|
SIZER STY 410MM MSZMM450
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
40005946
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
| Rate for Payer: Aetna Government |
$250.00
|
| Rate for Payer: Brighton Health Commercial |
$375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
SIZER,STY 410MM RE-STER 450CC
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
64906116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$551.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.32
|
| Rate for Payer: Aetna Government |
$402.32
|
| Rate for Payer: Brighton Health Commercial |
$315.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$262.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.88
|
| Rate for Payer: EmblemHealth Commercial |
$262.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$551.25
|
| Rate for Payer: Group Health Inc Commercial |
$262.50
|
| Rate for Payer: Group Health Inc Medicare |
$183.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$341.25
|
|
|
SIZER,STY 410MM RE-STER 450CC
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
64906116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.50
|
|
|
SJOGREN'S AB, ANTI-SS-A/-SS-B
|
Facility
|
IP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729335
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.93
|
|
|
SJOGREN'S AB, ANTI-SS-A/-SS-B
|
Facility
|
OP
|
$44.83
|
|
|
Service Code
|
HCPCS 86235
|
| Hospital Charge Code |
40729335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$33.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.93
|
| Rate for Payer: Aetna Government |
$17.93
|
| Rate for Payer: Brighton Health Commercial |
$33.62
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.93
|
| Rate for Payer: EmblemHealth Commercial |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Group Health Inc Commercial |
$17.93
|
| Rate for Payer: Group Health Inc Medicare |
$17.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.93
|
| Rate for Payer: Healthfirst QHP |
$17.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.14
|
|
|
SKID PORTAL
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$118.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.25
|
| Rate for Payer: Aetna Government |
$56.25
|
| Rate for Payer: Brighton Health Commercial |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.69
|
| Rate for Payer: EmblemHealth Commercial |
$56.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.12
|
| Rate for Payer: Group Health Inc Commercial |
$56.25
|
| Rate for Payer: Group Health Inc Medicare |
$39.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.12
|
|
|
SKID PORTAL
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907434
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
|
|
SKIN CLIP SET
|
Facility
|
OP
|
$25.52
|
|
| Hospital Charge Code |
40205720
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Brighton Health Commercial |
$19.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.35
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
|
|
SKIN DEBRIDEMENT WITH CC
|
Facility
|
IP
|
$31,405.87
|
|
|
Service Code
|
MSDRG 571
|
| Min. Negotiated Rate |
$14,317.38 |
| Max. Negotiated Rate |
$31,405.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,947.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,790.07
|
| Rate for Payer: Aetna Government |
$30,790.07
|
| Rate for Payer: Brighton Health Commercial |
$24,532.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,405.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,217.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,111.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,250.57
|
| Rate for Payer: EmblemHealth Commercial |
$14,508.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,790.07
|
| Rate for Payer: Group Health Inc Commercial |
$30,790.07
|
| Rate for Payer: Group Health Inc Medicare |
$30,790.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,790.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,317.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,790.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,790.07
|
| Rate for Payer: Wellcare Medicare |
$29,250.57
|
|
|
SKIN DEBRIDEMENT WITH MCC
|
Facility
|
IP
|
$50,463.47
|
|
|
Service Code
|
MSDRG 570
|
| Min. Negotiated Rate |
$22,250.77 |
| Max. Negotiated Rate |
$50,463.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43,087.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47,851.11
|
| Rate for Payer: Aetna Government |
$47,851.11
|
| Rate for Payer: Brighton Health Commercial |
$42,371.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48,808.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50,463.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41,644.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$45,458.55
|
| Rate for Payer: EmblemHealth Commercial |
$25,057.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$47,851.11
|
| Rate for Payer: Group Health Inc Commercial |
$47,851.11
|
| Rate for Payer: Group Health Inc Medicare |
$47,851.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47,851.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,250.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47,851.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47,851.11
|
| Rate for Payer: Wellcare Medicare |
$45,458.55
|
|
|
SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$23,593.72
|
|
|
Service Code
|
MSDRG 572
|
| Min. Negotiated Rate |
$9,772.07 |
| Max. Negotiated Rate |
$23,593.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,803.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,131.10
|
| Rate for Payer: Aetna Government |
$23,131.10
|
| Rate for Payer: Brighton Health Commercial |
$16,524.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,593.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,679.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,240.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,974.54
|
| Rate for Payer: EmblemHealth Commercial |
$9,772.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,131.10
|
| Rate for Payer: Group Health Inc Commercial |
$23,131.10
|
| Rate for Payer: Group Health Inc Medicare |
$23,131.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,131.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,755.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,131.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,131.10
|
| Rate for Payer: Wellcare Medicare |
$21,974.54
|
|
|
SKIN EMOLLIENT (AQUAPHOR) OINT 100 GRAMS
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41651585
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
SKIN EMOLLIENT (AQUAPHOR) OINT 100 GRAMS
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41641585
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
SKIN EMOLLIENT (AQUAPHOR) OINT 50 GRAMS
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41650027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
