|
SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
IP
|
$56,231.32
|
|
|
Service Code
|
MS-DRG 904
|
| Min. Negotiated Rate |
$24,404.52 |
| Max. Negotiated Rate |
$56,231.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48,012.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52,482.84
|
| Rate for Payer: Aetna Government |
$52,482.84
|
| Rate for Payer: Brighton Health Commercial |
$47,214.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53,532.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56,231.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46,404.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$49,858.70
|
| Rate for Payer: EmblemHealth Commercial |
$27,921.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$52,482.84
|
| Rate for Payer: Group Health Inc Commercial |
$52,482.84
|
| Rate for Payer: Group Health Inc Medicare |
$52,482.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52,482.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24,404.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52,482.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52,482.84
|
| Rate for Payer: Wellcare Medicare |
$49,858.70
|
|
|
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$29,875.39
|
|
|
Service Code
|
MS-DRG 905
|
| Min. Negotiated Rate |
$13,580.20 |
| Max. Negotiated Rate |
$29,875.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,351.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,289.60
|
| Rate for Payer: Aetna Government |
$29,289.60
|
| Rate for Payer: Brighton Health Commercial |
$22,963.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,875.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,348.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,569.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,825.12
|
| Rate for Payer: EmblemHealth Commercial |
$13,580.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,289.60
|
| Rate for Payer: Group Health Inc Commercial |
$29,289.60
|
| Rate for Payer: Group Health Inc Medicare |
$29,289.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,289.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,619.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,289.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,289.60
|
| Rate for Payer: Wellcare Medicare |
$27,825.12
|
|
|
SKIN GRAFTS (IDENTIFY DEFECT, LOC
|
Facility
OP
|
$12,758.00
|
|
|
Service Code
|
HCPCS D7920
|
| Hospital Charge Code |
42302055
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.59 |
| Max. Negotiated Rate |
$7,016.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,016.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$886.59
|
| Rate for Payer: Aetna Government |
$886.59
|
| 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 |
$6,379.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,465.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,379.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,379.00
|
|
|
SKIN GRAFT - SPLIT THICKNESS
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
40062430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$806.64 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$806.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$896.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SKIN PREP
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40200060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
SKINPREP NOSTING, BARRIER
|
Facility
OP
|
$1.05
|
|
| Hospital Charge Code |
40201970
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
|
|
SKIN PRIMX MESHED 6X6
|
Facility
IP
|
$6,185.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64905958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,092.50 |
| Max. Negotiated Rate |
$3,092.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,092.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,092.50
|
|
|
SKIN PRIMX MESHED 6X6
|
Facility
OP
|
$6,185.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64905958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$6,494.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,401.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,556.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,494.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,092.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,164.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,092.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,092.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,020.25
|
|
|
SKIN SUB GRAFT FACE/NK/HF/G
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
42500209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$2,108.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SKIN SUB GRAFT F/N/HF/G ADDL
|
Facility
OP
|
$120.25
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
42500210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.34
|
| Rate for Payer: Aetna Government |
$29.34
|
| 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 |
$27.32
|
| Rate for Payer: Group Health Inc Commercial |
$60.12
|
| Rate for Payer: Group Health Inc Medicare |
$42.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.35
|
|
|
SKIN SUB GRAFT T/A/L ADD-ON
|
Facility
OP
|
$120.25
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
42500206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.04
|
| Rate for Payer: Aetna Government |
$15.04
|
| 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 |
$17.87
|
| Rate for Payer: Group Health Inc Commercial |
$60.12
|
| Rate for Payer: Group Health Inc Medicare |
$42.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.86
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
42500205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.51 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$2,108.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SKIN SUB GRFT T/ARM/LG CHILD
|
Facility
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
42500207
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.45 |
| Max. Negotiated Rate |
$4,508.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$4,148.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SKIN SUBSTITUE, NOS
|
Facility
IP
|
$3,544.72
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
40203109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,772.36 |
| Max. Negotiated Rate |
