|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$154.21 |
| Max. Negotiated Rate |
$1,479.24 |
| Rate for Payer: Aetna Commercial |
$311.87
|
| Rate for Payer: Aetna Medicare |
$237.00
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.24
|
| Rate for Payer: BCN Commercial |
$347.94
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.40
|
| Rate for Payer: Priority Health Narrow Network |
$382.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.02
|
| Rate for Payer: UHC Exchange |
$297.02
|
| Rate for Payer: UHCCP Medicaid |
$154.21
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$1,188.68 |
| Rate for Payer: Aetna Commercial |
$351.84
|
| Rate for Payer: Aetna Medicare |
$404.50
|
| Rate for Payer: BCBS Complete |
$182.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.68
|
| Rate for Payer: BCN Commercial |
$686.59
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Meridian Medicaid |
$182.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.88
|
| Rate for Payer: Priority Health Narrow Network |
$430.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$334.58
|
| Rate for Payer: UHC Exchange |
$334.58
|
| Rate for Payer: UHCCP Medicaid |
$173.38
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$2,177.12 |
| Rate for Payer: Aetna Commercial |
$227.00
|
| Rate for Payer: Aetna Medicare |
$1,412.50
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,177.12
|
| Rate for Payer: BCN Commercial |
$1,100.50
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.29
|
| Rate for Payer: Priority Health Narrow Network |
$274.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.36
|
| Rate for Payer: UHC Exchange |
$257.36
|
| Rate for Payer: UHCCP Medicaid |
$110.76
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,050.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna Commercial |
$204.45
|
| Rate for Payer: Aetna Medicare |
$2,025.00
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,632.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.85
|
| Rate for Payer: Priority Health Narrow Network |
$258.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.19
|
| Rate for Payer: UHC Exchange |
$205.19
|
| Rate for Payer: UHCCP Medicaid |
$104.58
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$2,268.52 |
| Rate for Payer: Aetna Commercial |
$198.36
|
| Rate for Payer: Aetna Medicare |
$433.50
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,268.52
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.99
|
| Rate for Payer: Priority Health Narrow Network |
$244.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.21
|
| Rate for Payer: UHC Exchange |
$189.21
|
| Rate for Payer: UHCCP Medicaid |
$98.83
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$1,930.41 |
| Rate for Payer: Aetna Commercial |
$367.75
|
| Rate for Payer: Aetna Medicare |
$385.00
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.41
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$451.12
|
| Rate for Payer: Priority Health Narrow Network |
$451.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$349.35
|
| Rate for Payer: UHC Exchange |
$349.35
|
| Rate for Payer: UHCCP Medicaid |
$181.26
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$2,846.48 |
| Rate for Payer: Aetna Commercial |
$261.58
|
| Rate for Payer: Aetna Medicare |
$1,163.00
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.48
|
| Rate for Payer: BCN Commercial |
$1,149.37
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.42
|
| Rate for Payer: Priority Health Narrow Network |
$317.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.71
|
| Rate for Payer: UHC Exchange |
$205.71
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$155.49 |
| Max. Negotiated Rate |
$5,244.96 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Medicare |
$538.50
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS Trust/PPO |
$5,244.96
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.13
|
| Rate for Payer: Priority Health Narrow Network |
$386.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.13
|
| Rate for Payer: UHC Exchange |
$299.13
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$176.79 |
| Max. Negotiated Rate |
$1,512.52 |
| Rate for Payer: Aetna Commercial |
$358.89
|
| Rate for Payer: Aetna Medicare |
$275.00
|
| Rate for Payer: BCBS Complete |
$185.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.52
|
| Rate for Payer: BCN Commercial |
$400.23
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Meridian Medicaid |
$185.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.39
|
| Rate for Payer: Priority Health Narrow Network |
$439.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.92
|
| Rate for Payer: UHC Exchange |
$343.92
|
| Rate for Payer: UHCCP Medicaid |
$176.79
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$371.30
|
| Rate for Payer: Aetna Medicare |
$291.50
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.38
|
| Rate for Payer: Priority Health Narrow Network |
$455.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$356.79
|
| Rate for Payer: UHC Exchange |
$356.79
|
| Rate for Payer: UHCCP Medicaid |
$183.18
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$193.36
|
| Rate for Payer: Aetna Medicare |
$295.00
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$466.69
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.61
|
| Rate for Payer: Priority Health Narrow Network |
$238.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.28
|
| Rate for Payer: UHC Exchange |
$184.28
|
| Rate for Payer: UHCCP Medicaid |
$96.28
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$2,129.58 |
| Rate for Payer: Aetna Commercial |
$338.60
|
| Rate for Payer: Aetna Medicare |
$656.50
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,129.58
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Meridian Medicaid |
$171.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.84
|
| Rate for Payer: Priority Health Narrow Network |
$405.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.72
|
| Rate for Payer: UHC Exchange |
$320.72
|
| Rate for Payer: UHCCP Medicaid |
$163.37
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$217.47 |
| Max. Negotiated Rate |
$2,659.46 |
| Rate for Payer: Aetna Commercial |
$439.49
|
| Rate for Payer: Aetna Medicare |
$338.50
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.46
|
| Rate for Payer: BCN Commercial |
$490.63
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Meridian Medicaid |
$228.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.52
|
| Rate for Payer: Priority Health Narrow Network |
$539.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$427.42
