|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
IP
|
$34,132.97
|
|
|
Service Code
|
MS-DRG 902
|
| Min. Negotiated Rate |
$15,560.62 |
| Max. Negotiated Rate |
$34,132.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,789.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,463.70
|
| Rate for Payer: Aetna Government |
$33,463.70
|
| Rate for Payer: Brighton Health Commercial |
$27,328.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,132.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,546.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,859.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,790.52
|
| Rate for Payer: EmblemHealth Commercial |
$16,161.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,463.70
|
| Rate for Payer: Group Health Inc Commercial |
$33,463.70
|
| Rate for Payer: Group Health Inc Medicare |
$33,463.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,463.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,560.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,463.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,463.70
|
| Rate for Payer: Wellcare Medicare |
$31,790.52
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
IP
|
$74,736.78
|
|
|
Service Code
|
MS-DRG 901
|
| Min. Negotiated Rate |
$31,314.55 |
| Max. Negotiated Rate |
$74,736.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63,813.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67,343.12
|
| Rate for Payer: Aetna Government |
$67,343.12
|
| Rate for Payer: Brighton Health Commercial |
$62,753.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68,689.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74,736.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61,676.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$63,975.96
|
| Rate for Payer: EmblemHealth Commercial |
$37,110.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$67,343.12
|
| Rate for Payer: Group Health Inc Commercial |
$67,343.12
|
| Rate for Payer: Group Health Inc Medicare |
$67,343.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67,343.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31,314.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67,343.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67,343.12
|
| Rate for Payer: Wellcare Medicare |
$63,975.96
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$25,035.07
|
|
|
Service Code
|
MS-DRG 903
|
| Min. Negotiated Rate |
$10,645.90 |
| Max. Negotiated Rate |
$25,035.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,305.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,544.19
|
| Rate for Payer: Aetna Government |
$24,544.19
|
| Rate for Payer: Brighton Health Commercial |
$18,001.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,035.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,439.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,692.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,316.98
|
| Rate for Payer: EmblemHealth Commercial |
$10,645.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,544.19
|
| Rate for Payer: Group Health Inc Commercial |
$24,544.19
|
| Rate for Payer: Group Health Inc Medicare |
$24,544.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,544.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,413.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,544.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,544.19
|
| Rate for Payer: Wellcare Medicare |
$23,316.98
|
|
|
WOUND DEHISCENCE COMPLX CLOSR
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
40019517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$889.07 |
| 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 |
$889.07
|
| 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 |
$987.86
|
| 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
|
|
|
WOUND DEHISCENCE SIMPLE CLOSR
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
40019516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
WOUND EXPLORAT TRAUMA ABDOMEN
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
40099882
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.31 |
| 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 |
$291.31
|
| 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 |
$323.68
|
| 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
|
|
|
WOUND EXPLORAT TRAUMA CHEST
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
30102464
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| 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: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,108.87
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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 |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.12
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
WOUND EXPLORAT TRAUMA CHEST
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
40099883
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.12 |
| 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 |
$243.12
|
| 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 |
$270.13
|
| 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
|
|
|
WOUND EXPLORAT TRAUMA NECK
|
Facility
OP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 20100
|
| Hospital Charge Code |
40099884
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$509.02 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$636.27
|
| Rate for Payer: Aetna Government |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.27
|
| 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 |
$636.27
