|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$414.70 |
| Rate for Payer: Aetna Commercial |
$207.00
|
| Rate for Payer: Aetna Medicare |
$154.48
|
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCBS MAPPO |
$154.48
|
| Rate for Payer: BCN Medicare Advantage |
$154.48
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$222.45
|
| Rate for Payer: Cofinity Commercial |
$207.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.48
|
| Rate for Payer: Healthscope Commercial |
$185.38
|
| Rate for Payer: Healthscope Whirlpool |
$185.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.20
|
| Rate for Payer: Nomi Health Commercial |
$185.38
|
| Rate for Payer: PACE SWMI |
$154.48
|
| Rate for Payer: PHP Medicare Advantage |
$154.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health Medicare |
$154.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.48
|
| Rate for Payer: UHC Medicare Advantage |
$154.48
|
| Rate for Payer: UHCCP DNSP |
$154.48
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$250.77 |
| Max. Negotiated Rate |
$728.65 |
| Rate for Payer: Aetna Commercial |
$336.03
|
| Rate for Payer: Aetna Medicare |
$250.77
|
| Rate for Payer: BCBS Complete |
$448.40
|
| Rate for Payer: BCBS MAPPO |
$250.77
|
| Rate for Payer: BCN Medicare Advantage |
$250.77
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cash Price |
$896.80
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Cofinity Commercial |
$336.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.77
|
| Rate for Payer: Healthscope Commercial |
$300.92
|
| Rate for Payer: Healthscope Whirlpool |
$300.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.31
|
| Rate for Payer: Nomi Health Commercial |
$300.92
|
| Rate for Payer: PACE SWMI |
$250.77
|
| Rate for Payer: PHP Medicare Advantage |
$250.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.65
|
| Rate for Payer: Priority Health Medicare |
$250.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.77
|
| Rate for Payer: UHC Medicare Advantage |
$250.77
|
| Rate for Payer: UHCCP DNSP |
$250.77
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$172.95 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$172.95
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$172.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.95
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$249.05
|
| Rate for Payer: Cofinity Commercial |
$231.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.95
|
| Rate for Payer: Healthscope Commercial |
$207.54
|
| Rate for Payer: Healthscope Whirlpool |
$207.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.60
|
| Rate for Payer: Nomi Health Commercial |
$207.54
|
| Rate for Payer: PACE SWMI |
$172.95
|
| Rate for Payer: PHP Medicare Advantage |
$172.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$172.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.95
|
| Rate for Payer: UHC Medicare Advantage |
$172.95
|
| Rate for Payer: UHCCP DNSP |
$172.95
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$236.18 |
| Max. Negotiated Rate |
$635.05 |
| Rate for Payer: Aetna Commercial |
$316.48
|
| Rate for Payer: Aetna Medicare |
$236.18
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS MAPPO |
$236.18
|
| Rate for Payer: BCN Medicare Advantage |
$236.18
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$340.10
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.18
|
| Rate for Payer: Healthscope Commercial |
$283.42
|
| Rate for Payer: Healthscope Whirlpool |
$283.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.99
|
| Rate for Payer: Nomi Health Commercial |
$283.42
|
| Rate for Payer: PACE SWMI |
$236.18
|
| Rate for Payer: PHP Medicare Advantage |
$236.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health Medicare |
$236.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.18
|
| Rate for Payer: UHC Medicare Advantage |
$236.18
|
| Rate for Payer: UHCCP DNSP |
$236.18
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$486.20 |
| Rate for Payer: Aetna Commercial |
$179.64
|
| Rate for Payer: Aetna Medicare |
$134.06
|
| Rate for Payer: BCBS Complete |
$299.20
|
| Rate for Payer: BCBS MAPPO |
$134.06
|
| Rate for Payer: BCN Medicare Advantage |
