| Rate for Payer: Healthscope Whirlpool |
$165.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.96
|
| Rate for Payer: Meridian Medicaid |
$93.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$151.87
|
| Rate for Payer: Nomi Health Commercial |
$165.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.75
|
| Rate for Payer: PACE SWMI |
$138.06
|
| Rate for Payer: PHP Medicare Advantage |
$138.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$251.71
|
| Rate for Payer: Priority Health Medicare |
$138.06
|
| Rate for Payer: Priority Health Narrow Network |
$251.71
|
| Rate for Payer: Railroad Medicare Medicare |
$138.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.06
|
| Rate for Payer: UHC Exchange |
$273.01
|
| Rate for Payer: UHC Medicaid |
$89.03
|
| Rate for Payer: UHCCP DNSP |
$138.06
|
| Rate for Payer: UHCCP Medicaid |
$89.03
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$161.24 |
| Max. Negotiated Rate |
$594.75 |
| Rate for Payer: Aetna Commercial |
$336.54
|
| Rate for Payer: Aetna Medicare |
$251.15
|
| Rate for Payer: BCBS Complete |
$169.30
|
| Rate for Payer: BCBS MAPPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$423.78
|
| Rate for Payer: BCN Medicare Advantage |
$251.15
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Cofinity Commercial |
$336.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.15
|
| Rate for Payer: Healthscope Commercial |
$301.38
|
| Rate for Payer: Healthscope Whirlpool |
$301.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.71
|
| Rate for Payer: Meridian Medicaid |
$169.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$276.26
|
| Rate for Payer: Nomi Health Commercial |
$301.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.75
|
| Rate for Payer: PACE SWMI |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$251.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$461.64
|
| Rate for Payer: Priority Health Medicare |
$251.15
|
| Rate for Payer: Priority Health Narrow Network |
$461.64
|
| Rate for Payer: Railroad Medicare Medicare |
$251.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$251.15
|
| Rate for Payer: UHC Exchange |
$507.49
|
| Rate for Payer: UHC Medicaid |
$161.24
|
| Rate for Payer: UHCCP DNSP |
$251.15
|
| Rate for Payer: UHCCP Medicaid |
$161.24
|
|
