|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 46940
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$392.89 |
| Rate for Payer: Aetna Commercial |
$193.32
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$97.95
|
| Rate for Payer: BCN Commercial |
$392.89
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Meridian Medicaid |
$97.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.11
|
| Rate for Payer: Priority Health Narrow Network |
$260.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.11
|
| Rate for Payer: UHC Exchange |
$174.11
|
| Rate for Payer: UHCCP Medicaid |
$93.29
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 46942
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,144.83 |
| Rate for Payer: Aetna Commercial |
$172.65
|
| Rate for Payer: Aetna Medicare |
$167.50
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.83
|
| Rate for Payer: BCN Commercial |
$373.84
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.87
|
| Rate for Payer: Priority Health Narrow Network |
$233.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.28
|
| Rate for Payer: UHC Exchange |
$155.28
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR CUSTOM EAR PLUGS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00592
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR CUTANANEOUS APPENDICO-VESICOSTOMY
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 50845
|
| Min. Negotiated Rate |
$801.73 |
| Max. Negotiated Rate |
$2,554.33 |
| Rate for Payer: Aetna Commercial |
$1,606.57
|
| Rate for Payer: Aetna Medicare |
$1,293.50
|
| Rate for Payer: BCBS Complete |
$841.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.33
|
| Rate for Payer: BCN Commercial |
$1,804.19
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Meridian Medicaid |
$841.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,990.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,990.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,503.54
|
| Rate for Payer: UHC Exchange |
$1,503.54
|
| Rate for Payer: UHCCP Medicaid |
$801.73
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$457.52 |
| Max. Negotiated Rate |
$2,370.48 |
| Rate for Payer: Aetna Commercial |
$916.03
|
| Rate for Payer: Aetna Medicare |
$730.00
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,370.48
|
| Rate for Payer: BCN Commercial |
$1,030.14
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Meridian Medicaid |
$480.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$855.00
|
| Rate for Payer: UHC Exchange |
$855.00
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$20.04
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Narrow Network |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.09
|
| Rate for Payer: UHC Exchange |
$20.09
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$1,426.94 |
| Rate for Payer: Aetna Commercial |
$43.41
|
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.94
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.20
|
| Rate for Payer: Priority Health Narrow Network |
$53.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.79
|
| Rate for Payer: UHC Exchange |
$64.79
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$1,780.90 |
| Rate for Payer: Aetna Commercial |
$28.99
|
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.90
|
| Rate for Payer: BCN Commercial |
$30.29
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.11
|
| Rate for Payer: UHC Exchange |
$30.11
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$91.71 |
| Max. Negotiated Rate |
$2,485.65 |
| Rate for Payer: Aetna Commercial |
$91.71
|
| Rate for Payer: Aetna Medicare |
$226.00
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,485.65
|
| Rate for Payer: BCN Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.70
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.99
|
| Rate for Payer: UHC Exchange |
$114.99
|
|
|
PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,811.00
|
|
|
Service Code
|
HCPCS 51570
|
| Min. Negotiated Rate |
$935.71 |
| Max. Negotiated Rate |
$3,145.50 |
| Rate for Payer: Aetna Commercial |
$1,887.68
|
| Rate for Payer: Aetna Medicare |
$1,405.50
|
| Rate for Payer: BCBS Complete |
$982.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,145.50
|
| Rate for Payer: BCN Commercial |
$2,115.97
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Meridian Medicaid |
$982.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,328.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,328.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,775.85
|
| Rate for Payer: UHC Exchange |
$1,775.85
|
| Rate for Payer: UHCCP Medicaid |
$935.71
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$7,752.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$803.65 |
| Max. Negotiated Rate |
$5,038.80 |
| Rate for Payer: Aetna Commercial |
$1,622.71
|
| Rate for Payer: Aetna Medicare |
$3,876.00
|
| Rate for Payer: BCBS Complete |
$843.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.69
|
| Rate for Payer: BCN Commercial |
$1,811.04
|
| Rate for Payer: Cash Price |
$6,201.60
|
| Rate for Payer: Cash Price |
$6,201.60
|
| Rate for Payer: Meridian Medicaid |
$843.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$803.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,038.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,997.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,997.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,522.61
|
| Rate for Payer: UHC Exchange |
$1,522.61
|
| Rate for Payer: UHCCP Medicaid |
$803.65
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,405.35 |
| Rate for Payer: Aetna Commercial |
$1,235.96
|
| Rate for Payer: Aetna Medicare |
$772.50
|
| Rate for Payer: BCBS Complete |
$646.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.35
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Meridian Medicaid |
$646.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,531.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,531.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,152.31
|
| Rate for Payer: UHC Exchange |
$1,152.31
|
| Rate for Payer: UHCCP Medicaid |
$615.36
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$3,796.00
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,152.97 |
| Max. Negotiated Rate |
$3,111.16 |
| Rate for Payer: Aetna Commercial |
$2,337.60
|
| Rate for Payer: Aetna Medicare |
$1,898.00
|
| Rate for Payer: BCBS Complete |
$1,210.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,111.16
|
| Rate for Payer: BCN Commercial |
$2,610.03
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Meridian Medicaid |
$1,210.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,152.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,467.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,866.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,866.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,208.08
|
| Rate for Payer: UHC Exchange |
$2,208.08
|
| Rate for Payer: UHCCP Medicaid |