$134.06
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Cofinity Commercial |
$179.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.06
|
| Rate for Payer: Healthscope Commercial |
$160.87
|
| Rate for Payer: Healthscope Whirlpool |
$160.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.76
|
| Rate for Payer: Nomi Health Commercial |
$160.87
|
| Rate for Payer: PACE SWMI |
$134.06
|
| Rate for Payer: PHP Medicare Advantage |
$134.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.20
|
| Rate for Payer: Priority Health Medicare |
$134.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.06
|
| Rate for Payer: UHC Medicare Advantage |
$134.06
|
| Rate for Payer: UHCCP DNSP |
$134.06
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$234.12 |
| Max. Negotiated Rate |
$926.90 |
| Rate for Payer: Aetna Commercial |
$313.72
|
| Rate for Payer: Aetna Medicare |
$234.12
|
| Rate for Payer: BCBS Complete |
$570.40
|
| Rate for Payer: BCBS MAPPO |
$234.12
|
| Rate for Payer: BCN Medicare Advantage |
$234.12
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cofinity Commercial |
$337.13
|
| Rate for Payer: Cofinity Commercial |
$313.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.12
|
| Rate for Payer: Healthscope Commercial |
$280.94
|
| Rate for Payer: Healthscope Whirlpool |
$280.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.83
|
| Rate for Payer: Nomi Health Commercial |
$280.94
|
| Rate for Payer: PACE SWMI |
$234.12
|
| Rate for Payer: PHP Medicare Advantage |
$234.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$926.90
|
| Rate for Payer: Priority Health Medicare |
$234.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.12
|
| Rate for Payer: UHC Medicare Advantage |
$234.12
|
| Rate for Payer: UHCCP DNSP |
$234.12
|
|
|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$276.77 |
| Rate for Payer: Aetna Commercial |
$257.55
|
| Rate for Payer: Aetna Medicare |
$192.20
|
| Rate for Payer: BCBS Complete |
$166.40
|
| Rate for Payer: BCBS MAPPO |
$192.20
|
| Rate for Payer: BCN Medicare Advantage |
$192.20
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$276.77
|
| Rate for Payer: Cofinity Commercial |
$257.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.20
|
| Rate for Payer: Healthscope Commercial |
$230.64
|
| Rate for Payer: Healthscope Whirlpool |
$230.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.81
|
| Rate for Payer: Nomi Health Commercial |
$230.64
|
| Rate for Payer: PACE SWMI |
$192.20
|
| Rate for Payer: PHP Medicare Advantage |
$192.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health Medicare |
$192.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.20
|
| Rate for Payer: UHC Medicare Advantage |
$192.20
|
| Rate for Payer: UHCCP DNSP |
$192.20
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$363.35 |
| Rate for Payer: Aetna Commercial |
$169.59
|
| Rate for Payer: Aetna Medicare |
$126.56
|
| Rate for Payer: BCBS Complete |
$223.60
|
| Rate for Payer: BCBS MAPPO |
$126.56
|
| Rate for Payer: BCN Medicare Advantage |
$126.56
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cofinity Commercial |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$169.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.56
|
| Rate for Payer: Healthscope Commercial |
$151.87
|
| Rate for Payer: Healthscope Whirlpool |
$151.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.89
|
| Rate for Payer: Nomi Health Commercial |
$151.87
|
| Rate for Payer: PACE SWMI |
$126.56
|
| Rate for Payer: PHP Medicare Advantage |
$126.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health Medicare |
$126.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.56
|
| Rate for Payer: UHC Medicare Advantage |
$126.56
|
| Rate for Payer: UHCCP DNSP |
$126.56
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$332.91 |
| Rate for Payer: Aetna Commercial |
$309.79
|
| Rate for Payer: Aetna Medicare |
$231.19
|
| Rate for Payer: BCBS Complete |
$189.60
|
| Rate for Payer: BCBS MAPPO |
$231.19
|
| Rate for Payer: BCN Medicare Advantage |
$231.19
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$332.91
|
| Rate for Payer: Cofinity Commercial |
