|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: BCBS Complete |
$720.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.00
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$192.77 |
| Max. Negotiated Rate |
$2,683.76 |
| Rate for Payer: Aetna Commercial |
$398.56
|
| Rate for Payer: Aetna Medicare |
$297.43
|
| Rate for Payer: BCBS Complete |
$202.41
|
| Rate for Payer: BCBS MAPPO |
$297.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.76
|
| Rate for Payer: BCN Commercial |
$546.34
|
| Rate for Payer: BCN Medicare Advantage |
$297.43
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cash Price |
$563.20
|
| Rate for Payer: Cofinity Commercial |
$428.30
|
| Rate for Payer: Cofinity Commercial |
$398.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.43
|
| Rate for Payer: Healthscope Commercial |
$356.92
|
| Rate for Payer: Healthscope Whirlpool |
$356.92
|
| Rate for Payer: Meridian Medicaid |
$202.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.30
|
| Rate for Payer: PACE SWMI |
$297.43
|
| Rate for Payer: PHP Medicare Advantage |
$297.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.08
|
| Rate for Payer: Priority Health Medicare |
$297.43
|
| Rate for Payer: Priority Health Narrow Network |
$483.08
|
| Rate for Payer: UHC Medicare Advantage |
$306.35
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$2,814.78 |
| Rate for Payer: Aetna Commercial |
$412.45
|
| Rate for Payer: Aetna Medicare |
$307.80
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$307.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,814.78
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$307.80
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$443.23
|
| Rate for Payer: Cofinity Commercial |
$412.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Whirlpool |
$369.36
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$323.19
|
| Rate for Payer: PACE SWMI |
$307.80
|
| Rate for Payer: PHP Medicare Advantage |
$307.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.84
|
| Rate for Payer: Priority Health Medicare |
$307.80
|
| Rate for Payer: Priority Health Narrow Network |
$499.84
|
| Rate for Payer: UHC Medicare Advantage |
$317.03
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$831.34 |
| Max. Negotiated Rate |
$3,097.95 |
| Rate for Payer: Aetna Commercial |
$1,718.83
|
| Rate for Payer: Aetna Medicare |
$1,282.71
|
| Rate for Payer: BCBS Complete |
$872.91
|
| Rate for Payer: BCBS MAPPO |
$1,282.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.95
|
| Rate for Payer: BCN Commercial |
$1,888.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,282.71
|
| Rate for Payer: Cash Price |
$2,711.20
|
| Rate for Payer: Cash Price |
$2,711.20
|
| Rate for Payer: Cofinity Commercial |
$1,718.83
|
| Rate for Payer: Cofinity Commercial |
$1,847.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,282.71
|
| Rate for Payer: Healthscope Commercial |
$1,539.25
|
| Rate for Payer: Healthscope Whirlpool |
$1,539.25
|
| Rate for Payer: Meridian Medicaid |
$872.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,346.85
|
| Rate for Payer: PACE SWMI |
$1,282.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,282.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,372.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,088.48
|
| Rate for Payer: Priority Health Medicare |
$1,282.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,088.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,321.19
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$652.42 |
| Max. Negotiated Rate |
$4,734.10 |
| Rate for Payer: Aetna Commercial |
$1,355.60
|
| Rate for Payer: Aetna Medicare |
$1,011.64
|
| Rate for Payer: BCBS Complete |
$685.04
|
| Rate for Payer: BCBS MAPPO |
$1,011.64
|
| Rate for Payer: BCBS Trust/PPO |
$4,734.10
|
| Rate for Payer: BCN Commercial |
$1,489.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,011.64
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$1,456.76
|
| Rate for Payer: Cofinity Commercial |
$1,355.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,011.64
|
| Rate for Payer: Healthscope Commercial |
$1,213.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,213.97
|
| Rate for Payer: Meridian Medicaid |
$685.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,062.22
|
| Rate for Payer: PACE SWMI |
$1,011.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,011.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,647.01
|
| Rate for Payer: Priority Health Medicare |
$1,011.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,647.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.99
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$770.21 |
| Max. Negotiated Rate |