$1,152.97
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$2,364.67 |
| Rate for Payer: Aetna Commercial |
$193.91
|
| Rate for Payer: Aetna Medicare |
$386.50
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.67
|
| Rate for Payer: BCN Commercial |
$478.42
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.66
|
| Rate for Payer: Priority Health Narrow Network |
$239.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.52
|
| Rate for Payer: UHC Exchange |
$187.52
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$201.92 |
| Max. Negotiated Rate |
$4,083.76 |
| Rate for Payer: Aetna Commercial |
$410.09
|
| Rate for Payer: Aetna Medicare |
$332.50
|
| Rate for Payer: BCBS Complete |
$212.02
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.76
|
| Rate for Payer: BCN Commercial |
$456.42
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Meridian Medicaid |
$212.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.71
|
| Rate for Payer: Priority Health Narrow Network |
$501.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$391.13
|
| Rate for Payer: UHC Exchange |
$391.13
|
| Rate for Payer: UHCCP Medicaid |
$201.92
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$894.94 |
| Rate for Payer: Aetna Commercial |
$356.38
|
| Rate for Payer: Aetna Medicare |
$273.50
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCBS Trust/PPO |
$894.94
|
| Rate for Payer: BCN Commercial |
$397.79
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.19
|
| Rate for Payer: Priority Health Narrow Network |
$436.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$339.69
|
| Rate for Payer: UHC Exchange |
$339.69
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,276.43 |
| Rate for Payer: Aetna Commercial |
$66.05
|
| Rate for Payer: Aetna Medicare |
$860.00
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$1,276.43
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.36
|
| Rate for Payer: Priority Health Narrow Network |
$79.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.04
|
| Rate for Payer: UHC Exchange |
$74.04
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$132.91 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$268.82
|
| Rate for Payer: Aetna Medicare |
$1,124.00
|
| Rate for Payer: BCBS Complete |
$139.56
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: BCN Commercial |
$1,866.75
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Meridian Medicaid |
$139.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,461.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.15
|
| Rate for Payer: Priority Health Narrow Network |
$329.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.70
|
| Rate for Payer: UHC Exchange |
$276.70
|
| Rate for Payer: UHCCP Medicaid |
$132.91
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$2,807.39 |
| Rate for Payer: Aetna Commercial |
$233.82
|
| Rate for Payer: Aetna Medicare |
$472.00
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.39
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Meridian Medicaid |
$122.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.07
|
| Rate for Payer: Priority Health Narrow Network |
$287.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.25
|
| Rate for Payer: UHC Exchange |
$312.25
|
| Rate for Payer: UHCCP Medicaid |
$116.30
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$304.59 |
| Max. Negotiated Rate |
$3,253.27 |
| Rate for Payer: Aetna Commercial |
$604.90
|
| Rate for Payer: Aetna Medicare |
$519.00
|
| Rate for Payer: BCBS Complete |
$319.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.27
|
| Rate for Payer: BCN Commercial |
$682.20
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Meridian Medicaid |
$319.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.23
|
| Rate for Payer: Priority Health Narrow Network |
$755.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.47
|
| Rate for Payer: UHC Exchange |
$566.47
|
| Rate for Payer: UHCCP Medicaid |
$304.59
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$6,449.49 |
| Rate for Payer: Aetna Commercial |
$337.43
|
| Rate for Payer: Aetna Medicare |
$525.00
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS Trust/PPO |
$6,449.49
|
| Rate for Payer: BCN Commercial |
$884.01
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.30
|
| Rate for Payer: Priority Health Narrow Network |
$413.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.61
|
| Rate for Payer: UHC Exchange |
$321.61
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$263.48 |
| Max. Negotiated Rate |
$654.03 |
| Rate for Payer: Aetna Commercial |
$534.36
|
| Rate for Payer: Aetna Medicare |
$381.00
|
| Rate for Payer: BCBS Complete |
$276.65
|
| Rate for Payer: BCBS Trust/PPO |
$475.77
|
| Rate for Payer: BCN Commercial |
$593.74
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Meridian Medicaid |
$276.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.03
|
| Rate for Payer: Priority Health Narrow Network |
$654.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$476.66
|
| Rate for Payer: UHC Exchange |
$476.66
|
| Rate for Payer: UHCCP Medicaid |
$263.48
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$295.22 |
| Max. Negotiated Rate |
$7,524.58 |
| Rate for Payer: Aetna Commercial |
$598.21
|
| Rate for Payer: Aetna Medicare |
$726.00
|
| Rate for Payer: BCBS Complete |
$309.98
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.58
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Meridian Medicaid |
$309.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.86
|
| Rate for Payer: Priority Health Narrow Network |
$732.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$568.54
|
| Rate for Payer: UHC Exchange |
$568.54
|
| Rate for Payer: UHCCP Medicaid |
$295.22
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,197.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$2,078.05 |
| Rate for Payer: Aetna Commercial |
$1,154.60
|
| Rate for Payer: Aetna Medicare |
$1,598.50
|
| Rate for Payer: BCBS Complete |
$600.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: BCN Commercial |
$1,294.51
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Meridian Medicaid |
$600.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,078.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,424.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,066.79
|
| Rate for Payer: UHC Exchange |
$1,066.79
|
| Rate for Payer: UHCCP Medicaid |
$571.91
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$476.91 |
| Max. Negotiated Rate |
$2,379.46 |
| Rate for Payer: Aetna Commercial |
$958.23
|
| Rate for Payer: Aetna Medicare |
$1,224.00
|
| Rate for Payer: BCBS Complete |
$500.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.46
|
| Rate for Payer: BCN Commercial |
$1,080.96
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Meridian Medicaid |
$500.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$872.09
|
| Rate for Payer: UHC Exchange |
$872.09
|
| Rate for Payer: UHCCP Medicaid |
$476.91
|
|
