|
DURVALUMAB 120MG/2.4ML INJ
|
Facility
OP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41657857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.71
|
| Rate for Payer: Aetna Government |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.71
|
| Rate for Payer: EmblemHealth Commercial |
$80.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.74
|
| Rate for Payer: Group Health Inc Commercial |
$80.71
|
| Rate for Payer: Group Health Inc Medicare |
$80.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.35
|
| Rate for Payer: SOMOS Essential |
$85.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare |
$76.67
|
|
|
DURVALUMAB 120MG/2.4ML INJ
|
Facility
OP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41647857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.71
|
| Rate for Payer: Aetna Government |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.71
|
| Rate for Payer: EmblemHealth Commercial |
$80.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.74
|
| Rate for Payer: Group Health Inc Commercial |
$80.71
|
| Rate for Payer: Group Health Inc Medicare |
$80.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.35
|
| Rate for Payer: SOMOS Essential |
$85.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare |
$76.67
|
|
|
DURVALUMAB 500MG/10ML INJ
|
Facility
IP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41647856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$88.94 |
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.94
|
|
|
DURVALUMAB 500MG/10ML INJ
|
Facility
IP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41657856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$88.94 |
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.94
|
|
|
DURVALUMAB 500MG/10ML INJ
|
Facility
OP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41657856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.71
|
| Rate for Payer: Aetna Government |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.71
|
| Rate for Payer: EmblemHealth Commercial |
$80.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.74
|
| Rate for Payer: Group Health Inc Commercial |
$80.71
|
| Rate for Payer: Group Health Inc Medicare |
$80.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.35
|
| Rate for Payer: SOMOS Essential |
$85.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare |
$76.67
|
|
|
DURVALUMAB 500MG/10ML INJ
|
Facility
OP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41647856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$115.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.71
|
| Rate for Payer: Aetna Government |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Cash Price |
$80.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.71
|
| Rate for Payer: EmblemHealth Commercial |
$80.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.74
|
| Rate for Payer: Group Health Inc Commercial |
$80.71
|
| Rate for Payer: Group Health Inc Medicare |
$80.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.35
|
| Rate for Payer: SOMOS Essential |
$85.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.56
|
| Rate for Payer: Wellcare Medicare |
$76.67
|
|
|
DUST FRAMES 5 X 24
|
Facility
OP
|
$24.75
|
|
| Hospital Charge Code |
64902889
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.38
|
| Rate for Payer: Aetna Government |
$12.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.83
|
| Rate for Payer: Group Health Inc Commercial |
$12.38
|
| Rate for Payer: Group Health Inc Medicare |
$8.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.38
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
40004089
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$136.77 |
| 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: 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 CHP/HARP/Medicaid |
$136.77
|
| 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 CHP/FHP/Medicaid |
$151.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Senior Whole Health 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
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
41103952
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.77 |
| 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: 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 |
$1,962.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.77
|
| 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 CHP/FHP/Medicaid |
$151.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Senior Whole Health 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
|
|
|
DX BRONCHOSCOPE/WASH
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
40029413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.96 |
| 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: 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 CHP/HARP/Medicaid |
$139.96
|
| 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 CHP/FHP/Medicaid |
$155.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Senior Whole Health 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
|
|
|
DXC CUVETTES
|
Facility
OP
|
$110.53
|
|
| Hospital Charge Code |
64902651
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$88.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.26
|
| Rate for Payer: Aetna Government |
$55.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.16
|
| Rate for Payer: Group Health Inc Commercial |
$55.26
|
| Rate for Payer: Group Health Inc Medicare |
$38.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.26
|
|
|
DXC REAGENT PROBE
|
Facility
OP
|
$685.95
|
|
| Hospital Charge Code |
64902657
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$240.08 |
| Max. Negotiated Rate |
$548.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$377.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.98
|
| Rate for Payer: Aetna Government |
$342.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$548.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$466.45
|
| Rate for Payer: Group Health Inc Commercial |
$342.98
|
| Rate for Payer: Group Health Inc Medicare |
$240.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.98
|
|
|
DX LARYNGOSCOPY DIAGNOSTIC
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
40019831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.05 |
| 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: 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 CHP/HARP/Medicaid |
$175.05
|
| 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 CHP/FHP/Medicaid |
$194.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Senior Whole Health 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
