Urology · Pennsylvania
Urology commercial reimbursement in Pennsylvania
How Pennsylvania urology rates compare with the national market.
Urology in Pennsylvania
37 codes · 111 sampled providers
Index vs national
102
2% above
Rank among states
26 of 50
1 = highest
Codes above national
20 of 37
median code at 102%
Providers
111
sampled
What the data shows
1
Urology ranks 26th of 50 states in Pennsylvania with an index of 102 (100 = the specialty's national median), across 37 codes and 111 sampled providers.
2
Of the 37 urology codes with enough data in Pennsylvania, 20 pay above the national median and 17 below; the typical code sits at 102% of the national median.
3
Largest premium over the national median: CPT 64566 (Neuroeltrd stim post tibial) at 112%; largest discount: CPT 52649 (Prostate laser enucleation) at 90%.
4
Measured against Medicare, Pennsylvania urology rates have a median of 156% of the Medicare rate across these codes.
Codes above and below the national median
The five largest gaps in each direction
Highest vs national
All urology codes in Pennsylvania
Median across payers vs the specialty's national median and the Medicare rate; sorted by premium
| Code | Pennsylvania | National | Gap | % of Medicare | Providers | TINs | Level |
|---|---|---|---|---|---|---|---|
| CPT 64566 Neuroeltrd stim post tibial | $77 | $69 | +12% | 297% | 111 | 172 | |
| CPT 99215 Office o/p est hi 40 min | $201 | $187 | +7% | 104% | 109 | 159 | |
| CPT 51702 Insert temp bladder cath | $65 | $61 | +7% | 287% | 111 | 182 | |
| CPT 52287 Cystoscopy chemodenervation | $391 | $367 | +7% | 263% | 111 | 183 | |
| CPT 99204 Office o/p new mod 45 min | $210 | $197 | +6% | 118% | 109 | 161 | |
| CPT 99212 Office o/p est sf 10 min | $56 | $52 | +6% | 93% | 109 | 161 | |
| CPT 99214 Office o/p est mod 30 min | $142 | $134 | +6% | 105% | 109 | 152 | |
| CPT 51700 Irrigation of bladder | $82 | $77 | +6% | 314% | 108 | 165 | |
| CPT 99203 Office o/p new low 30 min | $132 | $125 | +6% | 113% | 109 | 162 | |
| CPT 99213 Office o/p est low 20 min | $97 | $92 | +6% | 102% | 110 | 166 | |
| CPT 52000 Cystourethroscopy | $222 | $210 | +6% | 312% | 109 | 156 | |
| CPT 99426 Prin care mgmt staff 1st 30 | $80 | $77 | +5% | 118% | 108 | 178 | |
| CPT 52224 Cystoscopy and treatment | $477 | $459 | +4% | 271% | 107 | 147 | |
| CPT 74178 Ct abd&plv wo cntr flwd cntr | $516 | $498 | +4% | 153% | 108 | 178 | |
| CPT 99205 Office o/p new hi 60 min | $265 | $257 | +3% | 112% | 109 | 157 | |
| CPT 52281 Cystoscopy and treatment | $344 | $334 | +3% | 252% | 109 | 159 | |
| CPT 52310 Cystoscopy and treatment | $327 | $317 | +3% | 243% | 109 | 157 | |
| CPT 99490 Chrnc care mgmt staff 1st 20 | $61 | $60 | +2% | 93% | 108 | 181 | |
| CPT 52332 Cystoscopy and treatment | $366 | $360 | +2% | 262% | 111 | 184 | |
| CPT 76856 Us exam pelvic complete | $149 | $148 | +1% | 142% | 108 | 160 | |
| CPT 76872 Us transrectal | $188 | $188 | +0% | 157% | 109 | 180 | |
| CPT 51729 Cystometrogram w/vp&up | $553 | $554 | -0% | 156% | 107 | 154 | |
| CPT 51728 Cystometrogram w/vp | $518 | $520 | -0% | 154% | 109 | 150 | |
| CPT 20610 Drain/inj joint/bursa w/o us | $85 | $86 | -1% | 123% | 111 | 186 | |
| CPT 76770 Us exam abdo back wall comp | $149 | $153 | -3% | 140% | 106 | 163 | |
| CPT 76857 Us exam pelvic limited | $73 | $75 | -3% | 142% | 108 | 181 | |
| CPT 50590 Fragmenting of kidney stone | $1,030 | $1,065 | -3% | 135% | 111 | 184 | |
| CPT 55874 Tprnl plmt biodegrdabl matrl | $245 | $257 | -5% | 172% | 107 | 153 | |
| CPT 51798 Us urine capacity measure | $20 | $21 | -5% | 160% | 103 | 153 | |
| CPT 52356 Cysto/uretero w/lithotripsy | $616 | $657 | -6% | 169% | 111 | 185 | |
| CPT 51720 Treatment of bladder lesion | $103 | $111 | -7% | 271% | 107 | 154 | |
| CPT 93000 Electrocardiogram complete | $24 | $26 | -8% | 154% | 109 | 184 | |
| CPT 76775 Us exam abdo back wall lim | $85 | $92 | -8% | 140% | 107 | 153 | |
| CPT 55866 Laps surg prst8ect rpbic rad | $2,060 | $2,237 | -8% | 190% | 109 | 181 | |
| CPT 52601 Prostatectomy (turp) | $1,080 | $1,181 | -9% | 205% | 107 | 147 | |
| CPT 52648 Laser surgery of prostate | $1,374 | $1,508 | -9% | 260% | 107 | 146 | |
| CPT 52649 Prostate laser enucleation | $1,220 | $1,355 | -10% | 186% | 109 | 181 |
Frequently asked questions
How do Pennsylvania urology rates compare with the rest of the country?
Pennsylvania ranks 26th of 50 states with an index of 102; 20 of 37 codes are above the national median.
Which urology code has the biggest premium in Pennsylvania?
CPT 64566 (Neuroeltrd stim post tibial), at 112% of the national median.
Are these Medicare or commercial rates?
Commercial in-network negotiated rates from four national payers' published files; the Medicare comparison column uses the CY2026 Medicare physician fee schedule.
Methodology
How these numbers are calculated
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Pennsylvania urology contracts
Compare your rates with these medians.