|
| Rate for Payer: UHC Exchange |
$427.42
|
| Rate for Payer: UHCCP Medicaid |
$217.47
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,537.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$2,160.75 |
| Rate for Payer: Aetna Commercial |
$363.22
|
| Rate for Payer: Aetna Medicare |
$768.50
|
| Rate for Payer: BCBS Complete |
$188.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.75
|
| Rate for Payer: BCN Commercial |
$405.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Meridian Medicaid |
$188.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.32
|
| Rate for Payer: Priority Health Narrow Network |
$446.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.82
|
| Rate for Payer: UHC Exchange |
$352.82
|
| Rate for Payer: UHCCP Medicaid |
$179.35
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: Aetna Commercial |
$395.15
|
| Rate for Payer: Aetna Medicare |
$856.00
|
| Rate for Payer: BCBS Complete |
$205.09
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$440.30
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Meridian Medicaid |
$205.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.73
|
| Rate for Payer: Priority Health Narrow Network |
$485.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$383.56
|
| Rate for Payer: UHC Exchange |
$383.56
|
| Rate for Payer: UHCCP Medicaid |
$195.32
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$7,607.52 |
| Rate for Payer: Aetna Commercial |
$501.54
|
| Rate for Payer: Aetna Medicare |
$412.00
|
| Rate for Payer: BCBS Complete |
$259.43
|
| Rate for Payer: BCBS Trust/PPO |
$7,607.52
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.62
|
| Rate for Payer: Priority Health Narrow Network |
$614.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$515.41
|
| Rate for Payer: UHC Exchange |
$515.41
|
| Rate for Payer: UHCCP Medicaid |
$247.08
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$452.78
|
| Rate for Payer: Aetna Medicare |
$1,500.00
|
| Rate for Payer: BCBS Complete |
$235.05
|
| Rate for Payer: BCBS Trust/PPO |
$677.97
|
| Rate for Payer: BCN Commercial |
$504.80
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Meridian Medicaid |
$235.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.50
|
| Rate for Payer: Priority Health Narrow Network |
$555.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.43
|
| Rate for Payer: UHC Exchange |
$448.43
|
| Rate for Payer: UHCCP Medicaid |
$223.86
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$475.62 |
| Rate for Payer: Aetna Commercial |
$386.83
|
| Rate for Payer: Aetna Medicare |
$304.00
|
| Rate for Payer: BCBS Complete |
$201.06
|
| Rate for Payer: BCBS Trust/PPO |
$393.43
|
| Rate for Payer: BCN Commercial |
$431.01
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Meridian Medicaid |
$201.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.62
|
| Rate for Payer: Priority Health Narrow Network |
$475.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$381.51
|
| Rate for Payer: UHC Exchange |
$381.51
|
| Rate for Payer: UHCCP Medicaid |
$191.49
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$281.37 |
| Max. Negotiated Rate |
$2,753.98 |
| Rate for Payer: Aetna Commercial |
$571.60
|
| Rate for Payer: Aetna Medicare |
$442.00
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,753.98
|
| Rate for Payer: BCN Commercial |
$635.28
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Meridian Medicaid |
$295.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$699.84
|
| Rate for Payer: Priority Health Narrow Network |
$699.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$558.27
|
| Rate for Payer: UHC Exchange |
$558.27
|
| Rate for Payer: UHCCP Medicaid |
$281.37
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$3,736.67 |
| Rate for Payer: Aetna Commercial |
$471.86
|
| Rate for Payer: Aetna Medicare |
$399.50
|
| Rate for Payer: BCBS Complete |
$244.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,736.67
|
| Rate for Payer: BCN Commercial |
$525.33
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Meridian Medicaid |
$244.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.00
|
| Rate for Payer: Priority Health Narrow Network |
$580.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$463.05
|
| Rate for Payer: UHC Exchange |
$463.05
|
| Rate for Payer: UHCCP Medicaid |
$233.24
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$1,127.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$248.78 |
| Max. Negotiated Rate |
$3,934.25 |
| Rate for Payer: Aetna Commercial |
$504.64
|
| Rate for Payer: Aetna Medicare |
$563.50
|
| Rate for Payer: BCBS Complete |
$261.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.25
|
| Rate for Payer: BCN Commercial |
$561.49
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Meridian Medicaid |
$261.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$618.88
|
| Rate for Payer: Priority Health Narrow Network |
$618.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.20
|
| Rate for Payer: UHC Exchange |
$494.20
|
| Rate for Payer: UHCCP Medicaid |
$248.78
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$245.66 |
| Max. Negotiated Rate |
$1,411.96 |
| Rate for Payer: Aetna Commercial |
$1,040.24
|
| Rate for Payer: Aetna Medicare |
$786.00
|
| Rate for Payer: BCBS Complete |
$537.65
|
| Rate for Payer: BCBS Trust/PPO |
$245.66
|
| Rate for Payer: BCN Commercial |
$1,172.83
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Meridian Medicaid |
$537.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,411.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,411.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$805.12
|
| Rate for Payer: UHC Exchange |
$805.12
|
| Rate for Payer: UHCCP Medicaid |
$512.05
|
|
|
PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01996
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.50
|
| Rate for Payer: Priority Health Narrow Network |
$133.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.00
|
| Rate for Payer: UHC Exchange |
$165.00
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$30.50
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.03
|
| Rate for Payer: Priority Health Narrow Network |
$37.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.12
|
| Rate for Payer: UHC Exchange |
$33.12
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$32.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.87
|
| Rate for Payer: Priority Health Narrow Network |
$19.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.56
|
| Rate for Payer: UHC Exchange |
$16.56
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
|
