|
SPIRONOLACTONE 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
SPIRONOLACTONE 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
SPIRONOLACTONE 5 MG/ML PO SUSP - COMPOUNDED [701384]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 09999701384
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
SP IVC FILTER RETREVIAL
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
41542900
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
SP IVC FILTER RETREVIAL
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37193
|
| Hospital Charge Code |
41542900
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP IVUS NONCORONARY 1ST
|
Facility
|
OP
|
$2,536.83
|
|
|
Service Code
|
HCPCS 37252 TC
|
| Hospital Charge Code |
41561847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.89 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,516.34
|
| Rate for Payer: Aetna Government |
$1,516.34
|
| Rate for Payer: Brighton Health Commercial |
$1,902.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$1,268.42
|
| Rate for Payer: Group Health Inc Medicare |
$887.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,268.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,268.42
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP KNEE ARTHROGRAM
|
Facility
|
OP
|
$464.83
|
|
|
Service Code
|
HCPCS 27369 TC
|
| Hospital Charge Code |
41547467
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$145.96
|
| Rate for Payer: Aetna Government |
$145.96
|
| Rate for Payer: Brighton Health Commercial |
$348.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$232.42
|
| Rate for Payer: Group Health Inc Medicare |
$162.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.42
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP KYPHOPLASTY ADD'L
|
Facility
|
OP
|
$13,964.12
|
|
|
Service Code
|
HCPCS 22515 TC
|
| Hospital Charge Code |
41543161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$1,628,818.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,518.40
|
| Rate for Payer: Aetna Government |
$4,518.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$36,648.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$36,648.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16,288.18
|
| Rate for Payer: Amida Care Medicaid |
$16,288.18
|
| Rate for Payer: Brighton Health Commercial |
$10,473.09
|
| 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: Fidelis CHP/HARP/Medicaid |
$1,628,818.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16,288.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16,288.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17,102.59
|
| Rate for Payer: Group Health Inc Commercial |
$6,982.06
|
| Rate for Payer: Group Health Inc Medicare |
$4,887.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16,288.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,982.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16,288.18
|
| Rate for Payer: Healthfirst Essential Plan |
$36,648.40
|
| Rate for Payer: Healthfirst QHP |
$16,288.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16,288.18
|
| Rate for Payer: SOMOS Essential |
$36,648.40
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$36,648.40
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17,917.00
|
| Rate for Payer: United Healthcare Medicaid |
$16,288.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,288.18
|
|
|
SP KYPHOPLASTY LUMBAR
|
Facility
|
IP
|
$18,618.83
|
|
|
Service Code
|
HCPCS 22514 TC
|
| Hospital Charge Code |
41543160
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
SP KYPHOPLASTY LUMBAR
|
Facility
|
OP
|
$18,618.83
|
|
|
Service Code
|
HCPCS 22514 TC
|
| Hospital Charge Code |
41543160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$13,964.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,964.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$8,273.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,309.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
SP KYPHOPLASTY THORACIC
|
Facility
|
IP
|
$18,618.83
|
|
|
Service Code
|
HCPCS 22513 TC
|
| Hospital Charge Code |
41543162
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
SP KYPHOPLASTY THORACIC
|
Facility
|
OP
|
$18,618.83
|
|
|
Service Code
|
HCPCS 22513 TC
|
| Hospital Charge Code |
41543162
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$13,964.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,964.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$8,273.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,309.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
SP LATERAL VE ARTERIAL
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Hospital Charge Code |
41201168
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
SP LATERAL VE ARTERIAL
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Hospital Charge Code |
41201168
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
SPLENECTOMY
|
Facility
|
OP
|
$2,783.55
|
|
|
Service Code
|
HCPCS 38100
|
| Hospital Charge Code |
40011100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$974.24 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,530.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,217.08
|
| Rate for Payer: Aetna Government |
$1,217.08
|
| Rate for Payer: Brighton Health Commercial |
$2,087.66
|
| 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 |
$1,391.78
|
| Rate for Payer: Group Health Inc Medicare |
$974.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,391.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,391.78
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
|
IP
