|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$684.74
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$147.09 |
| Max. Negotiated Rate |
$582.03 |
| Rate for Payer: AlohaCare Medicaid |
$166.96
|
| Rate for Payer: AlohaCare Medicare |
$147.09
|
| Rate for Payer: Cash Price |
$410.84
|
| Rate for Payer: Cash Price |
$410.84
|
| Rate for Payer: Devoted Health Medicare |
$161.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$166.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$260.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$166.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$335.14
|
| Rate for Payer: Health Management Network Commercial |
$582.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$176.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$176.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$176.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$166.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$166.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.09
|
|
|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$570.00
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$293.26 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: AlohaCare Medicaid |
$332.63
|
| Rate for Payer: AlohaCare Medicare |
$293.26
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Devoted Health Medicare |
$322.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$293.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$338.00
|
| Rate for Payer: Health Management Network Commercial |
$484.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$351.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$351.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$351.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$332.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$293.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$332.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$293.26
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$345.95 |
| Rate for Payer: AlohaCare Medicaid |
$236.80
|
| Rate for Payer: AlohaCare Medicare |
$210.29
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Devoted Health Medicare |
$231.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$210.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.20
|
| Rate for Payer: Health Management Network Commercial |
$345.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$252.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$252.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$252.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$236.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$210.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$236.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$210.29
|
|
|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$604.55
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$513.87 |
| Rate for Payer: AlohaCare Medicaid |
$194.78
|
| Rate for Payer: AlohaCare Medicare |
$171.91
|
| Rate for Payer: Cash Price |
$362.73
|
| Rate for Payer: Cash Price |
$362.73
|
| Rate for Payer: Devoted Health Medicare |
$189.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$194.78
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$300.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$171.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$194.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$216.58
|
| Rate for Payer: Health Management Network Commercial |
$513.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$206.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$206.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$194.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$171.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$194.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$171.91
|
| Rate for Payer: University Health Alliance Commercial |
$254.44
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$252.46 |
| Max. Negotiated Rate |
$415.65 |
| Rate for Payer: AlohaCare Medicaid |
$285.39
|
| Rate for Payer: AlohaCare Medicare |
$252.46
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Devoted Health Medicare |
$277.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$252.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$353.86
|
| Rate for Payer: Health Management Network Commercial |
$415.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$302.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$302.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$302.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$252.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$285.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$252.46
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$340.39 |
| Max. Negotiated Rate |
$594.62 |
| Rate for Payer: AlohaCare Medicaid |
$386.55
|
| Rate for Payer: AlohaCare Medicare |
$340.39
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Devoted Health Medicare |
$374.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$340.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$594.62
|
| Rate for Payer: Health Management Network Commercial |
$562.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$408.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$408.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$386.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$340.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$340.39
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$184.21 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: AlohaCare Medicaid |
$208.72
|
| Rate for Payer: AlohaCare Medicare |
$184.21
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Devoted Health Medicare |
$202.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$184.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$223.08
|
| Rate for Payer: Health Management Network Commercial |
$304.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$221.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$221.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$221.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$208.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$184.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$208.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$184.21
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$231.62 |
| Max. Negotiated Rate |
$393.38 |
| Rate for Payer: AlohaCare Medicaid |
$261.45
|
| Rate for Payer: AlohaCare Medicare |
$231.62
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Devoted Health Medicare |
$254.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.38
|
| Rate for Payer: Health Management Network Commercial |
$381.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$277.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$261.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$231.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$261.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$231.62
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$977.27
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$217.41 |
| Max. Negotiated Rate |
$830.68 |
| Rate for Payer: AlohaCare Medicaid |
$245.75
|
| Rate for Payer: AlohaCare Medicare |
$217.41
|
| Rate for Payer: Cash Price |
$586.36
|
| Rate for Payer: Cash Price |
$586.36
|
| Rate for Payer: Devoted Health Medicare |
$239.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$245.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$381.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$217.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$245.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$341.64
|
| Rate for Payer: Health Management Network Commercial |
$830.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$260.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$260.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$260.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$245.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$217.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$245.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$217.41
|
| Rate for Payer: University Health Alliance Commercial |
$322.76
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$675.78
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$574.41 |
| Rate for Payer: AlohaCare Medicaid |
$141.15
|
| Rate for Payer: AlohaCare Medicare |
$126.40
|
| Rate for Payer: Cash Price |
$405.47
|
| Rate for Payer: Cash Price |
$405.47
|
| Rate for Payer: Devoted Health Medicare |
$139.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$141.15
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$217.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$141.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$214.76
|
| Rate for Payer: Health Management Network Commercial |
$574.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$141.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.40
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$214.37 |
| Max. Negotiated Rate |
$354.45 |
| Rate for Payer: AlohaCare Medicaid |
$243.07
|
| Rate for Payer: AlohaCare Medicare |
$214.37
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Devoted Health Medicare |
$235.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$214.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$264.42
|
| Rate for Payer: Health Management Network Commercial |
$354.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$257.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$257.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$214.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$243.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$214.37
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$530.30
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$119.98 |
| Max. Negotiated Rate |
$450.75 |
| Rate for Payer: AlohaCare Medicaid |
$133.65
|
| Rate for Payer: AlohaCare Medicare |
$119.98
|
| Rate for Payer: Cash Price |
$318.18
|
| Rate for Payer: Cash Price |
$318.18
|
| Rate for Payer: Devoted Health Medicare |
$131.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.65
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$205.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$201.24
|
| Rate for Payer: Health Management Network Commercial |
$450.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$143.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$133.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.98
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$848.72
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$721.41 |
| Rate for Payer: AlohaCare Medicaid |
$271.10
|
| Rate for Payer: AlohaCare Medicare |
$240.02
|
| Rate for Payer: Cash Price |
$509.23
|
| Rate for Payer: Cash Price |
$509.23
|
| Rate for Payer: Devoted Health Medicare |
$264.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$271.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$420.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$240.02
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$271.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.96
