|
WIRE LIGATURE
|
Facility
OP
|
$23.85
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64907428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$25.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.04
|
| Rate for Payer: Group Health Inc Commercial |
$11.92
|
| Rate for Payer: Group Health Inc Medicare |
$8.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.50
|
|
|
WIRE NITINOL PILOT
|
Facility
IP
|
$350.18
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.09 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.09
|
|
|
WIRE NITINOL PILOT
|
Facility
OP
|
$350.18
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$122.56 |
| Max. Negotiated Rate |
$367.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$175.09
|
| Rate for Payer: Aetna Government |
$175.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$175.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.69
|
| Rate for Payer: Group Health Inc Commercial |
$175.09
|
| Rate for Payer: Group Health Inc Medicare |
$122.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.62
|
|
|
WIRE NUT
|
Facility
OP
|
$252.50
|
|
| Hospital Charge Code |
64906017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.38 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.25
|
| Rate for Payer: Aetna Government |
$126.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$202.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.70
|
| Rate for Payer: Group Health Inc Commercial |
$126.25
|
| Rate for Payer: Group Health Inc Medicare |
$88.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.25
|
|
|
WIRE OLIVE 1.8
|
Facility
OP
|
$803.85
|
|
| Hospital Charge Code |
64905980
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.35 |
| Max. Negotiated Rate |
$643.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$442.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$401.92
|
| Rate for Payer: Aetna Government |
$401.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$643.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$546.62
|
| Rate for Payer: Group Health Inc Commercial |
$401.92
|
| Rate for Payer: Group Health Inc Medicare |
$281.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.92
|
|
|
WIRE, OLIVE THREAD 1.4MM
|
Facility
OP
|
$227.01
|
|
| Hospital Charge Code |
40004432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$181.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.50
|
| Rate for Payer: Aetna Government |
$113.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$181.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$154.37
|
| Rate for Payer: Group Health Inc Commercial |
$113.50
|
| Rate for Payer: Group Health Inc Medicare |
$79.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.50
|
|
|
WIRE RECON 11 3.2 X 400MM
|
Facility
OP
|
$265.00
|
|
| Hospital Charge Code |
64904486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$145.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$132.50
|
| Rate for Payer: Aetna Government |
$132.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$212.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.20
|
| Rate for Payer: Group Health Inc Commercial |
$132.50
|
| Rate for Payer: Group Health Inc Medicare |
$92.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.50
|
|
|
WIRE SENSOR.038 150CM FLEX ANG
|
Facility
OP
|
$149.50
|
|
| Hospital Charge Code |
64904882
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.75
|
| Rate for Payer: Aetna Government |
$74.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.66
|
| Rate for Payer: Group Health Inc Commercial |
$74.75
|
| Rate for Payer: Group Health Inc Medicare |
$52.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.75
|
|
|
WIRE SENSOR.038 150CM FLEX STR
|
Facility
OP
|
$109.47
|
|
| Hospital Charge Code |
64904884
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.31 |
| Max. Negotiated Rate |
$87.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.74
|
| Rate for Payer: Aetna Government |
$54.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.44
|
| Rate for Payer: Group Health Inc Commercial |
$54.74
|
| Rate for Payer: Group Health Inc Medicare |
$38.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.74
|
|
|
WIRE V-14 300CM
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$113.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.50
|
|
|
WIRE V-14 300CM
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$238.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$130.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.35
|
| Rate for Payer: Group Health Inc Commercial |
$113.50
|
| Rate for Payer: Group Health Inc Medicare |
$79.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.55
|
|
|
WIRE WITH OLIVE-DIA 2.0 X 45
|
Facility
OP
|
$300.00
|
|
| Hospital Charge Code |
64905259
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
|
WIRE X-RAY 31MM
|
Facility
OP
|
$1,314.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40209671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$722.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$657.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$755.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,379.70
|
| Rate for Payer: Group Health Inc Commercial |
$657.00
|
| Rate for Payer: Group Health Inc Medicare |
$459.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$854.10
|
|
|
WIRE X-RAY 31MM
|
Facility
IP
|
$1,314.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40209671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.00
|
|
|
WITCH HAZEL PAD
|
Facility
OP
|
$0.19
|
|
| Hospital Charge Code |
41651620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
WITCH HAZEL PAD
|
Facility
OP
|
$0.19
|
|
| Hospital Charge Code |
41641620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
WL GORE STENT VIABHN HPRN
|
Facility
OP
|
$9,027.68
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