$4,058.93 |
| Rate for Payer: Aetna Commercial |
$1,591.24
|
| Rate for Payer: Aetna Medicare |
$1,187.49
|
| Rate for Payer: BCBS Complete |
$808.72
|
| Rate for Payer: BCBS MAPPO |
$1,187.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,058.93
|
| Rate for Payer: BCN Commercial |
$1,749.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.49
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Commercial |
$1,709.99
|
| Rate for Payer: Cofinity Commercial |
$1,591.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.49
|
| Rate for Payer: Healthscope Commercial |
$1,424.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,424.99
|
| Rate for Payer: Meridian Medicaid |
$808.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,246.86
|
| Rate for Payer: PACE SWMI |
$1,187.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,557.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.02
|
| Rate for Payer: Priority Health Medicare |
$1,187.49
|
| Rate for Payer: Priority Health Narrow Network |
$1,935.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,223.11
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$706.73 |
| Max. Negotiated Rate |
$2,795.76 |
| Rate for Payer: Aetna Commercial |
$1,456.62
|
| Rate for Payer: Aetna Medicare |
$1,087.03
|
| Rate for Payer: BCBS Complete |
$742.07
|
| Rate for Payer: BCBS MAPPO |
$1,087.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,795.76
|
| Rate for Payer: BCN Commercial |
$1,600.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,087.03
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$1,565.32
|
| Rate for Payer: Cofinity Commercial |
$1,456.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,087.03
|
| Rate for Payer: Healthscope Commercial |
$1,304.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,304.44
|
| Rate for Payer: Meridian Medicaid |
$742.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,141.38
|
| Rate for Payer: PACE SWMI |
$1,087.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,087.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$706.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,769.68
|
| Rate for Payer: Priority Health Medicare |
$1,087.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,769.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,119.64
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$680.96 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Aetna Commercial |
$1,404.61
|
| Rate for Payer: Aetna Medicare |
$1,048.22
|
| Rate for Payer: BCBS Complete |
$715.01
|
| Rate for Payer: BCBS MAPPO |
$1,048.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.25
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.22
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cash Price |
$1,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,404.61
|
| Rate for Payer: Cofinity Commercial |
$1,509.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.22
|
| Rate for Payer: Healthscope Commercial |
$1,257.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,257.86
|
| Rate for Payer: Meridian Medicaid |
$715.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,100.63
|
| Rate for Payer: PACE SWMI |
$1,048.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.06
|
| Rate for Payer: Priority Health Medicare |
$1,048.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,708.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.67
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$713.76 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$1,472.59
|
| Rate for Payer: Aetna Medicare |
$1,098.95
|
| Rate for Payer: BCBS Complete |
$749.45
|
| Rate for Payer: BCBS MAPPO |
$1,098.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$1,618.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.95
|
| Rate for Payer: Cash Price |
$1,839.20
|
| Rate for Payer: Cash Price |
$1,839.20
|
| Rate for Payer: Cofinity Commercial |
$1,582.49
|
| Rate for Payer: Cofinity Commercial |
$1,472.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.95
|
| Rate for Payer: Healthscope Commercial |
$1,318.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,318.74
|
| Rate for Payer: Meridian Medicaid |
$749.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,153.90
|
| Rate for Payer: PACE SWMI |
$1,098.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,609.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,790.20
|
| Rate for Payer: Priority Health Medicare |
$1,098.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,790.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,131.92
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$784.48 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$1,632.28
|
