|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$951.60 |
| Max. Negotiated Rate |
$1,670.25 |
| Rate for Payer: AlohaCare Medicaid |
$1,260.38
|
| Rate for Payer: AlohaCare Medicare |
$1,122.62
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Devoted Health Medicare |
$1,234.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,122.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network Commercial |
$1,670.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,347.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,347.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,347.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,260.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,122.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,260.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,122.62
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$750.88 |
| Max. Negotiated Rate |
$1,290.30 |
| Rate for Payer: AlohaCare Medicaid |
$967.18
|
| Rate for Payer: AlohaCare Medicare |
$867.53
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Devoted Health Medicare |
$954.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$867.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$750.88
|
| Rate for Payer: Health Management Network Commercial |
$1,290.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,041.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,041.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,041.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$967.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$867.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$967.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$867.53
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$584.87
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$497.14 |
| Rate for Payer: AlohaCare Medicaid |
$151.82
|
| Rate for Payer: AlohaCare Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Cash Price |
$350.92
|
| Rate for Payer: Devoted Health Medicare |
$149.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$151.82
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$234.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$136.35
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$151.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$206.44
|
| Rate for Payer: Health Management Network Commercial |
$497.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$163.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$163.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$163.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$151.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$136.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$151.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$136.35
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$278.15 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: AlohaCare Medicaid |
$315.30
|
| Rate for Payer: AlohaCare Medicare |
$278.15
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Devoted Health Medicare |
$305.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$278.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$357.76
|
| Rate for Payer: Health Management Network Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$333.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$333.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$333.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$315.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$278.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$315.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$278.15
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$242.41 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: AlohaCare Medicaid |
$274.43
|
| Rate for Payer: AlohaCare Medicare |
$242.41
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Devoted Health Medicare |
$266.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$242.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$245.70
|
| Rate for Payer: Health Management Network Commercial |
$399.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$290.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$290.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$290.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$274.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$242.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$274.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$242.41
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$162.64 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: AlohaCare Medicaid |
$181.61
|
| Rate for Payer: AlohaCare Medicare |
$162.64
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Devoted Health Medicare |
$178.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$162.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$228.02
|
| Rate for Payer: Health Management Network Commercial |
$266.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$195.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$195.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$195.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$162.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$181.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$162.64
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: AlohaCare Medicaid |
$483.64
|
| Rate for Payer: AlohaCare Medicare |
$438.94
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Devoted Health Medicare |
$482.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$438.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$403.00
|
| Rate for Payer: Health Management Network Commercial |
$705.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$526.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$526.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$526.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$483.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$438.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$483.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$438.94
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,115.54
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$228.82 |
| Max. Negotiated Rate |
$948.21 |
| Rate for Payer: AlohaCare Medicaid |
$259.91
|
| Rate for Payer: AlohaCare Medicare |
$228.82
|
| Rate for Payer: Cash Price |
$669.32
|
| Rate for Payer: Cash Price |
$669.32
|
| Rate for Payer: Devoted Health Medicare |
$251.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$259.91
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$403.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$228.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$259.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$468.26
|
| Rate for Payer: Health Management Network Commercial |
$948.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$274.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$274.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$274.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$259.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$228.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$259.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$228.82
|
| Rate for Payer: University Health Alliance Commercial |
$341.55
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$361.90 |
| Max. Negotiated Rate |
$598.40 |
| Rate for Payer: AlohaCare Medicaid |
$410.82
|
| Rate for Payer: AlohaCare Medicare |
$361.90
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Devoted Health Medicare |
$398.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$361.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$413.92
|
| Rate for Payer: Health Management Network Commercial |
$598.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$434.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$361.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$410.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$361.90
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$743.60 |
| Max. Negotiated Rate |
$1,310.70 |
| Rate for Payer: AlohaCare Medicaid |
$902.28
|
| Rate for Payer: AlohaCare Medicare |
$809.23
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Cash Price |
$925.20
|
| Rate for Payer: Devoted Health Medicare |
$890.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$809.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$743.60
|
| Rate for Payer: Health Management Network Commercial |
$1,310.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$971.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$971.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$971.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$902.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$809.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$902.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$809.23
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$567.58 |
| Max. Negotiated Rate |
$1,093.10 |
| Rate for Payer: AlohaCare Medicaid |
$754.37
|
| Rate for Payer: AlohaCare Medicare |
$682.16
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Cash Price |
$771.60
|
| Rate for Payer: Devoted Health Medicare |
$750.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$567.58
|
| Rate for Payer: Health Management Network Commercial |
$1,093.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$818.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$818.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$818.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$754.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$754.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.16
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$278.46 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: AlohaCare Medicaid |
$303.54
|
| Rate for Payer: AlohaCare Medicare |
$279.79
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Devoted Health Medicare |
$307.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.46
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$335.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$335.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$335.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$303.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$303.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.79
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$393.38 |
| Max. Negotiated Rate |
$705.50 |
| Rate for Payer: AlohaCare Medicaid |
$485.04
|
| Rate for Payer: AlohaCare Medicare |
$442.63
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Cash Price |
$498.00
|
| Rate for Payer: Devoted Health Medicare |
$486.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$442.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$393.38
|
| Rate for Payer: Health Management Network Commercial |
$705.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$531.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$531.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$485.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$442.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$485.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$442.63
|
|
|
PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
HCPCS 51525
|
| Min. Negotiated Rate |
$699.66 |
| Max. Negotiated Rate |
$1,258.85 |
| Rate for Payer: AlohaCare Medicaid |
$864.50
|
| Rate for Payer: AlohaCare Medicare |
$773.11
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Cash Price |
$888.60
|
| Rate for Payer: Devoted Health Medicare |
$850.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$773.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$699.66
|
| Rate for Payer: Health Management Network Commercial |
$1,258.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$927.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$927.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$927.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$864.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$773.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$864.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$773.11
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$360.38 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: AlohaCare Medicaid |
$409.29
|
| Rate for Payer: AlohaCare Medicare |
$360.38
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Cash Price |
$421.20
|
| Rate for Payer: Devoted Health Medicare |
$396.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$360.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$432.90
|
| Rate for Payer: Health Management Network Commercial |
$596.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$432.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$432.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$432.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$409.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$360.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$409.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$360.38
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$410.86
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$70.34 |
| Max. Negotiated Rate |
$349.23 |
| Rate for Payer: AlohaCare Medicaid |
$79.72
|
| Rate for Payer: AlohaCare Medicare |
$70.34
|
| Rate for Payer: Cash Price |
$246.52
|
| Rate for Payer: Cash Price |
$246.52
|
| Rate for Payer: Devoted Health Medicare |
$77.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$79.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$190.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$79.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.48
|
| Rate for Payer: Health Management Network Commercial |
$349.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$84.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.34
|
|
|
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
|
|