SKIN EMOLLIENT (AQUAPHOR) OINT 50 GRAMS
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41640027
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
SKIN FULL GRAFT TRUNK 20SQ CM OR<
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15200
|
| Hospital Charge Code |
40014342
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKIN FULL GRAFT TRUNK 20SQ CM OR<
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15200
|
| Hospital Charge Code |
40014342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,686.16 |
| 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 |
$3,686.16
|
| 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 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 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 FUNGI CULTURE
|
Facility
|
OP
|
$19.28
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
40614317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.71
|
| Rate for Payer: Aetna Government |
$7.71
|
| Rate for Payer: Brighton Health Commercial |
$14.46
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.71
|
| Rate for Payer: EmblemHealth Commercial |
$7.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.86
|
| Rate for Payer: Group Health Inc Commercial |
$7.71
|
| Rate for Payer: Group Health Inc Medicare |
$7.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.71
|
| Rate for Payer: Healthfirst QHP |
$7.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.17
|
| Rate for Payer: Wellcare Medicare |
$6.94
|
|
|
SKIN FUNGI CULTURE
|
Facility
|
IP
|
$19.28
|
|
|
Service Code
|
HCPCS 87101
|
| Hospital Charge Code |
40614317
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$7.71
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$45,747.31
|
|
|
Service Code
|
MSDRG 577
|
| Min. Negotiated Rate |
$20,489.73 |
| Max. Negotiated Rate |
$45,747.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39,060.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44,063.93
|
| Rate for Payer: Aetna Government |
$44,063.93
|
| Rate for Payer: Brighton Health Commercial |
$38,411.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44,945.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45,747.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37,752.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$41,860.73
|
| Rate for Payer: EmblemHealth Commercial |
$22,716.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$44,063.93
|
| Rate for Payer: Group Health Inc Commercial |
$44,063.93
|
| Rate for Payer: Group Health Inc Medicare |
$44,063.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44,063.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,489.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44,063.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44,063.93
|
| Rate for Payer: Wellcare Medicare |
$41,860.73
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$98,141.45
|
|
|
Service Code
|
MSDRG 576
|
| Min. Negotiated Rate |
$40,053.97 |
| Max. Negotiated Rate |
$98,141.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83,797.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86,137.57
|
| Rate for Payer: Aetna Government |
$86,137.57
|
| Rate for Payer: Brighton Health Commercial |
$82,404.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87,860.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98,141.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80,990.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81,830.69
|
| Rate for Payer: EmblemHealth Commercial |
$48,732.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$86,137.57
|
| Rate for Payer: Group Health Inc Commercial |
$86,137.57
|
| Rate for Payer: Group Health Inc Medicare |
$86,137.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86,137.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40,053.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86,137.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86,137.57
|
| Rate for Payer: Wellcare Medicare |
$81,830.69
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$30,254.50
|
|
|
Service Code
|
MSDRG 578
|
| Min. Negotiated Rate |
$13,792.49 |
| Max. Negotiated Rate |
$30,254.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,746.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,661.27
|
| Rate for Payer: Aetna Government |
$29,661.27
|
| Rate for Payer: Brighton Health Commercial |
$23,352.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,254.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,811.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,951.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,178.21
|
| Rate for Payer: EmblemHealth Commercial |
$13,810.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,661.27
|
| Rate for Payer: Group Health Inc Commercial |
$29,661.27
|
| Rate for Payer: Group Health Inc Medicare |
$29,661.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,661.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,792.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,661.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,661.27
|
| Rate for Payer: Wellcare Medicare |
$28,178.21
|
|
|
SKIN GRAFT FOREHEAD,CHEEKS,CHIN,N
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15620
|
| Hospital Charge Code |
40014343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,686.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Brighton Health Commercial |
$3,686.16
|
| 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 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 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 GRAFT FOREHEAD,CHEEKS,CHIN,N
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15620
|
| Hospital Charge Code |
40014343
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
|
IP
|
$58,814.76
|
|
|
Service Code
|
MSDRG 574
|
| Min. Negotiated Rate |
$25,369.18 |
| Max. Negotiated Rate |
$58,814.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50,218.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54,557.38
|
| Rate for Payer: Aetna Government |
$54,557.38
|
| Rate for Payer: Brighton Health Commercial |
$49,384.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55,648.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58,814.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48,536.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$51,829.51
|
| Rate for Payer: EmblemHealth Commercial |
$29,204.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$54,557.38
|
| Rate for Payer: Group Health Inc Commercial |
$54,557.38
|
| Rate for Payer: Group Health Inc Medicare |
$54,557.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54,557.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25,369.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54,557.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54,557.38
|
| Rate for Payer: Wellcare Medicare |
$51,829.51
|
|
