|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: Aetna Commercial |
$215.32
|
| Rate for Payer: Aetna Medicare |
$175.00
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCN Commercial |
$339.45
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.21
|
| Rate for Payer: UHC Exchange |
$194.21
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: Aetna Commercial |
$189.68
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCN Commercial |
$299.03
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.09
|
| Rate for Payer: UHC Exchange |
$171.09
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$720.85 |
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: BCBS Complete |
$488.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.00
|
|
|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$2,683.76 |
| Rate for Payer: Aetna Commercial |
$393.03
|
| Rate for Payer: Aetna Medicare |
$359.00
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.76
|
| Rate for Payer: BCN Commercial |
$546.34
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Meridian Medicaid |
$203.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.00
|
| Rate for Payer: Priority Health Narrow Network |
$482.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.56
|
| Rate for Payer: UHC Exchange |
$374.56
|
| Rate for Payer: UHCCP Medicaid |
$193.83
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$2,814.78 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Aetna Medicare |
$384.50
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,814.78
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.98
|
| Rate for Payer: Priority Health Narrow Network |
$497.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.23
|
| Rate for Payer: UHC Exchange |
$387.23
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$836.88 |
| Max. Negotiated Rate |
$3,097.95 |
| Rate for Payer: Aetna Commercial |
$1,686.79
|
| Rate for Payer: Aetna Medicare |
$1,728.50
|
| Rate for Payer: BCBS Complete |
$878.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.95
|
| Rate for Payer: BCN Commercial |
$1,888.74
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Meridian Medicaid |
$878.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,078.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,078.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.70
|
| Rate for Payer: UHC Exchange |
$1,577.70
|
| Rate for Payer: UHCCP Medicaid |
$836.88
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$652.63 |
| Max. Negotiated Rate |
$4,734.10 |
| Rate for Payer: Aetna Commercial |
$1,324.66
|
| Rate for Payer: Aetna Medicare |
$1,316.50
|
| Rate for Payer: BCBS Complete |
$685.26
|
| Rate for Payer: BCBS Trust/PPO |
$4,734.10
|
| Rate for Payer: BCN Commercial |
$1,489.49
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Meridian Medicaid |
$685.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,631.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,196.07
|
| Rate for Payer: UHC Exchange |
$1,196.07
|
| Rate for Payer: UHCCP Medicaid |
$652.63
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$774.89 |
| Max. Negotiated Rate |
$4,058.93 |
| Rate for Payer: Aetna Commercial |
$1,548.70
|
| Rate for Payer: Aetna Medicare |
$1,135.00
|
| Rate for Payer: BCBS Complete |
$813.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,058.93
|
| Rate for Payer: BCN Commercial |
$1,749.95
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Meridian Medicaid |
$813.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,925.89
|
| Rate for Payer: Priority Health Narrow Network |
$1,925.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,354.85
|
| Rate for Payer: UHC Exchange |
$1,354.85
|
| Rate for Payer: UHCCP Medicaid |
$774.89
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$711.21 |
| Max. Negotiated Rate |
$2,795.76 |
| Rate for Payer: Aetna Commercial |
$1,427.06
|
| Rate for Payer: Aetna Medicare |
$1,046.50
|
| Rate for Payer: BCBS Complete |
$746.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,795.76
|
| Rate for Payer: BCN Commercial |
$1,600.42
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Meridian Medicaid |
$746.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,767.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,767.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,322.97
|
| Rate for Payer: UHC Exchange |
$1,322.97
|
| Rate for Payer: UHCCP Medicaid |
$711.21
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$685.43 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Aetna Commercial |
$1,378.95
|
| Rate for Payer: Aetna Medicare |
$1,118.00
|
| Rate for Payer: BCBS Complete |
$719.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.25
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Meridian Medicaid |
$719.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,702.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,702.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,359.77
|
| Rate for Payer: UHC Exchange |
$1,359.77
|
| Rate for Payer: UHCCP Medicaid |
$685.43
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$717.81 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$1,446.33
|
| Rate for Payer: Aetna Medicare |
$1,172.50
|
| Rate for Payer: BCBS Complete |
$753.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$1,618.99
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Meridian Medicaid |
$753.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$717.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,784.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,784.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.66
|
| Rate for Payer: UHC Exchange |
$1,346.66
|
| Rate for Payer: UHCCP Medicaid |
$717.81
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$788.74 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$1,593.30
|
| Rate for Payer: Aetna Medicare |
$1,281.50
|
| Rate for Payer: BCBS Complete |
$828.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,670.03
|
| Rate for Payer: BCN Commercial |
$1,788.07
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Meridian Medicaid |
$828.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,961.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,961.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,381.20
|
| Rate for Payer: UHC Exchange |
$1,381.20
|
| Rate for Payer: UHCCP Medicaid |
$788.74
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$539.32 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,080.97
|
| Rate for Payer: Aetna Medicare |
$884.50
|
