|
WIRE X-RAY 31MM
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40209671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.00 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.00
|
|
|
WITCH HAZEL-GLYCERIN EX PADS [11678]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 50289325001
|
| Hospital Charge Code |
50289325001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
WITCH HAZEL PAD
|
Facility
|
OP
|
$0.19
|
|
| Hospital Charge Code |
41651620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
WITCH HAZEL PAD
|
Facility
|
OP
|
$0.19
|
|
| Hospital Charge Code |
41641620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
WL GORE STENT VIABHN HPRN
|
Facility
|
OP
|
$9,027.68
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
64907054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$9,479.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,965.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Brighton Health Commercial |
$5,416.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,513.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,190.92
|
| Rate for Payer: EmblemHealth Commercial |
$4,513.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,479.06
|
| Rate for Payer: Group Health Inc Commercial |
$4,513.84
|
| Rate for Payer: Group Health Inc Medicare |
$3,159.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,513.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,513.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,867.99
|
|
|
WL GORE STENT VIABHN HPRN
|
Facility
|
IP
|
$9,027.68
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
64907054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,513.84 |
| Max. Negotiated Rate |
$4,513.84 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,513.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,513.84
|
|
|
WORE, K NITONOL, RELINE MAS
|
Facility
|
OP
|
$385.00
|
|
| Hospital Charge Code |
64906132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.50
|
| Rate for Payer: Aetna Government |
$192.50
|
| Rate for Payer: Brighton Health Commercial |
$288.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$308.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$261.80
|
| Rate for Payer: Group Health Inc Commercial |
$192.50
|
| Rate for Payer: Group Health Inc Medicare |
$134.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
|
|
WOUND CARE > 20CM (SELECTIVE)
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
41809552
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.26
|
| Rate for Payer: Aetna Government |
$9.26
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$264.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.62
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
WOUND, CLEANING/DRESSING
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30105181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| 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 Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
WOUND, CLEANING/DRESSING
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
30105181
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$78.58
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
30101148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.96
|
| Rate for Payer: Aetna Government |
$63.96
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$51,831.18
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$22,761.47 |
| Max. Negotiated Rate |
$51,831.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,255.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48,949.40
|
| Rate for Payer: Aetna Government |
$48,949.40
|
| Rate for Payer: Brighton Health Commercial |
$43,520.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49,928.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51,831.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42,773.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$46,501.93
|
| Rate for Payer: EmblemHealth Commercial |
$25,737.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$48,949.40
|
| Rate for Payer: Group Health Inc Commercial |
$48,949.40
|
| Rate for Payer: Group Health Inc Medicare |
$48,949.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48,949.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,761.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48,949.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48,949.40
|
| Rate for Payer: Wellcare Medicare |
$46,501.93
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$97,806.44
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$39,928.87 |
| Max. Negotiated Rate |
$97,806.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83,511.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85,868.53
|
| Rate for Payer: Aetna Government |
$85,868.53
|
| Rate for Payer: Brighton Health Commercial |
$82,123.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87,585.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97,806.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80,714.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$81,575.10
|
| Rate for Payer: EmblemHealth Commercial |
$48,566.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$85,868.53
|
| Rate for Payer: Group Health Inc Commercial |
$85,868.53
|
| Rate for Payer: Group Health Inc Medicare |
$85,868.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85,868.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39,928.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85,868.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85,868.53
|
| Rate for Payer: Wellcare Medicare |
$81,575.10
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$33,936.36
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$15,470.99 |
| Max. Negotiated Rate |
$33,936.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,584.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,270.94
|
| Rate for Payer: Aetna Government |
$33,270.94
|
| Rate for Payer: Brighton Health Commercial |
$27,126.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,936.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,306.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,661.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,607.39
|
| Rate for Payer: EmblemHealth Commercial |
$16,042.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,270.94
|
| Rate for Payer: Group Health Inc Commercial |
$33,270.94
|
| Rate for Payer: Group Health Inc Medicare |
$33,270.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,270.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,470.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,270.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,270.94
|
| Rate for Payer: Wellcare Medicare |
$31,607.39
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$34,132.97
|
|
|
Service Code
|
MSDRG 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
|
MSDRG 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
|
MSDRG 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
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
40019517
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
WOUND DEHISCENCE COMPLX CLOSR
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
40019517
|
|
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
|
|
|
WOUND DEHISCENCE SIMPLE CLOSR
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
40019516
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
WOUND DEHISCENCE SIMPLE CLOSR
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
40019516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.03 |
| 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: Brighton Health Commercial |
$1,129.01
|
| 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 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 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 |
$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
|
|
|
WOUND EXPLORAT TRAUMA ABDOMEN
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
40099882
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
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 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
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
30102464
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
