|
DURVALUMAB 120MG/2.4ML INJ
|
Facility
|
IP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41647857
|
|
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 120MG/2.4ML INJ
|
Facility
|
OP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41647857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.49 |
| 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: Affinity Essential Plan 1&2 |
$56.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$56.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$56.49
|
| Rate for Payer: Brighton Health Commercial |
$106.73
|
| 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 Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Humana Medicare |
$82.32
|
| 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: United Healthcare Commercial |
$78.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.71
|
| 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 120 MG/2.4ML IV SOLN [139352]
|
Facility
|
IP
|
$483.27
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
00310450012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.63 |
| Max. Negotiated Rate |
$241.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.63
|
|
|
DURVALUMAB 120 MG/2.4ML IV SOLN [139352]
|
Facility
|
OP
|
$483.27
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
00310450012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$314.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$265.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.71
|
| Rate for Payer: Aetna Government |
$80.71
|
| Rate for Payer: Brighton Health Commercial |
$289.96
|
| 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 |
$241.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$277.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.71
|
| Rate for Payer: EmblemHealth Commercial |
$241.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.71
|
| 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 |
$241.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Humana Medicare |
$82.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.56
|
|
|
DURVALUMAB 500MG/10ML INJ
|
Facility
|
OP
|
$177.88
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
41657856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.49 |
| 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: Affinity Essential Plan 1&2 |
$56.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$56.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$56.49
|
| Rate for Payer: Brighton Health Commercial |
$106.73
|
| 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 Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Humana Medicare |
$82.32
|
| 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: United Healthcare Commercial |
$78.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.71
|
| 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 |
$56.49 |
| 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: Affinity Essential Plan 1&2 |
$56.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$56.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$56.49
|
| Rate for Payer: Brighton Health Commercial |
$106.73
|
| 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 Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Humana Medicare |
$82.32
|
| 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: United Healthcare Commercial |
$78.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.71
|
| 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 500 MG/10ML IV SOLN [139353]
|
Facility
|
IP
|
$483.27
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
00310461150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.63 |
| Max. Negotiated Rate |
$241.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.63
|
|
|
DURVALUMAB 500 MG/10ML IV SOLN [139353]
|
Facility
|
OP
|
$483.27
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
00310461150
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$314.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$265.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.71
|
| Rate for Payer: Aetna Government |
$80.71
|
| Rate for Payer: Brighton Health Commercial |
$289.96
|
| 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 |
$241.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$277.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.71
|
| Rate for Payer: EmblemHealth Commercial |
$241.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.71
|
| 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 |
$241.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.60
|
| Rate for Payer: Healthfirst QHP |
$80.71
|
| Rate for Payer: Humana Medicare |
$82.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.56
|
|
|
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: Brighton Health Commercial |
$18.56
|
| 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 |
41103952
|
|
Hospital Revenue Code
|
361
|
| 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 |
$1,962.76
|
| 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 |
$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
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
|
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
40004089
|
|
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
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
40004089
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
DX BRONCHOSCOPE/BRUSH
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31623
|
| Hospital Charge Code |
41103952
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
DX BRONCHOSCOPE/WASH
|
Facility
|
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
40029413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,373.93 |
| Max. Negotiated Rate |
$3,249.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,962.76
|
| Rate for Payer: Aetna Government |
$1,962.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,373.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,373.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,373.93
|
| Rate for Payer: Brighton Health Commercial |
$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
|
|
|
DX BRONCHOSCOPE/WASH
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31622
|
| Hospital Charge Code |
40029413
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
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: Brighton Health Commercial |
$82.90
|
| 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: Brighton Health Commercial |
$514.46
|
| 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 |
$1,373.93 |
| Max. Negotiated Rate |
$3,249.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,962.76
|
| Rate for Payer: Aetna Government |
$1,962.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,373.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,373.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,373.93
|
| Rate for Payer: Brighton Health Commercial |
$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
|
|
|
DX LARYNGOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
40019831
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
DX LARYNGOSCOPY EXCL NB
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31525
|
| Hospital Charge Code |
30300158
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
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: 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 |
$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 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: 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 |
$569.00
|
| 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
|
|
|
DX LARYNGOSCOPY W/OPER SCOPE
|
Facility
|
IP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31526
|
| Hospital Charge Code |
40019941
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,962.76
|
|
|
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 |
$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
|
|