|
$63,802.70
|
|
|
Service Code
|
MSDRG 800
|
| Min. Negotiated Rate |
$21,576.91 |
| Max. Negotiated Rate |
$63,802.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41,546.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46,401.96
|
| Rate for Payer: Aetna Government |
$46,401.96
|
| Rate for Payer: Brighton Health Commercial |
$40,856.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47,330.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48,658.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40,155.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$44,081.86
|
| Rate for Payer: EmblemHealth Commercial |
$24,161.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$46,401.96
|
| Rate for Payer: Group Health Inc Commercial |
$46,401.96
|
| Rate for Payer: Group Health Inc Medicare |
$46,401.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46,401.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,576.91
|
| Rate for Payer: Humana Medicare |
$63,802.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46,401.96
|
| Rate for Payer: United Healthcare Commercial |
$56,035.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,401.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46,401.96
|
| Rate for Payer: Wellcare Medicare |
$44,081.86
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$104,548.39
|
|
|
Service Code
|
MSDRG 799
|
| Min. Negotiated Rate |
$35,356.36 |
| Max. Negotiated Rate |
$104,548.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73,055.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76,035.19
|
| Rate for Payer: Aetna Government |
$76,035.19
|
| Rate for Payer: Brighton Health Commercial |
$71,841.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77,555.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85,560.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70,608.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$72,233.43
|
| Rate for Payer: EmblemHealth Commercial |
$42,485.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$76,035.19
|
| Rate for Payer: Group Health Inc Commercial |
$76,035.19
|
| Rate for Payer: Group Health Inc Medicare |
$76,035.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76,035.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35,356.36
|
| Rate for Payer: Humana Medicare |
$104,548.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76,035.19
|
| Rate for Payer: United Healthcare Commercial |
$98,532.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76,035.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76,035.19
|
| Rate for Payer: Wellcare Medicare |
$72,233.43
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,201.15
|
|
|
Service Code
|
MSDRG 801
|
| Min. Negotiated Rate |
$14,948.02 |
| Max. Negotiated Rate |
$44,201.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,389.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,146.29
|
| Rate for Payer: Aetna Government |
$32,146.29
|
| Rate for Payer: Brighton Health Commercial |
$25,950.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,789.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,906.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,505.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,538.98
|
| Rate for Payer: EmblemHealth Commercial |
$15,346.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,146.29
|
| Rate for Payer: Group Health Inc Commercial |
$32,146.29
|
| Rate for Payer: Group Health Inc Medicare |
$32,146.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,146.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,948.02
|
| Rate for Payer: Humana Medicare |
$44,201.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,146.29
|
| Rate for Payer: United Healthcare Commercial |
$35,591.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,146.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,146.29
|
| Rate for Payer: Wellcare Medicare |
$30,538.98
|
|
|
SPLENORRAPHY
|
Facility
|
OP
|
$2,586.65
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
40019520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$905.33 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,422.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,330.09
|
| Rate for Payer: Aetna Government |
$1,330.09
|
| Rate for Payer: Brighton Health Commercial |
$1,939.99
|
| 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 |
$1,293.32
|
| Rate for Payer: Group Health Inc Medicare |
$905.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,293.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,293.32
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP LIMITED LE ARTERIAL
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93926 TC
|
| Hospital Charge Code |
41201167
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
SP LIMITED LE ARTERIAL
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93926 TC
|
| Hospital Charge Code |
41201167
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
SP LIMITED LE VENOUS
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
41201171
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
SP LIMITED LE VENOUS
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
41201171
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
SP LIMITED PENILE
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93981 TC
|
| Hospital Charge Code |
41201177
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
SP LIMITED PENILE
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93981 TC
|
| Hospital Charge Code |
41201177
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
