|
51701-Insert Bladder Cath Non-Dwelling
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
8080223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$388.97 |
| Rate for Payer: AlohaCare Medicaid |
$200.50
|
| Rate for Payer: AlohaCare Medicare |
$200.50
|
| Rate for Payer: Cash Price |
$260.65
|
| Rate for Payer: Cash Price |
$260.65
|
| Rate for Payer: Devoted Health Medicare |
$220.55
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.95
|
| Rate for Payer: Health Management Network Commercial |
$340.85
|
| Rate for Payer: Humana Medicare |
$200.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.50
|
| Rate for Payer: MDX Hawaii PPO |
$388.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.50
|
| Rate for Payer: University Health Alliance Commercial |
$292.29
|
|
|
51702 Insert Foley Catheter Charges
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
8221527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.35 |
| Max. Negotiated Rate |
$437.47 |
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.90
|
| Rate for Payer: MDX Hawaii PPO |
$437.47
|
|
|
51702 Insert Foley Catheter Charges
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
8221527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$437.47 |
| Rate for Payer: AlohaCare Medicaid |
$225.50
|
| Rate for Payer: AlohaCare Medicare |
$225.50
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Cash Price |
$293.15
|
| Rate for Payer: Devoted Health Medicare |
$248.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$225.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$428.45
|
| Rate for Payer: Health Management Network Commercial |
$383.35
|
| Rate for Payer: Humana Medicare |
$225.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$405.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$230.01
|
| Rate for Payer: Kaiser Permanente Medicare |
$225.50
|
| Rate for Payer: MDX Hawaii PPO |
$437.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$225.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$225.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$225.50
|
| Rate for Payer: University Health Alliance Commercial |
$328.73
|
|
|
51702-Insertion Indwelling Catheter
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
8080225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
|
|
51702-Insertion Indwelling Catheter
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
8080225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$385.09 |
| Rate for Payer: AlohaCare Medicaid |
$198.50
|
| Rate for Payer: AlohaCare Medicare |
$198.50
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Devoted Health Medicare |
$218.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$377.15
|
| Rate for Payer: Health Management Network Commercial |
$337.45
|
| Rate for Payer: Humana Medicare |
$198.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$357.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$202.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.50
|
| Rate for Payer: MDX Hawaii PPO |
$385.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$21.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.50
|
| Rate for Payer: University Health Alliance Commercial |
$289.37
|
|
|
51703-Insert Indwelling Cath Complicated
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
8080226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$268.00
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Devoted Health Medicare |
$294.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$268.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$509.20
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Humana Medicare |
$268.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$268.00
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$268.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$268.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$268.00
|
| Rate for Payer: University Health Alliance Commercial |
$390.69
|
|
|
51703-Insert Indwelling Cath Complicated
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
8080226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.60 |
| Max. Negotiated Rate |
$519.92 |
| Rate for Payer: Cash Price |
$348.40
|
| Rate for Payer: Health Management Network Commercial |
$455.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$482.40
|
| Rate for Payer: MDX Hawaii PPO |
$519.92
|
|
|
51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED TechFee
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
8211336
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$612.07 |
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.90
|
| Rate for Payer: MDX Hawaii PPO |
$612.07
|
|
|
51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED TechFee
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
8211336
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$315.50 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$315.50
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Cash Price |
$410.15
|
| Rate for Payer: Devoted Health Medicare |
$347.05
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$315.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$599.45
|
| Rate for Payer: Health Management Network Commercial |
$536.35
|
| Rate for Payer: Humana Medicare |
$315.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$315.50
|
| Rate for Payer: MDX Hawaii PPO |
$612.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$315.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$315.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$315.50
|
| Rate for Payer: University Health Alliance Commercial |
$459.94
|
|
|
51705-Change Cystostomy Tube Simple
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
8080228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$848.30 |
| Max. Negotiated Rate |
$968.06 |
| Rate for Payer: Cash Price |
$648.70
|
| Rate for Payer: Health Management Network Commercial |
$848.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.20
|
| Rate for Payer: MDX Hawaii PPO |
$968.06
|
|
|
51705-Change Cystostomy Tube Simple
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
HCPCS 51705
|
| Hospital Charge Code |
8080228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$499.00
|
| Rate for Payer: Cash Price |
$648.70
|
| Rate for Payer: Cash Price |
$648.70
|
| Rate for Payer: Cash Price |
$648.70
|
| Rate for Payer: Devoted Health Medicare |
$548.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$499.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$948.10
|
| Rate for Payer: Health Management Network Commercial |
$848.30
|
| Rate for Payer: Humana Medicare |
$499.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$898.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$499.00
|
| Rate for Payer: MDX Hawaii PPO |
$968.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$499.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$499.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$499.00
|
| Rate for Payer: University Health Alliance Commercial |
$727.44
|
|
|
51865 Cystorrhaphy, suture of bladder wound, injury or rupture; complicated
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
HCPCS 51865
|
| Hospital Charge Code |
8039696
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$743.60 |
| Max. Negotiated Rate |
$2,151.35 |
| Rate for Payer: AlohaCare Medicaid |
$902.28
|
| Rate for Payer: AlohaCare Medicare |
$809.23
|
| Rate for Payer: Cash Price |
$1,645.15
|
| Rate for Payer: Cash Price |
$1,645.15
|
| 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 |
$2,151.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$890.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$890.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$890.15
|
| 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
|
|
|
51865 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE; COMPLICATED ProFee
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
HCPCS 51865
|
| Hospital Charge Code |
8020652
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$743.60 |
| Max. Negotiated Rate |
$2,151.35 |
| Rate for Payer: AlohaCare Medicaid |
$902.28
|
| Rate for Payer: AlohaCare Medicare |
$809.23
|
| Rate for Payer: Cash Price |
$1,645.15
|
| Rate for Payer: Cash Price |
$1,645.15
|
| 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 |
$2,151.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$890.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$890.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$890.15
|
| 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