|
| Rate for Payer: Health Management Network Commercial |
$721.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$288.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$288.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$271.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$240.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$271.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$240.02
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$1,407.49
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$1,196.37 |
| Rate for Payer: AlohaCare Medicaid |
$171.39
|
| Rate for Payer: AlohaCare Medicare |
$149.18
|
| Rate for Payer: Cash Price |
$844.49
|
| Rate for Payer: Cash Price |
$844.49
|
| Rate for Payer: Devoted Health Medicare |
$164.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$171.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$297.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$171.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.46
|
| Rate for Payer: Health Management Network Commercial |
$1,196.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$179.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$179.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$171.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$171.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.18
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$5,305.11
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$144.87 |
| Max. Negotiated Rate |
$4,509.34 |
| Rate for Payer: AlohaCare Medicaid |
$163.07
|
| Rate for Payer: AlohaCare Medicare |
$144.87
|
| Rate for Payer: Cash Price |
$3,183.07
|
| Rate for Payer: Cash Price |
$3,183.07
|
| Rate for Payer: Devoted Health Medicare |
$159.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$163.07
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$240.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$163.07
|
| Rate for Payer: Health Management Network Commercial |
$4,509.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$173.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$173.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$163.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$163.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.87
|
| Rate for Payer: University Health Alliance Commercial |
$203.37
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$707.93
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$139.45 |
| Max. Negotiated Rate |
$601.74 |
| Rate for Payer: AlohaCare Medicaid |
$155.10
|
| Rate for Payer: AlohaCare Medicare |
$139.45
|
| Rate for Payer: Cash Price |
$424.76
|
| Rate for Payer: Cash Price |
$424.76
|
| Rate for Payer: Devoted Health Medicare |
$153.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$155.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$239.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$139.45
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$155.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$434.46
|
| Rate for Payer: Health Management Network Commercial |
$601.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$167.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$167.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$155.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$139.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$155.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$139.45
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.10
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$654.59 |
| Rate for Payer: AlohaCare Medicaid |
$283.86
|
| Rate for Payer: AlohaCare Medicare |
$250.56
|
| Rate for Payer: Cash Price |
$462.06
|
| Rate for Payer: Cash Price |
$462.06
|
| Rate for Payer: Devoted Health Medicare |
$275.62
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$283.86
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$440.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$250.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$283.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$391.82
|
| Rate for Payer: Health Management Network Commercial |
$654.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$300.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$300.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$283.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$250.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$283.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$250.56
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$1,465.66
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$172.55 |
| Max. Negotiated Rate |
$1,245.81 |
| Rate for Payer: AlohaCare Medicaid |
$198.28
|
| Rate for Payer: AlohaCare Medicare |
$172.55
|
| Rate for Payer: Cash Price |
$879.40
|
| Rate for Payer: Cash Price |
$879.40
|
| Rate for Payer: Devoted Health Medicare |
$189.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$198.28
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$310.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$172.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$198.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$199.42
|
| Rate for Payer: Health Management Network Commercial |
$1,245.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$207.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$207.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$172.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$198.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$172.55
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$354.45 |
| Rate for Payer: AlohaCare Medicaid |
$243.42
|
| Rate for Payer: AlohaCare Medicare |
$215.25
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Devoted Health Medicare |
$236.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$291.72
|
| Rate for Payer: Health Management Network Commercial |
$354.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$243.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$243.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.25
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$245.07 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: AlohaCare Medicaid |
$276.73
|
| Rate for Payer: AlohaCare Medicare |
$245.07
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Devoted Health Medicare |
$269.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$245.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.44
|
| Rate for Payer: Health Management Network Commercial |
$402.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$294.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$294.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$294.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$276.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$245.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$276.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$245.07
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$560.47
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$476.40 |
| Rate for Payer: AlohaCare Medicaid |
$150.56
|
| Rate for Payer: AlohaCare Medicare |
$133.80
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Cash Price |
$336.28
|
| Rate for Payer: Devoted Health Medicare |
$147.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$150.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$232.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$150.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$330.46
|
| Rate for Payer: Health Management Network Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$160.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$150.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.80
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$248.64 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: AlohaCare Medicaid |
$281.06
|
| Rate for Payer: AlohaCare Medicare |
$248.64
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Devoted Health Medicare |
$273.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$248.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$306.80
|
| Rate for Payer: Health Management Network Commercial |
$408.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$298.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$298.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$281.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$248.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$281.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$248.64
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$269.82 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: AlohaCare Medicaid |
$305.71
|
| Rate for Payer: AlohaCare Medicare |
$269.82
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Cash Price |
$313.80
|
| Rate for Payer: Devoted Health Medicare |
$296.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$269.82
|
| Rate for Payer: Health Management Network Commercial |
$444.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$323.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$323.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$323.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$305.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$269.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$305.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$269.82
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$562.70 |
| Rate for Payer: AlohaCare Medicaid |
$386.17
|
| Rate for Payer: AlohaCare Medicare |
$340.00
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Cash Price |
$397.20
|
| Rate for Payer: Devoted Health Medicare |
$374.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$340.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$475.80
|
| Rate for Payer: Health Management Network Commercial |
$562.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$408.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$408.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$408.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$386.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$340.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$386.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$340.00
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$308.37 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: AlohaCare Medicaid |
$349.39
|
| Rate for Payer: AlohaCare Medicare |
$308.37
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Devoted Health Medicare |
$339.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$308.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$410.54
|
| Rate for Payer: Health Management Network Commercial |
$509.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$370.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$370.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$370.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$349.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$308.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$349.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$308.37
|
|
