|
NASAL FUNCTION STUDY
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 92512
|
| Hospital Charge Code |
30304094
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
NASAL MASK, SUPERNOVA ADLT LARGE
|
Facility
|
OP
|
$57.50
|
|
| Hospital Charge Code |
64903844
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.75
|
| Rate for Payer: Aetna Government |
$28.75
|
| Rate for Payer: Brighton Health Commercial |
$43.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.10
|
| Rate for Payer: Group Health Inc Commercial |
$28.75
|
| Rate for Payer: Group Health Inc Medicare |
$20.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.75
|
|
|
NASAL MASK SUPERNOVA , ADLT MED
|
Facility
|
OP
|
$57.50
|
|
| Hospital Charge Code |
64903846
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.12 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.75
|
| Rate for Payer: Aetna Government |
$28.75
|
| Rate for Payer: Brighton Health Commercial |
$43.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.10
|
| Rate for Payer: Group Health Inc Commercial |
$28.75
|
| Rate for Payer: Group Health Inc Medicare |
$20.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.75
|
|
|
NASAL PACKING
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
40109010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
NASAL PACKING
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
40109010
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
NASAL PACKING
|
Facility
|
OP
|
$8.51
|
|
| Hospital Charge Code |
40207628
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
|
|
NASAL PACKING MEROCEL1.5X2.5X10CM
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
64902826
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.00
|
| Rate for Payer: Aetna Government |
$33.00
|
| Rate for Payer: Brighton Health Commercial |
$49.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.88
|
| Rate for Payer: Group Health Inc Commercial |
$33.00
|
| Rate for Payer: Group Health Inc Medicare |
$23.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
|
|
NASAL PACKING TRAY (RU)
|
Facility
|
OP
|
$38.63
|
|
| Hospital Charge Code |
40207815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.32
|
| Rate for Payer: Aetna Government |
$19.32
|
| Rate for Payer: Brighton Health Commercial |
$28.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.27
|
| Rate for Payer: Group Health Inc Commercial |
$19.32
|
| Rate for Payer: Group Health Inc Medicare |
$13.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.32
|
|
|
Nasal Pharyngeal Airway
|
Facility
|
OP
|
$26.23
|
|
| Hospital Charge Code |
40204000
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$20.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.12
|
| Rate for Payer: Aetna Government |
$13.12
|
| Rate for Payer: Brighton Health Commercial |
$19.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.84
|
| Rate for Payer: Group Health Inc Commercial |
$13.12
|
| Rate for Payer: Group Health Inc Medicare |
$9.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
|
|
NASAL PROSTHESIS
|
Facility
|
OP
|
$2,899.00
|
|
|
Service Code
|
HCPCS D5913
|
| Hospital Charge Code |
42301225
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,014.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,594.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,150.41
|
| Rate for Payer: Aetna Government |
$2,150.41
|
| Rate for Payer: Brighton Health Commercial |
$2,174.25
|
| 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: Group Health Inc Commercial |
$1,449.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,014.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,449.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,449.50
|
|
|
NASAL PROSTHESIS, REPLACEMENT
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
HCPCS D5926
|
| Hospital Charge Code |
42301270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,080.69
|
| Rate for Payer: Aetna Government |
$1,080.69
|
| Rate for Payer: Brighton Health Commercial |
$203.25
|
| 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: Group Health Inc Commercial |
$135.50
|
| Rate for Payer: Group Health Inc Medicare |
$94.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.50
|
|
|
NASAL RECONSTRUCTION DEMATOPLASTY
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 30620
|
| Hospital Charge Code |
40108890
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
NASAL RECONSTRUCTION DEMATOPLASTY
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 30620
|
| Hospital Charge Code |
40108890
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
NASAL SEPTAL PROSTHESIS
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS D5922
|
| Hospital Charge Code |
42301250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.99 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$726.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.99
|
| Rate for Payer: Aetna Government |
$80.99
|
| Rate for Payer: Brighton Health Commercial |
$990.75
|
| 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: Group Health Inc Commercial |
$660.50
|
| Rate for Payer: Group Health Inc Medicare |
$462.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$660.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$660.50
|
|
|
NASAL/SINUS ENDOSCOPY
|
Facility
|
IP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
40014063
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,330.61
|
|
|
NASAL/SINUS ENDOSCOPY
|
Facility
|
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31256
|
| Hospital Charge Code |
40014063
|
|
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
|
|
|
NASAL/SINUS ENDOSCOPY FRONTAL SIN
|
Facility
|
IP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31276
|
| Hospital Charge Code |
40019940
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,914.90
|
|
|
NASAL/SINUS ENDOSCOPY FRONTAL SIN
|
Facility
|
OP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31276
|
| Hospital Charge Code |
40019940
|
|
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/SINUS ENDOSCOPY SURGERY
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
40109200
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
NASAL/SINUS ENDOSCOPY SURGERY
|
Facility
|
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31237
|
| Hospital Charge Code |
40109200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,373.93 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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: 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: EmblemHealth Commercial |
$1,505.00
|
| 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 |
$1,962.76
|
| Rate for Payer: Group Health Inc Medicare |
$1,962.76
|
| 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: Senior Whole Health Medicare Advantage |
$1,962.76
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| 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/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)
|
Facility
|
OP
|
$8,073.20
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$8,073.20 |
| 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: 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 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/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)
|
Facility
|
OP
|
$8,073.20
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$8,073.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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: 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 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/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus
|
Facility
|
OP
|
$8,073.20
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$8,073.20 |
| 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: 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 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/SINUS ENDO TOTAL
|
Facility
|
IP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31255
|
| Hospital Charge Code |
40014062
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,914.90
|
|