64907054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$9,479.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,965.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,513.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,190.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,479.06
|
| Rate for Payer: Group Health Inc Commercial |
$4,513.84
|
| Rate for Payer: Group Health Inc Medicare |
$3,159.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,513.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,513.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,867.99
|
|
|
WL GORE STENT VIABHN HPRN
|
Facility
IP
|
$9,027.68
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
64907054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,513.84 |
| Max. Negotiated Rate |
$4,513.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,513.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,513.84
|
|
|
WORE, K NITONOL, RELINE MAS
|
Facility
OP
|
$385.00
|
|
| Hospital Charge Code |
64906132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.50
|
| Rate for Payer: Aetna Government |
$192.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$308.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$261.80
|
| Rate for Payer: Group Health Inc Commercial |
$192.50
|
| Rate for Payer: Group Health Inc Medicare |
$134.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
|
|
WOUND CARE > 20CM (SELECTIVE)
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
41809552
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.26
|
| Rate for Payer: Aetna Government |
$9.26
|
| 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 |
$26.61
|
| Rate for Payer: Group Health Inc Commercial |
$264.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.57
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
WOUND, CLEANING/DRESSING
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30105181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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 |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.15
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| 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
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
OP
|
$78.58
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
30101148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.96
|
| Rate for Payer: Aetna Government |
$63.96
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.79
|
| 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 |
$39.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$51,831.18
|
|
|
Service Code
|
MS-DRG 464
|
| Min. Negotiated Rate |
$22,761.47 |
| Max. Negotiated Rate |
$51,831.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,255.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48,949.40
|
| Rate for Payer: Aetna Government |
$48,949.40
|
| Rate for Payer: Brighton Health Commercial |
$43,520.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49,928.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51,831.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42,773.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$46,501.93
|
| Rate for Payer: EmblemHealth Commercial |
$25,737.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$48,949.40
|
| Rate for Payer: Group Health Inc Commercial |
$48,949.40
|
| Rate for Payer: Group Health Inc Medicare |
$48,949.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48,949.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,761.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48,949.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48,949.40
|
| Rate for Payer: Wellcare Medicare |
$46,501.93
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$97,806.44
|
|
|
Service Code
|
MS-DRG 463
|
| Min. Negotiated Rate |
$39,928.87 |
| Max. Negotiated Rate |
$97,806.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83,511.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85,868.53
|
| Rate for Payer: Aetna Government |
$85,868.53
|
| Rate for Payer: Brighton Health Commercial |
$82,123.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87,585.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97,806.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80,714.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$81,575.10
|
| Rate for Payer: EmblemHealth Commercial |
$48,566.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$85,868.53
|
| Rate for Payer: Group Health Inc Commercial |
$85,868.53
|
| Rate for Payer: Group Health Inc Medicare |
$85,868.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85,868.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39,928.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85,868.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85,868.53
|
| Rate for Payer: Wellcare Medicare |
$81,575.10
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$33,936.36
|
|
|
Service Code
|
MS-DRG 465
|
| Min. Negotiated Rate |
$15,470.99 |
| Max. Negotiated Rate |
$33,936.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,584.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,270.94
|
| Rate for Payer: Aetna Government |
$33,270.94
|
| Rate for Payer: Brighton Health Commercial |
$27,126.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,936.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,306.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,661.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,607.39
|
| Rate for Payer: EmblemHealth Commercial |
$16,042.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,270.94
|
| Rate for Payer: Group Health Inc Commercial |
$33,270.94
|
| Rate for Payer: Group Health Inc Medicare |
$33,270.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,270.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,470.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,270.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,270.94
|
| Rate for Payer: Wellcare Medicare |
$31,607.39
|
|