$309.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.19
|
| Rate for Payer: Healthscope Commercial |
$277.43
|
| Rate for Payer: Healthscope Whirlpool |
$277.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.75
|
| Rate for Payer: Nomi Health Commercial |
$277.43
|
| Rate for Payer: PACE SWMI |
$231.19
|
| Rate for Payer: PHP Medicare Advantage |
$231.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health Medicare |
$231.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.19
|
| Rate for Payer: UHC Medicare Advantage |
$231.19
|
| Rate for Payer: UHCCP DNSP |
$231.19
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$260.18 |
| Max. Negotiated Rate |
$525.85 |
| Rate for Payer: Aetna Commercial |
$348.64
|
| Rate for Payer: Aetna Medicare |
$260.18
|
| Rate for Payer: BCBS Complete |
$323.60
|
| Rate for Payer: BCBS MAPPO |
$260.18
|
| Rate for Payer: BCN Medicare Advantage |
$260.18
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$374.66
|
| Rate for Payer: Cofinity Commercial |
$348.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.18
|
| Rate for Payer: Healthscope Commercial |
$312.22
|
| Rate for Payer: Healthscope Whirlpool |
$312.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.19
|
| Rate for Payer: Nomi Health Commercial |
$312.22
|
| Rate for Payer: PACE SWMI |
$260.18
|
| Rate for Payer: PHP Medicare Advantage |
$260.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health Medicare |
$260.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.18
|
| Rate for Payer: UHC Medicare Advantage |
$260.18
|
| Rate for Payer: UHCCP DNSP |
$260.18
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$166.95 |
| Max. Negotiated Rate |
$1,836.25 |
| Rate for Payer: Aetna Commercial |
$223.71
|
| Rate for Payer: Aetna Medicare |
$166.95
|
| Rate for Payer: BCBS Complete |
$1,130.00
|
| Rate for Payer: BCBS MAPPO |
$166.95
|
| Rate for Payer: BCN Medicare Advantage |
$166.95
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cofinity Commercial |
$240.41
|
| Rate for Payer: Cofinity Commercial |
$223.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.95
|
| Rate for Payer: Healthscope Commercial |
$200.34
|
| Rate for Payer: Healthscope Whirlpool |
$200.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.30
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: PACE SWMI |
$166.95
|
| Rate for Payer: PHP Medicare Advantage |
$166.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.25
|
| Rate for Payer: Priority Health Medicare |
$166.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.95
|
| Rate for Payer: UHC Medicare Advantage |
$166.95
|
| Rate for Payer: UHCCP DNSP |
$166.95
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,050.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$156.92 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna Commercial |
$210.27
|
| Rate for Payer: Aetna Medicare |
$156.92
|
| Rate for Payer: BCBS Complete |
$1,620.00
|
| Rate for Payer: BCBS MAPPO |
$156.92
|
| Rate for Payer: BCN Medicare Advantage |
$156.92
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cofinity Commercial |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$210.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.92
|
| Rate for Payer: Healthscope Commercial |
$188.30
|
| Rate for Payer: Healthscope Whirlpool |
$188.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.77
|
| Rate for Payer: Nomi Health Commercial |
$188.30
|
| Rate for Payer: PACE SWMI |
$156.92
|
| Rate for Payer: PHP Medicare Advantage |
$156.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,632.50
|
| Rate for Payer: Priority Health Medicare |
$156.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.92
|
| Rate for Payer: UHC Medicare Advantage |
$156.92
|
| Rate for Payer: UHCCP DNSP |
$156.92
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$147.81 |
| Max. Negotiated Rate |
$563.55 |
| Rate for Payer: Aetna Commercial |
$198.07
|
| Rate for Payer: Aetna Medicare |
$147.81
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$147.81
|
| Rate for Payer: BCN Medicare Advantage |
$147.81
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$212.85
|
| Rate for Payer: Cofinity Commercial |
$198.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.81