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$680.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.28
|
| Rate for Payer: Group Health Inc Commercial |
$636.27
|
| Rate for Payer: Group Health Inc Medicare |
$636.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$756.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.83
|
| Rate for Payer: Healthfirst QHP |
$636.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$509.02
|
| Rate for Payer: Wellcare Medicare |
$604.46
|
|
|
WOUND POUCH 4.3X3.0
|
Facility
OP
|
$7.33
|
|
| Hospital Charge Code |
40201951
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.66
|
| Rate for Payer: Aetna Government |
$3.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.98
|
| Rate for Payer: Group Health Inc Commercial |
$3.66
|
| Rate for Payer: Group Health Inc Medicare |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.66
|
|
|
WOUND POUCH 6.9X4.3
|
Facility
OP
|
$9.30
|
|
| Hospital Charge Code |
40201952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.65
|
| Rate for Payer: Aetna Government |
$4.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.32
|
| Rate for Payer: Group Health Inc Commercial |
$4.65
|
| Rate for Payer: Group Health Inc Medicare |
$3.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.65
|
|
|
WOUND POUCH HORIZONTAL 9.7X6.3
|
Facility
OP
|
$16.85
|
|
| Hospital Charge Code |
40201953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.42
|
| Rate for Payer: Aetna Government |
$8.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$8.42
|
| Rate for Payer: Group Health Inc Medicare |
$5.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.42
|
|
|
WOUND POUCH VERTICAL 9.7X6.3
|
Facility
OP
|
$16.85
|
|
| Hospital Charge Code |
40201954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$13.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.42
|
| Rate for Payer: Aetna Government |
$8.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$8.42
|
| Rate for Payer: Group Health Inc Medicare |
$5.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.42
|
|
|
WOUND PREP 1ST 100 SQ CM
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15002
|
| Hospital Charge Code |
40019929
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$244.61
|
| 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 |
$271.79
|
| 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
|
|
|
WOUND PREP 1ST 100 SQ CM - FACE
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15004
|
| Hospital Charge Code |
40019656
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$284.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
WOUND VACCUM CHG <=50CM
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
30107557
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.70 |
| 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 |
$24.70
|
| 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
|
|
|
WRAP 24 X 24 STERILE KIMGUARD
|
Facility
OP
|
$0.57
|
|
| Hospital Charge Code |
64903650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.39
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
|
|
WRAP 36 X 36 STERILE KIMGUARD
|
Facility
OP
|
$2.73
|
|
| Hospital Charge Code |
64903629
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.86
|
| Rate for Payer: Group Health Inc Commercial |
$1.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
|
|
WRAP 45 X 45 KIMGUARD KC600
|
Facility
OP
|
$4.30
|
|
| Hospital Charge Code |
64903451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.15
|
| Rate for Payer: Aetna Government |
$2.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.92
|
| Rate for Payer: Group Health Inc Commercial |
$2.15
|
| Rate for Payer: Group Health Inc Medicare |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.15
|
|
|
WRAP 54 X 54 KIMGUARD QUICK CK
|
Facility
OP
|
$5.57
|
|
| Hospital Charge Code |
64903447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.78
|
| Rate for Payer: Aetna Government |
$2.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.79
|
| Rate for Payer: Group Health Inc Commercial |
$2.78
|
| Rate for Payer: Group Health Inc Medicare |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.78
|
|
|
WRAP, LEG RAPR-ROUND ADLT
|
Facility
OP
|
$83.75
|
|
| Hospital Charge Code |
64903334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.88
|
| Rate for Payer: Aetna Government |
$41.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.95
|
| Rate for Payer: Group Health Inc Commercial |
$41.88
|
| Rate for Payer: Group Health Inc Medicare |
$29.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.88
|
|
|
WRAP STERILE 24X24
|
Facility
OP
|
$0.33
|
|
| Hospital Charge Code |
64901585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
|
|
WRAP STERILE 36X 36
|
Facility
OP
|
$0.92
|
|
| Hospital Charge Code |
64901587
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.46
|
| Rate for Payer: Aetna Government |
$0.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
|
|
WRAP STERILE 45X 45
|
Facility
OP
|
$0.80
|
|
| Hospital Charge Code |
64901583
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.40
|
| Rate for Payer: Aetna Government |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.54
|
| Rate for Payer: Group Health Inc Commercial |
$0.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.40
|
|
|
WRAP STRETCH ADVANTAGE
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
64903008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.50
|
| Rate for Payer: Aetna Government |
$17.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.80
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
