|
LARYNGOSCOPY FOR ASPIRATION
|
Facility
|
IP
|
$1,144.53
|
|
|
Service Code
|
HCPCS 31515
|
| Hospital Charge Code |
40019920
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$472.20
|
|
|
LARYNGOSCOPY FOR ASPIRATION
|
Facility
|
OP
|
$1,144.53
|
|
|
Service Code
|
HCPCS 31515
|
| Hospital Charge Code |
30106000
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$472.20
|
| Rate for Payer: Aetna Government |
$472.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$330.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$330.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$330.54
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$472.20
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$472.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$472.20
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$420.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$420.26
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$472.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$472.20
|
| Rate for Payer: Humana Medicare |
$481.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$472.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$472.20
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$472.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$472.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$377.76
|
| Rate for Payer: Wellcare Medicare |
$448.59
|
|
|
LARYNGOSCOPY FOR ASPIRATION
|
Facility
|
OP
|
$1,144.53
|
|
|
Service Code
|
HCPCS 31515
|
| Hospital Charge Code |
40019920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$472.20
|
| Rate for Payer: Aetna Government |
$472.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$330.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$330.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$330.54
|
| Rate for Payer: Brighton Health Commercial |
$858.40
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Cash Price |
$472.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$472.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$472.20
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$420.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$420.26
|
| Rate for Payer: Group Health Inc Commercial |
$472.20
|
| Rate for Payer: Group Health Inc Medicare |
$472.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$472.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.37
|
| Rate for Payer: Healthfirst QHP |
$472.20
|
| Rate for Payer: Humana Medicare |
$481.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$472.20
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$472.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$472.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$377.76
|
| Rate for Payer: Wellcare Medicare |
$448.59
|
|
|
LARYNGOSCOPY -INDIRECT
|
Facility
|
IP
|
$474.15
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
40109213
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$229.07
|
|
|
LARYNGOSCOPY -INDIRECT
|
Facility
|
OP
|
$474.15
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
40109213
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.35 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$229.07
|
| Rate for Payer: Aetna Government |
$229.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$160.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$160.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$160.35
|
| Rate for Payer: Brighton Health Commercial |
$355.61
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$229.07
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.87
|
| Rate for Payer: Group Health Inc Commercial |
$229.07
|
| Rate for Payer: Group Health Inc Medicare |
$229.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.71
|
| Rate for Payer: Healthfirst QHP |
$229.07
|
| Rate for Payer: Humana Medicare |
$233.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.26
|
| Rate for Payer: Wellcare Medicare |
$217.62
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
30306679
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$4,447.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,031.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,031.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,031.43
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Humana Medicare |
$4,417.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,330.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
40019857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,671.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,031.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,031.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,031.43
|
| Rate for Payer: Brighton Health Commercial |
$6,671.38
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,330.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,330.61
|
| Rate for Payer: Group Health Inc Medicare |
$4,330.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Humana Medicare |
$4,417.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
40019857
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,330.61
|
|
|
LARYNGOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31535
|
| Hospital Charge Code |
30306679
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$4,330.61
|
|
|
LARYNGOSCOPY WITH EXCISION, TUMOR
|
Facility
|
IP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31540
|
| Hospital Charge Code |
40019858
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,330.61
|
|
|
LARYNGOSCOPY WITH EXCISION, TUMOR
|
Facility
|
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31540
|
| Hospital Charge Code |
40019858
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,671.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,031.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,031.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,031.43
|
| Rate for Payer: Brighton Health Commercial |
$6,671.38
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,330.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,330.61
|
| Rate for Payer: Group Health Inc Medicare |
$4,330.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Humana Medicare |
$4,417.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
LASER IRIDOTOMY-IRIDECTOMY
|
Facility
|
OP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 66761
|
| Hospital Charge Code |
40072475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.75 |
| Max. Negotiated Rate |
$62,084.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$672.19
|
| Rate for Payer: Aetna Government |
$672.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,396.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$620.84
|
| Rate for Payer: Amida Care Medicaid |
$620.84
|
| Rate for Payer: Brighton Health Commercial |
$1,151.54
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$672.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$672.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,084.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.88
|
| Rate for Payer: Group Health Inc Commercial |
$672.19
|
| Rate for Payer: Group Health Inc Medicare |
$672.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$672.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.36
|
| Rate for Payer: Healthfirst QHP |
$620.84
|
| Rate for Payer: Humana Medicare |
$685.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$672.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.84
|
| Rate for Payer: SOMOS Essential |
$1,396.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$682.92
|
| Rate for Payer: United Healthcare Medicaid |
$620.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$672.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$537.75
|
| Rate for Payer: Wellcare Medicare |
$638.58
|
|
|
LASER IRIDOTOMY-IRIDECTOMY
|
Facility
|
IP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 66761
|
| Hospital Charge Code |
40072475
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$672.19
|
|
|
LASER IRIDOTOMY-IRIDECTOMY
|
Facility
|
OP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 66761
|
| Hospital Charge Code |
30302034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$62,084.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$672.19