$1,772.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,772.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,772.36
|
|
|
SKIN SUBSTITUE, NOS
|
Facility
OP
|
$3,544.72
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
40203109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$2,304.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,949.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.74
|
| Rate for Payer: Aetna Government |
$9.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,772.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,038.21
|
| Rate for Payer: Group Health Inc Commercial |
$1,772.36
|
| Rate for Payer: Group Health Inc Medicare |
$1,240.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,772.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,772.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,304.07
|
|
|
SKIN TAGS
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
42201355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SKIN TISSUE PROCEDURE
|
Facility
OP
|
$552.75
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
30302049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$185.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SKIN TISSUE REARRANGE 10CM OR LES
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14060
|
| Hospital Charge Code |
40014251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.28 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$724.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$804.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SKIN TISSUE RE-ARRANGEMENT
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
40014205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.14 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$681.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$756.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SKIN TISSUE REARRANGEMENT TRUNK
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14000
|
| Hospital Charge Code |
40019655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$561.63 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$624.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SKIN ULCERS WITH CC
|
Facility
IP
|
$24,588.11
|
|
|
Service Code
|
MS-DRG 593
|
| Min. Negotiated Rate |
$10,374.90 |
| Max. Negotiated Rate |
$24,588.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,839.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,105.99
|
| Rate for Payer: Aetna Government |
$24,105.99
|
| Rate for Payer: Brighton Health Commercial |
$17,543.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,588.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,893.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,242.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,900.69
|
| Rate for Payer: EmblemHealth Commercial |
$10,374.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,105.99
|
| Rate for Payer: Group Health Inc Commercial |
$24,105.99
|
| Rate for Payer: Group Health Inc Medicare |
$24,105.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,105.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,209.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,105.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,105.99
|
| Rate for Payer: Wellcare Medicare |
$22,900.69
|
|
|
SKIN ULCERS WITH MCC
|
Facility
IP
|
$37,038.31
|
|
|
Service Code
|
MS-DRG 592
|
| Min. Negotiated Rate |
$16,885.11 |
| Max. Negotiated Rate |
$37,038.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,818.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,312.07
|
| Rate for Payer: Aetna Government |
$36,312.07
|
| Rate for Payer: Brighton Health Commercial |
$30,306.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,038.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,093.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,786.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,496.47
|
| Rate for Payer: EmblemHealth Commercial |
$17,922.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,312.07
|
| Rate for Payer: Group Health Inc Commercial |
$36,312.07
|
| Rate for Payer: Group Health Inc Medicare |
$36,312.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,312.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,885.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,312.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,312.07
|
| Rate for Payer: Wellcare Medicare |
$34,496.47
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
IP
|
$18,611.94
|
|
|
Service Code
|
MS-DRG 594
|
| Min. Negotiated Rate |
$6,751.96 |
| Max. Negotiated Rate |
$18,611.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,610.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,247.00
|
| Rate for Payer: Aetna Government |
$18,247.00
|
| Rate for Payer: Brighton Health Commercial |
$11,417.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,611.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,597.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,221.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,334.65
|
| Rate for Payer: EmblemHealth Commercial |
$6,751.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,247.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,247.00
|
| Rate for Payer: Group Health Inc Medicare |
$18,247.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,247.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,484.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,247.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,247.00
|
| Rate for Payer: Wellcare Medicare |
$17,334.65
|
|
|
SKN SUB GRFT F/N/HF/G CH ADD
|
Facility
OP
|
$261.10
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
42500212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.46
|
| Rate for Payer: Aetna Government |
$50.46
|
| 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 |
$62.58
|
| Rate for Payer: Group Health Inc Commercial |
$130.55
|
| Rate for Payer: Group Health Inc Medicare |
$91.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.53
|
|
|
SKN SUB GRFT F/N/HF/G CHILD
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
42500211
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.83 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$2,108.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$278.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