|
|
|
52000 Cystourethroscopy (separate procedure)
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
HCPCS 52000
|
| Hospital Charge Code |
8039699
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.34 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: AlohaCare Medicaid |
$79.72
|
| Rate for Payer: AlohaCare Medicare |
$70.34
|
| Rate for Payer: Cash Price |
$536.90
|
| Rate for Payer: Cash Price |
$536.90
|
| 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 |
$205.11
|
| 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 |
$702.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.37
|
| 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
|
|
|
52001 Cystourethroscopy with irrigation and evacuation of multiple obstructing clots
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
8039700
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$283.86
|
| Rate for Payer: AlohaCare Medicare |
$250.56
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| 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 |
$473.32
|
| 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 |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$275.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$275.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$275.62
|
| 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
|
|
|
52005 Cystourethroscopy w/ ureteral catheterization
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 52005
|
| Hospital Charge Code |
8039701
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.98 |
| Max. Negotiated Rate |
$2,472.65 |
| Rate for Payer: AlohaCare Medicaid |
$133.65
|
| Rate for Payer: AlohaCare Medicare |
$119.98
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| 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 |
$220.65
|
| 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 |
$2,472.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$131.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$131.98
|
| 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
|
|
|
52204 Cystourethroscopy, with biopsy(s)
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 52204
|
| Hospital Charge Code |
8039703
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$2,472.65 |
| Rate for Payer: AlohaCare Medicaid |
$141.15
|
| Rate for Payer: AlohaCare Medicare |
$126.40
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| 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 |
$234.19
|
| 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 |
$2,472.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.04
|
| 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
|
|
|
52214 Cystourethroscopy w/ fulguration of trigone or periurethral glands
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 52214
|
| Hospital Charge Code |
8039704
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$171.39
|
| Rate for Payer: AlohaCare Medicare |
$149.18
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| 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 |
$319.67
|
| 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 |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$164.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$164.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$164.10
|
| 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
|
|
|
52234 Cystourethroscopy w/ fulguration and/or resection of SMALL bladder tumor(s) (0.5 up to 2.0 cm)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 52234
|
| Hospital Charge Code |
8039705
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$243.42
|
| Rate for Payer: AlohaCare Medicare |
$215.25
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| 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 |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$236.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$236.78
|
| 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
|
|
|
52235 Cystourethroscopy w/ fulguration and/or resection of MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 52235
|
| Hospital Charge Code |
8039706
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$252.46 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$285.39
|
| Rate for Payer: AlohaCare Medicare |
$252.46
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| 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 |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$277.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$277.71
|
| 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
|
|
|
52276 Cystourethroscopy with direct vision internal urethrotomy
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
8039709
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$231.62 |
| Max. Negotiated Rate |
$2,472.65 |
| Rate for Payer: AlohaCare Medicaid |
$261.45
|
| Rate for Payer: AlohaCare Medicare |
$231.62
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| 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 |
$2,472.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$254.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$254.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$254.78
|
| 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
|
|
|
52281 Cystourethroscopy w/ calib/dilation, w/wo meatotomy, w/wo injection procedure, Male/Female
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 52281
|
| Hospital Charge Code |
8039711
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$2,472.65 |
| Rate for Payer: AlohaCare Medicaid |
$151.82
|
| Rate for Payer: AlohaCare Medicare |
$136.35
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| 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 |
$252.26
|
| 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 |
$2,472.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.99
|
| 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
|
|
|
52310 Cystourethroscopy, w/ removal of foreign body, calculus, or ureteral stent; simple
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 52310
|
| Hospital Charge Code |
8039716
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$2,472.65 |
| Rate for Payer: AlohaCare Medicaid |
$150.56
|
| Rate for Payer: AlohaCare Medicare |
$133.80
|
| Rate for Payer: Cash Price |
$1,890.85
|
| Rate for Payer: Cash Price |
$1,890.85
|
| 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 |
$250.28
|
| 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 |
$2,472.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$147.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.18
|
| 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
|
|
|
52317 Litholapaxy: crushing or fragmentation of calculus; simple or small (less than 2.5 cm)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
8039718
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$300.20 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$340.99
|
| Rate for Payer: AlohaCare Medicare |
$300.20
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Devoted Health Medicare |
$330.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$340.99
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$570.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$300.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$340.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$495.04
|
| Rate for Payer: Health Management Network Commercial |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$330.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$330.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$330.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$340.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$300.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$340.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$300.20
|
|
|
52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)
|
Professional
|
Both
|
$4,906.00
|
|
|
Service Code
|
HCPCS 52332
|
| Hospital Charge Code |
8039723
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$139.45 |
| Max. Negotiated Rate |
$4,170.10 |
| Rate for Payer: AlohaCare Medicaid |
$155.10
|
| Rate for Payer: AlohaCare Medicare |
$139.45
|
| Rate for Payer: Cash Price |
$3,188.90
|
| Rate for Payer: Cash Price |
$3,188.90
|
| 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 |
$257.86
|
| 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 |
$4,170.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$153.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.40
|
| 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
|
|