|
| Rate for Payer: Healthscope Commercial |
$177.37
|
| Rate for Payer: Healthscope Whirlpool |
$177.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.20
|
| Rate for Payer: Nomi Health Commercial |
$177.37
|
| Rate for Payer: PACE SWMI |
$147.81
|
| Rate for Payer: PHP Medicare Advantage |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$147.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.81
|
| Rate for Payer: UHC Medicare Advantage |
$147.81
|
| Rate for Payer: UHCCP DNSP |
$147.81
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$271.94 |
| Max. Negotiated Rate |
$500.50 |
| Rate for Payer: Aetna Commercial |
$364.40
|
| Rate for Payer: Aetna Medicare |
$271.94
|
| Rate for Payer: BCBS Complete |
$308.00
|
| Rate for Payer: BCBS MAPPO |
$271.94
|
| Rate for Payer: BCN Medicare Advantage |
$271.94
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$391.59
|
| Rate for Payer: Cofinity Commercial |
$364.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.94
|
| Rate for Payer: Healthscope Commercial |
$326.33
|
| Rate for Payer: Healthscope Whirlpool |
$326.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.54
|
| Rate for Payer: Nomi Health Commercial |
$326.33
|
| Rate for Payer: PACE SWMI |
$271.94
|
| Rate for Payer: PHP Medicare Advantage |
$271.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health Medicare |
$271.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.94
|
| Rate for Payer: UHC Medicare Advantage |
$271.94
|
| Rate for Payer: UHCCP DNSP |
$271.94
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$193.00 |
| Max. Negotiated Rate |
$1,511.90 |
| Rate for Payer: Aetna Commercial |
$258.62
|
| Rate for Payer: Aetna Medicare |
$193.00
|
| Rate for Payer: BCBS Complete |
$930.40
|
| Rate for Payer: BCBS MAPPO |
$193.00
|
| Rate for Payer: BCN Medicare Advantage |
$193.00
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cofinity Commercial |
$277.92
|
| Rate for Payer: Cofinity Commercial |
$258.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.00
|
| Rate for Payer: Healthscope Commercial |
$231.60
|
| Rate for Payer: Healthscope Whirlpool |
$231.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.65
|
| Rate for Payer: Nomi Health Commercial |
$231.60
|
| Rate for Payer: PACE SWMI |
$193.00
|
| Rate for Payer: PHP Medicare Advantage |
$193.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.90
|
| Rate for Payer: Priority Health Medicare |
$193.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.00
|
| Rate for Payer: UHC Medicare Advantage |
$193.00
|
| Rate for Payer: UHCCP DNSP |
$193.00
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$233.16 |
| Max. Negotiated Rate |
$700.05 |
| Rate for Payer: Aetna Commercial |
$312.43
|
| Rate for Payer: Aetna Medicare |
$233.16
|
| Rate for Payer: BCBS Complete |
$430.80
|
| Rate for Payer: BCBS MAPPO |
$233.16
|
| Rate for Payer: BCN Medicare Advantage |
$233.16
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$335.75
|
| Rate for Payer: Cofinity Commercial |
$312.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.16
|
| Rate for Payer: Healthscope Commercial |
$279.79
|
| Rate for Payer: Healthscope Whirlpool |
$279.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.82
|
| Rate for Payer: Nomi Health Commercial |
$279.79
|
| Rate for Payer: PACE SWMI |
$233.16
|
| Rate for Payer: PHP Medicare Advantage |
$233.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health Medicare |
$233.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.16
|
| Rate for Payer: UHC Medicare Advantage |
$233.16
|
| Rate for Payer: UHCCP DNSP |
$233.16
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$381.86 |
| Rate for Payer: Aetna Commercial |
$355.34
|
| Rate for Payer: Aetna Medicare |
$265.18
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS MAPPO |
$265.18
|
| Rate for Payer: BCN Medicare Advantage |
$265.18
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$381.86
|
| Rate for Payer: Cofinity Commercial |
$355.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.18
|
| Rate for Payer: Healthscope Commercial |
$318.22
|
| Rate for Payer: Healthscope Whirlpool |
$318.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.44
