|
SKIN SUBSTITUE, NOS
|
Facility
|
OP
|
$3,544.72
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
40203109
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$2,304.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,949.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.74
|
| Rate for Payer: Aetna Government |
$9.74
|
| Rate for Payer: Brighton Health Commercial |
$2,126.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,772.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,038.21
|
| Rate for Payer: Group Health Inc Commercial |
$1,772.36
|
| Rate for Payer: Group Health Inc Medicare |
$1,240.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,772.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,772.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,304.07
|
|
|
SKIN TAGS
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
42201355
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
SKIN TAGS
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
42201355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SKIN TISSUE PROCEDURE
|
Facility
|
OP
|
$552.75
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
30302049
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$185.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SKIN TISSUE PROCEDURE
|
Facility
|
IP
|
$552.75
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
30302049
|
|
Hospital Revenue Code
|
519
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
SKIN TISSUE REARRANGE 10CM OR LES
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14060
|
| Hospital Charge Code |
40014251
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKIN TISSUE REARRANGE 10CM OR LES
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14060
|
| Hospital Charge Code |
40014251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$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 TISSUE RE-ARRANGEMENT
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
40014205
|
|
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 TISSUE RE-ARRANGEMENT
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
40014205
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKIN TISSUE REARRANGEMENT TRUNK
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14000
|
| Hospital Charge Code |
40019655
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKIN TISSUE REARRANGEMENT TRUNK
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 14000
|
| Hospital Charge Code |
40019655
|
|
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 ULCERS WITH CC
|
Facility
|
IP
|
$24,588.11
|
|
|
Service Code
|
MSDRG 593
|
| Min. Negotiated Rate |
$10,374.90 |
| Max. Negotiated Rate |
$24,588.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,839.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,105.99
|
| Rate for Payer: Aetna Government |
$24,105.99
|
| Rate for Payer: Brighton Health Commercial |
$17,543.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,588.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,893.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,242.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,900.69
|
| Rate for Payer: EmblemHealth Commercial |
$10,374.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,105.99
|
| Rate for Payer: Group Health Inc Commercial |
$24,105.99
|
| Rate for Payer: Group Health Inc Medicare |
$24,105.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,105.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,209.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,105.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,105.99
|
| Rate for Payer: Wellcare Medicare |
$22,900.69
|
|
|
SKIN ULCERS WITH MCC
|
Facility
|
IP
|
$37,038.31
|
|
|
Service Code
|
MSDRG 592
|
| Min. Negotiated Rate |
$16,885.11 |
| Max. Negotiated Rate |
$37,038.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,818.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,312.07
|
| Rate for Payer: Aetna Government |
$36,312.07
|
| Rate for Payer: Brighton Health Commercial |
$30,306.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,038.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,093.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,786.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,496.47
|
| Rate for Payer: EmblemHealth Commercial |
$17,922.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,312.07
|
| Rate for Payer: Group Health Inc Commercial |
$36,312.07
|
| Rate for Payer: Group Health Inc Medicare |
$36,312.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,312.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,885.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,312.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,312.07
|
| Rate for Payer: Wellcare Medicare |
$34,496.47
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,611.94
|
|
|
Service Code
|
MSDRG 594
|
| Min. Negotiated Rate |
$6,751.96 |
| Max. Negotiated Rate |
$18,611.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,610.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,247.00
|
| Rate for Payer: Aetna Government |
$18,247.00
|
| Rate for Payer: Brighton Health Commercial |
$11,417.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,611.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,597.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,221.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,334.65
|
| Rate for Payer: EmblemHealth Commercial |
$6,751.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,247.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,247.00
|
| Rate for Payer: Group Health Inc Medicare |
$18,247.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,247.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,484.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,247.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,247.00
|
| Rate for Payer: Wellcare Medicare |
$17,334.65
|
|
|
SKN SUB GRFT F/N/HF/G CH ADD
|
Facility
|
OP
|
$261.10
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
42500212
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.46
|
| Rate for Payer: Aetna Government |
$50.46
|
| Rate for Payer: Brighton Health Commercial |
$195.82
|
| 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 |
$130.55
|
| Rate for Payer: Group Health Inc Medicare |
$91.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.55
|
|
|
SKN SUB GRFT F/N/HF/G CHILD
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
42500211
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SKN SUB GRFT F/N/HF/G CHILD
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
42500211
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$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
|
|
|
SKN SUB GRFT T/A/L CHILD ADD
|
Facility
|
OP
|
$261.11
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
42500208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.83 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.83
|
| Rate for Payer: Aetna Government |
$40.83
|
| Rate for Payer: Brighton Health Commercial |
$195.83
|
| 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 |
$130.56
|
| Rate for Payer: Group Health Inc Medicare |
$91.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.56
|
|
|
SKULL BOLT KIT MICRO CODMAN
|
Facility
|
OP
|
$2,110.00
|
|
| Hospital Charge Code |
64904948
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$738.50 |
| Max. Negotiated Rate |
$1,688.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,160.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,055.00
|
| Rate for Payer: Aetna Government |
$1,055.00
|
| Rate for Payer: Brighton Health Commercial |
$1,582.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,434.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,055.00
|
| Rate for Payer: Group Health Inc Medicare |
$738.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,055.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,055.00
|
|
|
SKULL &FACIAL BONE SURVEY FILM
|
Facility
|
OP
|
$147.42
|
|
|
Service Code
|
HCPCS D0290
|
| Hospital Charge Code |
42300706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.71
|
| Rate for Payer: Aetna Government |
$73.71
|
| Rate for Payer: Brighton Health Commercial |
$110.56
|
| 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 |
$73.71
|
| Rate for Payer: Group Health Inc Medicare |
$51.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.71
|
|
|
SKW DEEP SCOTAL RETRACT SYS
|
Facility
|
OP
|
$731.12
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40003446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.89 |
| Max. Negotiated Rate |
$3,775.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$438.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$365.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$420.39
|
| Rate for Payer: EmblemHealth Commercial |
$365.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$767.68
|
| Rate for Payer: Group Health Inc Commercial |
$365.56
|
| Rate for Payer: Group Health Inc Medicare |
$255.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$475.23
|
|
|
SKW DEEP SCOTAL RETRACT SYS
|
Facility
|
IP
|
$731.12
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40003446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.56 |
| Max. Negotiated Rate |
$365.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.56
|
|
|
SKYLER DRILL BIT 3.2
|
Facility
|
OP
|
$963.00
|
|
| Hospital Charge Code |
40203650
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.05 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$529.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$481.50
|
| Rate for Payer: Aetna Government |
$481.50
|
| Rate for Payer: Brighton Health Commercial |
$722.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$770.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$654.84
|
| Rate for Payer: Group Health Inc Commercial |
$481.50
|
| Rate for Payer: Group Health Inc Medicare |
$337.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.50
|
|
|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30305048
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SLCTV WND DEBRIDEM 20 CM OR <
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30305048
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$231.52
|
|
