|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
|
IP
|
$107,380.37
|
|
|
Service Code
|
MSDRG 573
|
| Min. Negotiated Rate |
$43,503.83 |
| Max. Negotiated Rate |
$107,380.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91,685.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93,556.62
|
| Rate for Payer: Aetna Government |
$93,556.62
|
| Rate for Payer: Brighton Health Commercial |
$90,162.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95,427.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107,380.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88,614.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$88,878.79
|
| Rate for Payer: EmblemHealth Commercial |
$53,320.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$93,556.62
|
| Rate for Payer: Group Health Inc Commercial |
$93,556.62
|
| Rate for Payer: Group Health Inc Medicare |
$93,556.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93,556.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,503.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93,556.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93,556.62
|
| Rate for Payer: Wellcare Medicare |
$88,878.79
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$36,414.52
|
|
|
Service Code
|
MSDRG 575
|
| Min. Negotiated Rate |
$16,600.74 |
| Max. Negotiated Rate |
$36,414.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,168.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35,700.51
|
| Rate for Payer: Aetna Government |
$35,700.51
|
| Rate for Payer: Brighton Health Commercial |
$29,667.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36,414.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35,332.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,157.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,915.48
|
| Rate for Payer: EmblemHealth Commercial |
$17,544.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$35,700.51
|
| Rate for Payer: Group Health Inc Commercial |
$35,700.51
|
| Rate for Payer: Group Health Inc Medicare |
$35,700.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35,700.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,600.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,700.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,700.51
|
| Rate for Payer: Wellcare Medicare |
$33,915.48
|
|
|
SKIN GRAFT - LEG
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15220
|
| Hospital Charge Code |
40062425
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKIN GRAFT - LEG
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15220
|
| Hospital Charge Code |
40062425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,686.16 |
| 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: 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 GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$33,803.40
|
|
|
Service Code
|
MSDRG 623
|
| Min. Negotiated Rate |
$15,410.37 |
| Max. Negotiated Rate |
$33,803.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,446.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,140.59
|
| Rate for Payer: Aetna Government |
$33,140.59
|
| Rate for Payer: Brighton Health Commercial |
$26,990.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,803.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,144.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,527.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,483.56
|
| Rate for Payer: EmblemHealth Commercial |
$15,961.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,140.59
|
| Rate for Payer: Group Health Inc Commercial |
$33,140.59
|
| Rate for Payer: Group Health Inc Medicare |
$33,140.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,140.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,410.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,140.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,140.59
|
| Rate for Payer: Wellcare Medicare |
$31,483.56
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$66,064.29
|
|
|
Service Code
|
MSDRG 622
|
| Min. Negotiated Rate |
$28,076.19 |
| Max. Negotiated Rate |
$66,064.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56,408.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60,378.91
|
| Rate for Payer: Aetna Government |
$60,378.91
|
| Rate for Payer: Brighton Health Commercial |
$55,471.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61,586.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66,064.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54,519.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$57,359.96
|
| Rate for Payer: EmblemHealth Commercial |
$32,804.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$60,378.91
|
| Rate for Payer: Group Health Inc Commercial |
$60,378.91
|
| Rate for Payer: Group Health Inc Medicare |
$60,378.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60,378.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,076.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60,378.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60,378.91
|
| Rate for Payer: Wellcare Medicare |
$57,359.96
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,238.70
|
|
|
Service Code
|
MSDRG 624
|
| Min. Negotiated Rate |
$9,556.84 |
| Max. Negotiated Rate |
$23,238.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,433.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,783.04
|
| Rate for Payer: Aetna Government |
$22,783.04
|
| Rate for Payer: Brighton Health Commercial |
$16,160.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,238.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,246.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,882.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,643.89
|
| Rate for Payer: EmblemHealth Commercial |
$9,556.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,783.04
|
| Rate for Payer: Group Health Inc Commercial |
$22,783.04
|
| Rate for Payer: Group Health Inc Medicare |
$22,783.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,783.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,594.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,783.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,783.04
|
| Rate for Payer: Wellcare Medicare |
$21,643.89
|
|
|
SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$56,231.32
|
|
|
Service Code
|
MSDRG 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
|
MSDRG 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 |
$9,568.50 |
| 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: Brighton Health Commercial |
$9,568.50
|
| 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 |
$1,505.00 |
| Max. Negotiated Rate |
$3,686.16 |
| 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: 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 - SPLIT THICKNESS
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
40062430
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
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: Brighton Health Commercial |
$9.04
|
| 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: Brighton Health Commercial |
$0.79
|
| 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
|
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: Brighton Health Commercial |
$3,711.00
|
| 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: EmblemHealth Commercial |
$3,092.50
|
| 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 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 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 |
$1,687.10 |
| Max. Negotiated Rate |
$3,686.16 |
| 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: 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 |
$2,108.87
|
| 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 SUB GRAFT FACE/NK/HF/G
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
42500209
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
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 |
$29.34 |
| 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: Brighton Health Commercial |
$90.19
|
| 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 |
$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
|
|
|
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: Brighton Health Commercial |
$90.19
|
| 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 |
$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
|
|
|
SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
42500205
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
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 |
$1,687.10 |
| Max. Negotiated Rate |
$3,686.16 |
| 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: 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 |
$2,108.87
|
| 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 SUB GRFT T/ARM/LG CHILD
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
42500207
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
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 |
$1,888.00 |
| Max. Negotiated Rate |
$6,763.11 |
| 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: Brighton Health Commercial |
$6,763.11
|
| 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 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 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
|
|
