|
NAPROXEN 375 MG TAB
|
Facility
|
OP
|
$0.21
|
|
| Hospital Charge Code |
41651104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
NAPROXEN 375 MG TAB
|
Facility
|
OP
|
$0.21
|
|
| Hospital Charge Code |
41641104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
NAPROXEN 500 MG PO TABS [5393]
|
Facility
|
OP
|
$1.07
|
|
|
Service Code
|
NDC 70010013905
|
| Hospital Charge Code |
70010013905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.69
|
|
|
NAPROXEN 500 MG PO TABS [5393]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
NDC 63739040310
|
| Hospital Charge Code |
63739040310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
NAPROXEN 500 MG PO TABS [5393]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 68462019005
|
| Hospital Charge Code |
68462019005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Brighton Health Commercial |
$0.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.81
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
NAPROXEN 500 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41651107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
NAPROXEN 500 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41641107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
NASAL CANNULA,DAILY RATE
|
Facility
|
OP
|
$35.44
|
|
| Hospital Charge Code |
40302000
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.72
|
| Rate for Payer: Aetna Government |
$17.72
|
| Rate for Payer: Brighton Health Commercial |
$26.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.10
|
| Rate for Payer: Group Health Inc Commercial |
$17.72
|
| Rate for Payer: Group Health Inc Medicare |
$12.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.72
|
|
|
NASAL CPAP
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
30103247
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
NASAL CPAP
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
30103247
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
NASAL CPAP
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
40302250
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
NASAL CPAP
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
40302250
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$474.15
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
30305696
|
|
Hospital Revenue Code
|
510
|
| 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 |
$233.00
|
| Rate for Payer: Cash Price |
$229.07
|
| 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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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
|
|
|
NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$474.15
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
30305696
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$229.07
|
|
|
NASAL ENDOSCOPY DX
|
Facility
|
IP
|
$474.15
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
40109201
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$229.07
|
|
|
NASAL ENDOSCOPY DX
|
Facility
|
OP
|
$474.15
|
|
|
Service Code
|
HCPCS 31231
|
| Hospital Charge Code |
40109201
|
|
Hospital Revenue Code
|
510
|
| 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 |
$233.00
|
| Rate for Payer: Cash Price |
$229.07
|
| 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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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
|
|
|
NASAL ENDOSCOPY W CONTROL OF HEMO
|
Facility
|
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
40109204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,962.76
|
| Rate for Payer: Aetna Government |
$1,962.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,373.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,373.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,373.93
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,962.76
|
| 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 |
$1,962.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,668.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,746.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,962.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,746.86
|
| 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 |
$2,166.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,962.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Humana Medicare |
$2,002.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,962.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,962.76
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,962.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,962.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,570.21
|
| Rate for Payer: Wellcare Medicare |
$1,864.62
|
|
|
NASAL ENDOSCOPY W CONTROL OF HEMO
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31238
|
| Hospital Charge Code |
40109204
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
NASAL ENDOSCOPY W ETHMOIDECTOMY
|
Facility
|
OP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31254
|
| Hospital Charge Code |
40109384
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,914.90
|
| Rate for Payer: Aetna Government |
$7,914.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,540.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,540.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,540.43
|
| Rate for Payer: Brighton Health Commercial |
$12,358.12
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,914.90
|
| 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 |
$7,914.90
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,727.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,044.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,914.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,044.26
|
| Rate for Payer: Group Health Inc Commercial |
$7,914.90
|
| Rate for Payer: Group Health Inc Medicare |
$7,914.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,238.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,914.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,727.66
|
| Rate for Payer: Healthfirst QHP |
$7,914.90
|
| Rate for Payer: Humana Medicare |
$8,073.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,914.90
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,914.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,914.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,331.92
|
| Rate for Payer: Wellcare Medicare |
$7,519.16
|
|
|
NASAL ENDOSCOPY W ETHMOIDECTOMY
|
Facility
|
IP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31254
|
| Hospital Charge Code |
40109384
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,914.90
|
|
|
NASAL ENDOSCOPY W TISSUE REMOVAL
|
Facility
|
IP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
40109385
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,914.90
|
|
|
NASAL ENDOSCOPY W TISSUE REMOVAL
|
Facility
|
OP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31267
|
| Hospital Charge Code |
40109385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,914.90
|
| Rate for Payer: Aetna Government |
$7,914.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,540.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,540.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,540.43
|
| Rate for Payer: Brighton Health Commercial |
$12,358.12
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,914.90
|
| 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 |
$7,914.90
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,727.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,044.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,914.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,044.26
|
| Rate for Payer: Group Health Inc Commercial |
$7,914.90
|
| Rate for Payer: Group Health Inc Medicare |
$7,914.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,238.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,914.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,727.66
|
| Rate for Payer: Healthfirst QHP |
$7,914.90
|
| Rate for Payer: Humana Medicare |
$8,073.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,914.90
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,914.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,914.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,331.92
|
| Rate for Payer: Wellcare Medicare |
$7,519.16
|
|
|
NASAL ENDO, W REM T SPHEN SINUS
|
Facility
|
IP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31288
|
| Hospital Charge Code |
40019977
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,914.90
|
|
|
NASAL ENDO, W REM T SPHEN SINUS
|
Facility
|
OP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31288
|
| Hospital Charge Code |
40019977
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,914.90
|
| Rate for Payer: Aetna Government |
$7,914.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,540.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,540.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,540.43
|
| Rate for Payer: Brighton Health Commercial |
$12,358.12
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,914.90
|
| 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 |
$7,914.90
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,727.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,044.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,914.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,044.26
|
| Rate for Payer: Group Health Inc Commercial |
$7,914.90
|
| Rate for Payer: Group Health Inc Medicare |
$7,914.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,238.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,914.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,727.66
|
| Rate for Payer: Healthfirst QHP |
$7,914.90
|
| Rate for Payer: Humana Medicare |
$8,073.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,914.90
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,914.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,914.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,331.92
|
| Rate for Payer: Wellcare Medicare |
$7,519.16
|
|
|
NASAL FUNCTION STUDY
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 92512
|
| Hospital Charge Code |
30304094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$421.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| 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 |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
