|
BROMOCRIPTINE MESYLATE 2.5 MG PO TABS [9297]
|
Facility
|
OP
|
$4.14
|
|
|
Service Code
|
NDC 00574010603
|
| Hospital Charge Code |
00574010603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.07
|
| Rate for Payer: Aetna Government |
$2.07
|
| Rate for Payer: Brighton Health Commercial |
$3.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.81
|
| Rate for Payer: Group Health Inc Commercial |
$2.07
|
| Rate for Payer: Group Health Inc Medicare |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.69
|
|
|
BROMOCRIPTINE MESYLATE 2.5 MG PO TABS [9297]
|
Facility
|
OP
|
$6.27
|
|
|
Service Code
|
NDC 00781532531
|
| Hospital Charge Code |
00781532531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.13
|
| Rate for Payer: Aetna Government |
$3.13
|
| Rate for Payer: Brighton Health Commercial |
$4.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.26
|
| Rate for Payer: Group Health Inc Commercial |
$3.13
|
| Rate for Payer: Group Health Inc Medicare |
$2.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.07
|
|
|
BRONCH EBUS SAMPLING 1/2 NODE
|
Facility
|
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31652
|
| Hospital Charge Code |
41543275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$6,671.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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 |
$745.00
|
| 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
|
|
|
BRONCH EBUS SAMPLING 1/2 NODE
|
Facility
|
IP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31652
|
| Hospital Charge Code |
41543275
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,330.61
|
|
|
BRONCHIAL ALLERGY TESTS
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
30301414
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$735.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
BRONCHIAL ALLERGY TESTS
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95070
|
| Hospital Charge Code |
30301414
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
BRONCHIAL VALVE INSERTION INITIAL
|
Facility
|
OP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31647
|
| Hospital Charge Code |
40008343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$12,358.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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
|
|
|
BRONCHIAL VALVE INSERTION INITIAL
|
Facility
|
IP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31647
|
| Hospital Charge Code |
40008343
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,914.90
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$28,333.06
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$8,210.56 |
| Max. Negotiated Rate |
$28,333.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,118.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,605.86
|
| Rate for Payer: Aetna Government |
$20,605.86
|
| Rate for Payer: Brighton Health Commercial |
$13,883.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,017.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,535.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,645.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,575.57
|
| Rate for Payer: EmblemHealth Commercial |
$8,210.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,605.86
|
| Rate for Payer: Group Health Inc Commercial |
$20,605.86
|
| Rate for Payer: Group Health Inc Medicare |
$20,605.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,605.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,581.72
|
| Rate for Payer: Humana Medicare |
$28,333.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,605.86
|
| Rate for Payer: United Healthcare Commercial |
$19,041.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,605.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,605.86
|
| Rate for Payer: Wellcare Medicare |
$19,575.57
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$23,325.88
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$5,958.77 |
| Max. Negotiated Rate |
$23,325.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,246.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,964.28
|
| Rate for Payer: Aetna Government |
$16,964.28
|
| Rate for Payer: Brighton Health Commercial |
$10,076.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,303.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,000.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,903.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,116.07
|
| Rate for Payer: EmblemHealth Commercial |
$5,958.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,964.28
|
| Rate for Payer: Group Health Inc Commercial |
$16,964.28
|
| Rate for Payer: Group Health Inc Medicare |
$16,964.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,964.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,888.39
|
| Rate for Payer: Humana Medicare |
$23,325.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,964.28
|
| Rate for Payer: United Healthcare Commercial |
$13,819.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,964.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,964.28
|
| Rate for Payer: Wellcare Medicare |
$16,116.07
|
|
|
Bronchitrac L
|
Facility
|
OP
|
$17.01
|
|
| Hospital Charge Code |
40200661
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Brighton Health Commercial |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.57
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
BRONCHITRAC L
|
Facility
|
OP
|
$4.97
|
|
| Hospital Charge Code |
40200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Brighton Health Commercial |
$3.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
BRONCHOGRAM TRAY
|
Facility
|
OP
|
$63.43
|
|
| Hospital Charge Code |
40200660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.72
|
| Rate for Payer: Aetna Government |
$31.72
|
| Rate for Payer: Brighton Health Commercial |
$47.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.13
|
| Rate for Payer: Group Health Inc Commercial |
$31.72
|
| Rate for Payer: Group Health Inc Medicare |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.72
|
|
|
BRONCHOSCOPE ASSIST
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 94799 TC
|
| Hospital Charge Code |
40302375
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
BRONCHOSCOPE ASSIST
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 94799 TC
|
| Hospital Charge Code |
40302375
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$315.75
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
BRONCHOSCOPY
|
Facility
|
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31625
|
| Hospital Charge Code |
40000445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,373.93 |
| Max. Negotiated Rate |
$3,249.71 |
| 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 |
$3,249.71
|
| 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: 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 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: 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
|
|
|
BRONCHOSCOPY
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31625
|
| Hospital Charge Code |
40000445
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
BRONCHOSCOPY/LAVAGE
|
Facility
|
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
40019994
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,373.93 |
| Max. Negotiated Rate |
$3,249.71 |
| 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 |
$3,249.71
|
| 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: 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 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: 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
|
|
|
BRONCHOSCOPY/LAVAGE
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31624
|
| Hospital Charge Code |
40019994
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
BRONCHOSCOPY,MEDIASTINOSCOPY
|
Facility
|
OP
|
$1,837.20
|
|
|
Service Code
|
HCPCS 39000
|
| Hospital Charge Code |
40042085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$513.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,010.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$513.46
|
| Rate for Payer: Aetna Government |
$513.46
|
| Rate for Payer: Brighton Health Commercial |
$1,377.90
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$918.60
|
| Rate for Payer: Group Health Inc Medicare |
$643.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$918.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$918.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
BRONCHOSCOPY/NEEDLE BX
|
Facility
|
IP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31629
|
| Hospital Charge Code |
40019650
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,330.61
|
|
|
BRONCHOSCOPY/NEEDLE BX
|
Facility
|
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31629
|
| Hospital Charge Code |
40019650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| 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 |
$1,835.00
|
| 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
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures
|
Facility
|
OP
|
$4,417.22
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$4,417.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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: 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 |
$745.00
|
| 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 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
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures
|
Facility
|
OP
|
$4,417.22
|
|
|
Service Code
|
CPT 31653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,417.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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: 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 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
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures
|
Facility
|
OP
|
$4,417.22
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,417.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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: 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 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
|
|