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PACE SWMI |
$265.18
|
| Rate for Payer: PHP Medicare Advantage |
$265.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health Medicare |
$265.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.18
|
| Rate for Payer: UHC Medicare Advantage |
$265.18
|
| Rate for Payer: UHCCP DNSP |
$265.18
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$395.78 |
| Rate for Payer: Aetna Commercial |
$368.30
|
| Rate for Payer: Aetna Medicare |
$274.85
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$274.85
|
| Rate for Payer: BCN Medicare Advantage |
$274.85
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Cofinity Commercial |
$368.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.85
|
| Rate for Payer: Healthscope Commercial |
$329.82
|
| Rate for Payer: Healthscope Whirlpool |
$329.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.59
|
| Rate for Payer: Nomi Health Commercial |
$329.82
|
| Rate for Payer: PACE SWMI |
$274.85
|
| Rate for Payer: PHP Medicare Advantage |
$274.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$274.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.85
|
| Rate for Payer: UHC Medicare Advantage |
$274.85
|
| Rate for Payer: UHCCP DNSP |
$274.85
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: Aetna Commercial |
$193.29
|
| Rate for Payer: Aetna Medicare |
$144.25
|
| Rate for Payer: BCBS Complete |
$236.00
|
| Rate for Payer: BCBS MAPPO |
$144.25
|
| Rate for Payer: BCN Medicare Advantage |
$144.25
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Cofinity Commercial |
$193.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.25
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Healthscope Whirlpool |
$173.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.46
|
| Rate for Payer: Nomi Health Commercial |
$173.10
|
| Rate for Payer: PACE SWMI |
$144.25
|
| Rate for Payer: PHP Medicare Advantage |
$144.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.50
|
| Rate for Payer: Priority Health Medicare |
$144.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.25
|
| Rate for Payer: UHC Medicare Advantage |
$144.25
|
| Rate for Payer: UHCCP DNSP |
$144.25
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$246.27 |
| Max. Negotiated Rate |
$853.45 |
| Rate for Payer: Aetna Commercial |
$330.00
|
| Rate for Payer: Aetna Medicare |
$246.27
|
| Rate for Payer: BCBS Complete |
$525.20
|
| Rate for Payer: BCBS MAPPO |
$246.27
|
| Rate for Payer: BCN Medicare Advantage |
$246.27
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cofinity Commercial |
$354.63
|
| Rate for Payer: Cofinity Commercial |
$330.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.27
|
| Rate for Payer: Healthscope Commercial |
$295.52
|
| Rate for Payer: Healthscope Whirlpool |
$295.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.58
|
| Rate for Payer: Nomi Health Commercial |
$295.52
|
| Rate for Payer: PACE SWMI |
$246.27
|
| Rate for Payer: PHP Medicare Advantage |
$246.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.45
|
| Rate for Payer: Priority Health Medicare |
$246.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.27
|
| Rate for Payer: UHC Medicare Advantage |
$246.27
|
| Rate for Payer: UHCCP DNSP |
$246.27
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$470.16 |
| Rate for Payer: Aetna Commercial |
$437.51
|
| Rate for Payer: Aetna Medicare |
$326.50
|
| Rate for Payer: BCBS Complete |
$270.80
|
| Rate for Payer: BCBS MAPPO |
$326.50
|
| Rate for Payer: BCN Medicare Advantage |
$326.50
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$470.16
|
| Rate for Payer: Cofinity Commercial |
$437.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.50
|
| Rate for Payer: Healthscope Commercial |
$391.80
|
| Rate for Payer: Healthscope Whirlpool |
$391.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$342.82
|
| Rate for Payer: Nomi Health Commercial |
$391.80
|
| Rate for Payer: PACE SWMI |
$326.50
|
| Rate for Payer: PHP Medicare Advantage |
$326.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.05
|
| Rate for Payer: Priority Health Medicare |
$326.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.50