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
30300158
|
|
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 |
$1,962.76
|
| Rate for Payer: Aetna Government |
$1,962.76
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,962.76
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.05
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,166.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,962.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| 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: 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
|
|
|
DX LARYNGOSCOPY W/OPER SCOPE
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31526
|
| Hospital Charge Code |
40019941
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.39 |
| 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: 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 CHP/HARP/Medicaid |
$172.39
|
| 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 CHP/FHP/Medicaid |
$191.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,668.35
|
| Rate for Payer: Healthfirst QHP |
$1,962.76
|
| Rate for Payer: Senior Whole Health 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
|
|
|
DXTERITY CATHETER 5FR MODEL
|
Facility
OP
|
$162.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$170.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$93.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.62
|
| Rate for Payer: Group Health Inc Commercial |
$81.25
|
| Rate for Payer: Group Health Inc Medicare |
$56.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.62
|
|
|
DXTERITY CATHETER 5FR MODEL
|
Facility
IP
|
$162.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
|
|
DXTRSE IN 0.2 S.C.-1000CC
|
Facility
OP
|
$8.51
|
|
| Hospital Charge Code |
40192160
|
|
Hospital Revenue Code
|
710
|
| 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: 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
|
|
|
DXTRSE IN 0.2 S.C.-500CC
|
Facility
OP
|
$7.80
|
|
| Hospital Charge Code |
40192161
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.90
|
| Rate for Payer: Aetna Government |
$3.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.30
|
| Rate for Payer: Group Health Inc Commercial |
$3.90
|
| Rate for Payer: Group Health Inc Medicare |
$2.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.90
|
|
|
DYNAMIZATION/DISTRACTION TUBE
|
Facility
OP
|
$4,312.00
|
|
| Hospital Charge Code |
40200506
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,509.20 |
| Max. Negotiated Rate |
$3,449.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,371.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,156.00
|
| Rate for Payer: Aetna Government |
$2,156.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,449.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,932.16
|
| Rate for Payer: Group Health Inc Commercial |
$2,156.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,509.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,156.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,156.00
|
|
|
DYSEQUILIBRIUM
|
Facility
IP
|
$18,007.97
|
|
|
Service Code
|
MS-DRG 149
|
| Min. Negotiated Rate |
$6,385.80 |
| Max. Negotiated Rate |
$18,007.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,980.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,654.87
|
| Rate for Payer: Aetna Government |
$17,654.87
|
| Rate for Payer: Brighton Health Commercial |
$10,798.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,007.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,860.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,612.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,772.13
|
| Rate for Payer: EmblemHealth Commercial |
$6,385.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,654.87
|
| Rate for Payer: Group Health Inc Commercial |
$17,654.87
|
| Rate for Payer: Group Health Inc Medicare |
$17,654.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,654.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,209.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,654.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,654.87
|
| Rate for Payer: Wellcare Medicare |
$16,772.13
|
|
|
DYSPHAGIA THERAPY 16-30 MINUTES
|
Facility
OP
|
$252.88
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
41904840
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$13,928.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.81
|
| Rate for Payer: Aetna Government |
$73.81
|
| Rate for Payer: Amida Care Medicaid |
$139.28
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,928.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.24
|
| Rate for Payer: Group Health Inc Commercial |
$126.44
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Healthfirst Essential Plan |
$313.38
|
| Rate for Payer: Healthfirst QHP |
$139.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.28
|
| Rate for Payer: SOMOS Essential |
$313.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
DYSPHAGIA THERAPY 31-45 MINUTES
|
Facility
OP
|
$252.88
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
41904841
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$13,928.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.81
|
| Rate for Payer: Aetna Government |
$73.81
|
| Rate for Payer: Amida Care Medicaid |
$139.28
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,928.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.24
|
| Rate for Payer: Group Health Inc Commercial |
$126.44
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Healthfirst Essential Plan |
$313.38
|
| Rate for Payer: Healthfirst QHP |
$139.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.28
|
| Rate for Payer: SOMOS Essential |
$313.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
DYSPHAGIA THERAPY 8-15 MINUTES
|
Facility
OP
|
$252.88
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
41904839
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$13,928.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.81
|
| Rate for Payer: Aetna Government |
$73.81
|
| Rate for Payer: Amida Care Medicaid |
$139.28
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,928.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.24
|
| Rate for Payer: Group Health Inc Commercial |
$126.44
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Healthfirst Essential Plan |
$313.38
|
| Rate for Payer: Healthfirst QHP |
$139.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.28
|
| Rate for Payer: SOMOS Essential |
$313.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
E001-IGE CAT DANDER
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