|
| Rate for Payer: Aetna Government |
$672.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,396.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$620.84
|
| Rate for Payer: Amida Care Medicaid |
$620.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$672.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,084.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.88
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$672.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.36
|
| Rate for Payer: Healthfirst QHP |
$620.84
|
| Rate for Payer: Humana Medicare |
$685.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$672.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$672.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.84
|
| Rate for Payer: SOMOS Essential |
$1,396.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$682.92
|
| Rate for Payer: United Healthcare Medicaid |
$620.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$672.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$537.75
|
| Rate for Payer: Wellcare Medicare |
$638.58
|
|
|
LASER IRIDOTOMY-IRIDECTOMY
|
Facility
|
IP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 66761
|
| Hospital Charge Code |
30302034
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$672.19
|
|
|
LASER LIGHT GREEN
|
Facility
|
OP
|
$4,250.00
|
|
| Hospital Charge Code |
64906022
|
|
Hospital Revenue Code
|
291
|
| Min. Negotiated Rate |
$1,487.50 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,125.00
|
| Rate for Payer: Aetna Government |
$2,125.00
|
| Rate for Payer: Brighton Health Commercial |
$3,187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,890.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
LASER SURGERY OF EYE
|
Facility
|
OP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 65855
|
| Hospital Charge Code |
30302033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$62,084.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$672.19
|
| Rate for Payer: Aetna Government |
$672.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,396.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$620.84
|
| Rate for Payer: Amida Care Medicaid |
$620.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$672.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,084.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.88
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$672.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.36
|
| Rate for Payer: Healthfirst QHP |
$620.84
|
| Rate for Payer: Humana Medicare |
$685.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$672.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$672.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.84
|
| Rate for Payer: SOMOS Essential |
$1,396.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$682.92
|
| Rate for Payer: United Healthcare Medicaid |
$620.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$672.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$537.75
|
| Rate for Payer: Wellcare Medicare |
$638.58
|
|
|
LASER SURGERY OF EYE
|
Facility
|
IP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 65855
|
| Hospital Charge Code |
40073269
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$672.19
|
|
|
LASER SURGERY OF EYE
|
Facility
|
OP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 65855
|
| Hospital Charge Code |
40073269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.75 |
| Max. Negotiated Rate |
$62,084.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$672.19
|
| Rate for Payer: Aetna Government |
$672.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,396.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$620.84
|
| Rate for Payer: Amida Care Medicaid |
$620.84
|
| Rate for Payer: Brighton Health Commercial |
$1,151.54
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$672.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$672.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,084.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.88
|
| Rate for Payer: Group Health Inc Commercial |
$672.19
|
| Rate for Payer: Group Health Inc Medicare |
$672.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$672.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.36
|
| Rate for Payer: Healthfirst QHP |
$620.84
|
| Rate for Payer: Humana Medicare |
$685.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$672.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.84
|
| Rate for Payer: SOMOS Essential |
$1,396.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,396.89
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$682.92
|
| Rate for Payer: United Healthcare Medicaid |
$620.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$672.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$672.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$537.75
|
| Rate for Payer: Wellcare Medicare |
$638.58
|
|
|
LASER SURGERY OF EYE
|
Facility
|
IP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 65855
|
| Hospital Charge Code |
30302033
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$672.19
|
|
|
LASER TREATMENT OF RETINA
|
Facility
|
IP
|
$11,564.78
|
|
|
Service Code
|
HCPCS 67040
|
| Hospital Charge Code |
40079681
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,701.83
|
|
|
LASER TREATMENT OF RETINA
|
Facility
|
OP
|
$11,564.78
|
|
|
Service Code
|
HCPCS 67040
|
| Hospital Charge Code |
40079681
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$8,673.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,701.83
|
| Rate for Payer: Aetna Government |
$4,701.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,291.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,291.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,291.28
|
| Rate for Payer: Brighton Health Commercial |
$8,673.58
|
| Rate for Payer: Cash Price |
$4,701.83
|
| Rate for Payer: Cash Price |
$4,701.83
|
| Rate for Payer: Cash Price |
$4,701.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,701.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,701.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,996.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,184.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,701.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,184.63
|
| Rate for Payer: Group Health Inc Commercial |
$4,701.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,701.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,782.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,701.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,996.56
|
| Rate for Payer: Healthfirst QHP |
$4,701.83
|
| Rate for Payer: Humana Medicare |
$4,795.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,701.83
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,701.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,701.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,761.46
|
| Rate for Payer: Wellcare Medicare |
$4,466.74
|
|
|
LASSO QUIK PASS 90 DEG
|
Facility
|
OP
|
$572.50
|
|
| Hospital Charge Code |
64905796
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$200.38 |
| Max. Negotiated Rate |
$458.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$286.25
|
| Rate for Payer: Aetna Government |
$286.25
|
| Rate for Payer: Brighton Health Commercial |
$429.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$458.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.30
|
| Rate for Payer: Group Health Inc Commercial |
$286.25
|
| Rate for Payer: Group Health Inc Medicare |
$200.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.25
|
|
|
LASSO SUTURE 25DEG, LFT
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
64906679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$200.00
|
| Rate for Payer: Aetna Government |
$200.00
|
| Rate for Payer: Brighton Health Commercial |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$272.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
LATANOPROST 0.005% OPHTHALMIC SOLN 2.5 M
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41650658
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