|
| Rate for Payer: UHC Medicare Advantage |
$326.50
|
| Rate for Payer: UHCCP DNSP |
$326.50
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,537.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$268.94 |
| Max. Negotiated Rate |
$999.05 |
| Rate for Payer: Aetna Commercial |
$360.38
|
| Rate for Payer: Aetna Medicare |
$268.94
|
| Rate for Payer: BCBS Complete |
$614.80
|
| Rate for Payer: BCBS MAPPO |
$268.94
|
| Rate for Payer: BCN Medicare Advantage |
$268.94
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cofinity Commercial |
$387.27
|
| Rate for Payer: Cofinity Commercial |
$360.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.94
|
| Rate for Payer: Healthscope Commercial |
$322.73
|
| Rate for Payer: Healthscope Whirlpool |
$322.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.39
|
| Rate for Payer: Nomi Health Commercial |
$322.73
|
| Rate for Payer: PACE SWMI |
$268.94
|
| Rate for Payer: PHP Medicare Advantage |
$268.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.05
|
| Rate for Payer: Priority Health Medicare |
$268.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.94
|
| Rate for Payer: UHC Medicare Advantage |
$268.94
|
| Rate for Payer: UHCCP DNSP |
$268.94
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$293.08 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: Aetna Commercial |
$392.73
|
| Rate for Payer: Aetna Medicare |
$293.08
|
| Rate for Payer: BCBS Complete |
$684.80
|
| Rate for Payer: BCBS MAPPO |
$293.08
|
| Rate for Payer: BCN Medicare Advantage |
$293.08
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$422.04
|
| Rate for Payer: Cofinity Commercial |
$392.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.08
|
| Rate for Payer: Healthscope Commercial |
$351.70
|
| Rate for Payer: Healthscope Whirlpool |
$351.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.73
|
| Rate for Payer: Nomi Health Commercial |
$351.70
|
| Rate for Payer: PACE SWMI |
$293.08
|
| Rate for Payer: PHP Medicare Advantage |
$293.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health Medicare |
$293.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.08
|
| Rate for Payer: UHC Medicare Advantage |
$293.08
|
| Rate for Payer: UHCCP DNSP |
$293.08
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$329.60 |
| Max. Negotiated Rate |
$535.60 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$370.96
|
| Rate for Payer: BCBS Complete |
$329.60
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCN Medicare Advantage |
$370.96
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cofinity Commercial |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.96
|
| Rate for Payer: Healthscope Commercial |
$445.15
|
| Rate for Payer: Healthscope Whirlpool |
$445.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$445.15
|
| Rate for Payer: PACE SWMI |
$370.96
|
| Rate for Payer: PHP Medicare Advantage |
$370.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.60
|
| Rate for Payer: Priority Health Medicare |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.96
|
| Rate for Payer: UHC Medicare Advantage |
$370.96
|
| Rate for Payer: UHCCP DNSP |
$370.96
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$336.09 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$450.36
|
| Rate for Payer: Aetna Medicare |
$336.09
|
| Rate for Payer: BCBS Complete |
$1,200.00
|
| Rate for Payer: BCBS MAPPO |
$336.09
|
| Rate for Payer: BCN Medicare Advantage |
$336.09
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cofinity Commercial |
$483.97
|
| Rate for Payer: Cofinity Commercial |
$450.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.09
|
| Rate for Payer: Healthscope Commercial |
$403.31
|
| Rate for Payer: Healthscope Whirlpool |
$403.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.89
|
| Rate for Payer: Nomi Health Commercial |
$403.31
|
| Rate for Payer: PACE SWMI |
$336.09
|
| Rate for Payer: PHP Medicare Advantage |
$336.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health Medicare |
$336.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.09
|
| Rate for Payer: UHC Medicare Advantage |
$336.09
|
| Rate for Payer: UHCCP DNSP |
$336.09
|
|