| Rate for Payer: BCBS Complete |
$566.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$1,214.37
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Meridian Medicaid |
$566.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,340.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,340.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,005.94
|
| Rate for Payer: UHC Exchange |
$1,005.94
|
| Rate for Payer: UHCCP Medicaid |
$539.32
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$646.03 |
| Max. Negotiated Rate |
$1,609.52 |
| Rate for Payer: Aetna Commercial |
$1,291.91
|
| Rate for Payer: Aetna Medicare |
$1,017.00
|
| Rate for Payer: BCBS Complete |
$678.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Meridian Medicaid |
$678.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$646.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,609.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,609.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,126.22
|
| Rate for Payer: UHC Exchange |
$1,126.22
|
| Rate for Payer: UHCCP Medicaid |
$646.03
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$720.79 |
| Max. Negotiated Rate |
$2,592.37 |
| Rate for Payer: Aetna Commercial |
$1,464.50
|
| Rate for Payer: Aetna Medicare |
$1,055.00
|
| Rate for Payer: BCBS Complete |
$756.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.37
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Meridian Medicaid |
$756.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,795.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,795.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,334.30
|
| Rate for Payer: UHC Exchange |
$1,334.30
|
| Rate for Payer: UHCCP Medicaid |
$720.79
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$397.81 |
| Max. Negotiated Rate |
$1,469.98 |
| Rate for Payer: Aetna Commercial |
$1,189.75
|
| Rate for Payer: Aetna Medicare |
$964.00
|
| Rate for Payer: BCBS Complete |
$622.20
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$1,335.55
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Meridian Medicaid |
$622.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,469.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,469.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,123.29
|
| Rate for Payer: UHC Exchange |
$1,123.29
|
| Rate for Payer: UHCCP Medicaid |
$592.57
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$479.25 |
| Max. Negotiated Rate |
$1,194.10 |
| Rate for Payer: Aetna Commercial |
$964.14
|
| Rate for Payer: Aetna Medicare |
$681.50
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,086.33
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,194.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,194.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$895.07
|
| Rate for Payer: UHC Exchange |
$895.07
|
| Rate for Payer: UHCCP Medicaid |
$479.25
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$264.33 |
| Max. Negotiated Rate |
$1,193.96 |
| Rate for Payer: Aetna Commercial |
$523.11
|
| Rate for Payer: Aetna Medicare |
$387.00
|
| Rate for Payer: BCBS Complete |
$277.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.96
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Meridian Medicaid |
$277.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.10
|
| Rate for Payer: Priority Health Narrow Network |
$655.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.83
|
| Rate for Payer: UHC Exchange |
$489.83
|
| Rate for Payer: UHCCP Medicaid |
$264.33
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$294.58 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$586.56
|
| Rate for Payer: Aetna Medicare |
$787.50
|
| Rate for Payer: BCBS Complete |
$309.31
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Meridian Medicaid |
$309.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| 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 |
$549.64
|
| Rate for Payer: UHC Exchange |
$549.64
|
| Rate for Payer: UHCCP Medicaid |
$294.58
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$625.16 |
| Max. Negotiated Rate |
$1,732.82 |
| Rate for Payer: Aetna Commercial |
$1,257.91
|
| Rate for Payer: Aetna Medicare |
$1,016.50
|
| Rate for Payer: BCBS Complete |
$656.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.82
|
| Rate for Payer: BCN Commercial |
$1,409.35
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Meridian Medicaid |
$656.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,555.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,555.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,182.86
|
| Rate for Payer: UHC Exchange |
$1,182.86
|
| Rate for Payer: UHCCP Medicaid |
$625.16
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$513.54 |
| Max. Negotiated Rate |
$2,001.20 |
| Rate for Payer: Aetna Commercial |
$1,025.75
|
| Rate for Payer: Aetna Medicare |
$762.00
|
| Rate for Payer: BCBS Complete |
$539.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,001.20
|
| Rate for Payer: BCN Commercial |
$1,154.25
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Meridian Medicaid |
$539.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,272.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,272.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$963.88
|
| Rate for Payer: UHC Exchange |
$963.88
|
| Rate for Payer: UHCCP Medicaid |
$513.54
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$558.70 |
| Max. Negotiated Rate |
$2,435.99 |
| Rate for Payer: Aetna Commercial |
$1,120.91
|
| Rate for Payer: Aetna Medicare |
$907.00
|
| Rate for Payer: BCBS Complete |
$586.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.99
|
| Rate for Payer: BCN Commercial |
$1,258.34
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Meridian Medicaid |
$586.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,057.32
|
| Rate for Payer: UHC Exchange |
$1,057.32
|
| Rate for Payer: UHCCP Medicaid |
$558.70
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$622.17 |
| Max. Negotiated Rate |
$2,049.80 |
| Rate for Payer: Aetna Commercial |
$1,252.24
|
| Rate for Payer: Aetna Medicare |
$882.00
|
| Rate for Payer: BCBS Complete |
$653.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.80
|
| Rate for Payer: BCN Commercial |
$1,406.42
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Meridian Medicaid |
$653.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$622.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,548.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,153.24
|
| Rate for Payer: UHC Exchange |
$1,153.24
|
| Rate for Payer: UHCCP Medicaid |
$622.17
|
|