| Rate for Payer: Aetna Medicare |
$1,218.12
|
| Rate for Payer: BCBS Complete |
$823.70
|
| Rate for Payer: BCBS MAPPO |
$1,218.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,670.03
|
| Rate for Payer: BCN Commercial |
$1,788.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.12
|
| Rate for Payer: Cash Price |
$2,010.40
|
| Rate for Payer: Cash Price |
$2,010.40
|
| Rate for Payer: Cofinity Commercial |
$1,754.09
|
| Rate for Payer: Cofinity Commercial |
$1,632.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.12
|
| Rate for Payer: Healthscope Commercial |
$1,461.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,461.74
|
| Rate for Payer: Meridian Medicaid |
$823.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,279.03
|
| Rate for Payer: PACE SWMI |
$1,218.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,977.17
|
| Rate for Payer: Priority Health Medicare |
$1,218.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,977.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,254.66
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$535.91 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,102.10
|
| Rate for Payer: Aetna Medicare |
$822.46
|
| Rate for Payer: BCBS Complete |
$562.71
|
| Rate for Payer: BCBS MAPPO |
$822.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$1,214.37
|
| Rate for Payer: BCN Medicare Advantage |
$822.46
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$1,184.34
|
| Rate for Payer: Cofinity Commercial |
$1,102.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$822.46
|
| Rate for Payer: Healthscope Commercial |
$986.95
|
| Rate for Payer: Healthscope Whirlpool |
$986.95
|
| Rate for Payer: Meridian Medicaid |
$562.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$863.58
|
| Rate for Payer: PACE SWMI |
$822.46
|
| Rate for Payer: PHP Medicare Advantage |
$822.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,213.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,342.79
|
| Rate for Payer: Priority Health Medicare |
$822.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,342.79
|
| Rate for Payer: UHC Medicare Advantage |
$847.13
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$1,994.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$643.69 |
| Max. Negotiated Rate |
$1,619.45 |
| Rate for Payer: Aetna Commercial |
$1,335.74
|
| Rate for Payer: Aetna Medicare |
$996.82
|
| Rate for Payer: BCBS Complete |
$675.87
|
| Rate for Payer: BCBS MAPPO |
$996.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$996.82
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cash Price |
$1,595.20
|
| Rate for Payer: Cofinity Commercial |
$1,435.42
|
| Rate for Payer: Cofinity Commercial |
$1,335.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.82
|
| Rate for Payer: Healthscope Commercial |
$1,196.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,196.18
|
| Rate for Payer: Meridian Medicaid |
$675.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,046.66
|
| Rate for Payer: PACE SWMI |
$996.82
|
| Rate for Payer: PHP Medicare Advantage |
$996.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$643.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,619.45
|
| Rate for Payer: Priority Health Medicare |
$996.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,619.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.72
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,069.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$718.24 |
| Max. Negotiated Rate |
$2,592.37 |
| Rate for Payer: Aetna Commercial |
$1,491.54
|
| Rate for Payer: Aetna Medicare |
$1,113.09
|
| Rate for Payer: BCBS Complete |
$754.15
|
| Rate for Payer: BCBS MAPPO |
$1,113.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.37
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,113.09
|
| Rate for Payer: Cash Price |
$1,655.20
|
| Rate for Payer: Cash Price |
$1,655.20
|
| Rate for Payer: Cofinity Commercial |
$1,491.54
|
| Rate for Payer: Cofinity Commercial |
$1,602.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,113.09
|
| Rate for Payer: Healthscope Commercial |
$1,335.71
|
| Rate for Payer: Healthscope Whirlpool |
$1,335.71
|
| Rate for Payer: Meridian Medicaid |
$754.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,168.74
|
| Rate for Payer: PACE SWMI |
$1,113.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,113.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,810.74
|
| Rate for Payer: Priority Health Medicare |
$1,113.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,810.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,146.48
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$397.81 |
| Max. Negotiated Rate |
$1,476.80 |
| Rate for Payer: Aetna Commercial |
$1,213.80
|
| Rate for Payer: Aetna Medicare |
$905.82
|
| Rate for Payer: BCBS Complete |
$617.27
|
| Rate for Payer: BCBS MAPPO |
$905.82
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$1,335.55
|
| Rate for Payer: BCN Medicare Advantage |
$905.82
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cofinity Commercial |
$1,304.38
|
| Rate for Payer: Cofinity Commercial |
$1,213.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.82
|
| Rate for Payer: Healthscope Commercial |
$1,086.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,086.98
|
| Rate for Payer: Meridian Medicaid |
$617.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$951.11
|
| Rate for Payer: PACE SWMI |
$905.82
|
| Rate for Payer: PHP Medicare Advantage |
$905.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$587.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,323.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,476.80
|
| Rate for Payer: Priority Health Medicare |
$905.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,476.80
|
| Rate for Payer: UHC Medicare Advantage |
$932.99
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$477.55 |
| Max. Negotiated Rate |
$1,201.21 |
| Rate for Payer: Aetna Commercial |
$986.00
|
| Rate for Payer: Aetna Medicare |
$735.82
|
| Rate for Payer: BCBS Complete |
$501.43
|
| Rate for Payer: BCBS MAPPO |
$735.82
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,086.33
|
| Rate for Payer: BCN Medicare Advantage |
$735.82
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cofinity Commercial |
$986.00
|
| Rate for Payer: Cofinity Commercial |
$1,059.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.82
|
| Rate for Payer: Healthscope Commercial |
$882.98
|
| Rate for Payer: Healthscope Whirlpool |
$882.98
|
| Rate for Payer: Meridian Medicaid |
$501.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$772.61
|
| Rate for Payer: PACE SWMI |
$735.82
|
| Rate for Payer: PHP Medicare Advantage |
$735.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,201.21
|
| Rate for Payer: Priority Health Medicare |
$735.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,201.21
|
| Rate for Payer: UHC Medicare Advantage |
$757.89
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$261.99 |
| Max. Negotiated Rate |
$1,193.96 |
| Rate for Payer: Aetna Commercial |
$534.73
|
| Rate for Payer: Aetna Medicare |
$399.05
|
| Rate for Payer: BCBS Complete |
$275.09
|
| Rate for Payer: BCBS MAPPO |
$399.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.96
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: BCN Medicare Advantage |
$399.05
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cofinity Commercial |
$534.73
|
| Rate for Payer: Cofinity Commercial |
$574.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.05
|
| Rate for Payer: Healthscope Commercial |
$478.86
|
| Rate for Payer: Healthscope Whirlpool |
$478.86
|
| Rate for Payer: Meridian Medicaid |
$275.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.00
|
| Rate for Payer: PACE SWMI |
$399.05
|
| Rate for Payer: PHP Medicare Advantage |
$399.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.91
|
| Rate for Payer: Priority Health Medicare |
$399.05
|
| Rate for Payer: Priority Health Narrow Network |
$654.91
|
| Rate for Payer: UHC Medicare Advantage |
$411.02
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,544.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$293.09 |
| Max. Negotiated Rate |
$1,080.80 |
| Rate for Payer: Aetna Commercial |
$598.26
|
| Rate for Payer: Aetna Medicare |
$446.46
|
| Rate for Payer: BCBS Complete |
$307.74
|
| Rate for Payer: BCBS MAPPO |
$446.46
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: BCN Medicare Advantage |
$446.46
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cofinity Commercial |
$642.90
|
| Rate for Payer: Cofinity Commercial |
$598.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$446.46
|
| Rate for Payer: Healthscope Commercial |
$535.75
|
| Rate for Payer: Healthscope Whirlpool |
$535.75
|
| Rate for Payer: Meridian Medicaid |
$307.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$468.78
|
| Rate for Payer: PACE SWMI |
$446.46
|
| Rate for Payer: PHP Medicare Advantage |
$446.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.64
|
| Rate for Payer: Priority Health Medicare |
$446.46
|
| Rate for Payer: Priority Health Narrow Network |
$731.64
|
| Rate for Payer: UHC Medicare Advantage |
$459.85
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$621.96 |
| Max. Negotiated Rate |
$1,732.82 |
| Rate for Payer: Aetna Commercial |
$1,280.22
|
| Rate for Payer: Aetna Medicare |
$955.39
|
| Rate for Payer: BCBS Complete |
$653.06
|
| Rate for Payer: BCBS MAPPO |
$955.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.82
|
| Rate for Payer: BCN Commercial |
$1,409.35
|
| Rate for Payer: BCN Medicare Advantage |
$955.39
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cofinity Commercial |
$1,375.76
|
| Rate for Payer: Cofinity Commercial |
$1,280.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$955.39
|
| Rate for Payer: Healthscope Commercial |
$1,146.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,146.47
|
| Rate for Payer: Meridian Medicaid |
$653.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,003.16
|
| Rate for Payer: PACE SWMI |
$955.39
|
| Rate for Payer: PHP Medicare Advantage |
$955.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$621.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.40
|
| Rate for Payer: Priority Health Medicare |
$955.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,558.40
|
| Rate for Payer: UHC Medicare Advantage |
$984.05
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,494.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$509.07 |
| Max. Negotiated Rate |
$2,001.20 |
| Rate for Payer: Aetna Commercial |
$1,047.02
|
| Rate for Payer: Aetna Medicare |
$781.36
|
| Rate for Payer: BCBS Complete |
$534.52
|
| Rate for Payer: BCBS MAPPO |
$781.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,001.20
|
| Rate for Payer: BCN Commercial |
$1,154.25
|
| Rate for Payer: BCN Medicare Advantage |
$781.36
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cash Price |
$1,195.20
|
| Rate for Payer: Cofinity Commercial |
$1,125.16
|
| Rate for Payer: Cofinity Commercial |
$1,047.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.36
|
| Rate for Payer: Healthscope Commercial |
$937.63
|
| Rate for Payer: Healthscope Whirlpool |
$937.63
|
| Rate for Payer: Meridian Medicaid |
$534.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$820.43
|
| Rate for Payer: PACE SWMI |
$781.36
|
| Rate for Payer: PHP Medicare Advantage |
$781.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,045.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,276.33
|
| Rate for Payer: Priority Health Medicare |
$781.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,276.33
|
| Rate for Payer: UHC Medicare Advantage |
$804.80
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,778.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$554.87 |
| Max. Negotiated Rate |
$2,435.99 |
| Rate for Payer: Aetna Commercial |
$1,142.51
|
| Rate for Payer: Aetna Medicare |
$852.62
|
| Rate for Payer: BCBS Complete |
$582.61
|
| Rate for Payer: BCBS MAPPO |
$852.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.99
|
| Rate for Payer: BCN Commercial |
$1,258.34
|
| Rate for Payer: BCN Medicare Advantage |
$852.62
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cofinity Commercial |
$1,142.51
|
| Rate for Payer: Cofinity Commercial |
$1,227.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.62
|
| Rate for Payer: Healthscope Commercial |
$1,023.14
|
| Rate for Payer: Healthscope Whirlpool |
$1,023.14
|
| Rate for Payer: Meridian Medicaid |
$582.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$895.25
|
| Rate for Payer: PACE SWMI |
$852.62
|
| Rate for Payer: PHP Medicare Advantage |
$852.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,244.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,391.43
|
| Rate for Payer: Priority Health Medicare |
$852.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,391.43
|
| Rate for Payer: UHC Medicare Advantage |
$878.20
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$619.40 |
| Max. Negotiated Rate |
$2,049.80 |
| Rate for Payer: Aetna Commercial |
$1,278.83
|
| Rate for Payer: Aetna Medicare |
$954.35
|
| Rate for Payer: BCBS Complete |
$650.37
|
| Rate for Payer: BCBS MAPPO |
$954.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.80
|
| Rate for Payer: BCN Commercial |
$1,406.42
|
| Rate for Payer: BCN Medicare Advantage |
$954.35
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$1,374.26
|
| Rate for Payer: Cofinity Commercial |
$1,278.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$954.35
|
| Rate for Payer: Healthscope Commercial |
$1,145.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.22
|
| Rate for Payer: Meridian Medicaid |
$650.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,002.07
|
| Rate for Payer: PACE SWMI |
$954.35
|
| Rate for Payer: PHP Medicare Advantage |
$954.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,210.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,555.14
|
| Rate for Payer: Priority Health Medicare |
$954.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,555.14
|
| Rate for Payer: UHC Medicare Advantage |
$982.98
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$311.19 |
| Max. Negotiated Rate |
$777.04 |
| Rate for Payer: Aetna Commercial |
$635.59
|
| Rate for Payer: Aetna Medicare |
$474.32
|
| Rate for Payer: BCBS Complete |
$326.75
|
| Rate for Payer: BCBS MAPPO |
$474.32
|
| Rate for Payer: BCBS Trust/PPO |
$701.05
|
| Rate for Payer: BCN Commercial |
$702.72
|
| Rate for Payer: BCN Medicare Advantage |
$474.32
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cofinity Commercial |
$683.02
|
| Rate for Payer: Cofinity Commercial |
$635.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.32
|
| Rate for Payer: Healthscope Commercial |
$569.18
|
| Rate for Payer: Healthscope Whirlpool |
$569.18
|
| Rate for Payer: Meridian Medicaid |
$326.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$498.04
|
| Rate for Payer: PACE SWMI |
$474.32
|
| Rate for Payer: PHP Medicare Advantage |
$474.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.04
|
| Rate for Payer: Priority Health Medicare |
$474.32
|
| Rate for Payer: Priority Health Narrow Network |
$777.04
|
| Rate for Payer: UHC Medicare Advantage |
$488.55
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$776.50 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: Aetna Medicare |
$474.01
|
| Rate for Payer: BCBS Complete |
$326.53
|
| Rate for Payer: BCBS MAPPO |
$474.01
|
| Rate for Payer: BCBS Trust/PPO |
$288.98
|
| Rate for Payer: BCN Commercial |
$702.23
|
| Rate for Payer: BCN Medicare Advantage |
$474.01
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$682.57
|
| Rate for Payer: Cofinity Commercial |
$635.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.01
|
| Rate for Payer: Healthscope Commercial |
$568.81
|
| Rate for Payer: Healthscope Whirlpool |
$568.81
|
| Rate for Payer: Meridian Medicaid |
$326.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$497.71
|
| Rate for Payer: PACE SWMI |
$474.01
|
| Rate for Payer: PHP Medicare Advantage |
$474.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$776.50
|
| Rate for Payer: Priority Health Medicare |
$474.01
|
| Rate for Payer: Priority Health Narrow Network |
$776.50
|
| Rate for Payer: UHC Medicare Advantage |
$488.23
|
|
|
PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 53010
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$476.06 |
| Rate for Payer: Aetna Commercial |
$386.40
|
| Rate for Payer: Aetna Medicare |
$288.36
|
| Rate for Payer: BCBS Complete |
$200.83
|
| Rate for Payer: BCBS MAPPO |
$288.36
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$430.52
|
| Rate for Payer: BCN Medicare Advantage |
$288.36
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cofinity Commercial |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$415.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.36
|
| Rate for Payer: Healthscope Commercial |
$346.03
|
| Rate for Payer: Healthscope Whirlpool |
$346.03
|
| Rate for Payer: Meridian Medicaid |
$200.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$302.78
|
| Rate for Payer: PACE SWMI |
$288.36
|
| Rate for Payer: PHP Medicare Advantage |
$288.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.06
|
| Rate for Payer: Priority Health Medicare |
$288.36
|
| Rate for Payer: Priority Health Narrow Network |
$476.06
|
| Rate for Payer: UHC Medicare Advantage |
$297.01
|
|
|
PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,284.00
|
|
|
Service Code
|
HCPCS 50650
|
| Min. Negotiated Rate |
$659.24 |
| Max. Negotiated Rate |
$2,298.80 |
| Rate for Payer: Aetna Commercial |
$1,355.97
|
| Rate for Payer: Aetna Medicare |
$1,011.92
|
| Rate for Payer: BCBS Complete |
$692.20
|
| Rate for Payer: BCBS MAPPO |
$1,011.92
|
| Rate for Payer: BCBS Trust/PPO |
$809.36
|
| Rate for Payer: BCN Commercial |
$1,491.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,011.92
|
| Rate for Payer: Cash Price |
$2,627.20
|
| Rate for Payer: Cash Price |
$2,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,457.16
|
| Rate for Payer: Cofinity Commercial |
$1,355.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,011.92
|
| Rate for Payer: Healthscope Commercial |
$1,214.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,214.30
|
| Rate for Payer: Meridian Medicaid |
$692.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,062.52
|
| Rate for Payer: PACE SWMI |
$1,011.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,011.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,298.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,649.18
|
| Rate for Payer: Priority Health Medicare |
$1,011.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,649.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.28
|
|
