|
HC DEBRIDEMENT NAIL, 6 OR MORE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
3611172101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC DEBRIDEMENT OF NAIL(S), 1-5
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
3611172002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC DEBRIDEMENT OF NAIL(S), 1-5
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
3611172002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC DEBRIDEMENT OF NAILS, 6 OR MORE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
3611172102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC DEBRIDEMENT OF NAILS, 6 OR MORE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
3611172102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
3619759701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
4509759701
|
|
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 |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$242.78
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$242.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| 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 |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$254.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
4509759701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
3619759701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$1,113.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$423.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$359.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
7619759801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
7619759801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.26
|
| Rate for Payer: Aetna Government |
$9.26
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$423.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$359.72
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$264.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.91
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
3611104202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
3611104202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$488.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| Rate for Payer: Group Health Inc Commercial |
$488.15
|
| Rate for Payer: Group Health Inc Medicare |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
3611104502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$410.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.50
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
3611104502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.47
|
| Rate for Payer: Aetna Government |
$22.47
|
| Rate for Payer: Brighton Health Commercial |
$615.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$410.50
|
| Rate for Payer: Group Health Inc Commercial |
$410.50
|
| Rate for Payer: Group Health Inc Medicare |
$287.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.15
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
3611104402
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
3611104402
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$2,494.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
3611104702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$1,247.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,247.00
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$2,494.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
3611104702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.45 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.45
|
| Rate for Payer: Aetna Government |
$87.45
|
| Rate for Payer: Brighton Health Commercial |
$1,870.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,247.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,247.00
|
| Rate for Payer: Group Health Inc Medicare |
$872.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,247.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,247.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.37
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
3611104602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.49
|
| Rate for Payer: Aetna Government |
$63.49
|
| Rate for Payer: Brighton Health Commercial |
$615.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$410.50
|
| Rate for Payer: Group Health Inc Commercial |
$410.50
|
| Rate for Payer: Group Health Inc Medicare |
$287.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$410.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
3611104602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$410.50 |
| Max. Negotiated Rate |
$410.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.50
|
|
|
HC DEBRIDE SKIN AT FRACTURE SITE, SKIN & SUBCUTANEOUS TISSUE
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
3611101001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.06 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$1,385.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| Rate for Payer: Group Health Inc Commercial |
$859.66
|
| Rate for Payer: Group Health Inc Medicare |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
|
HC DEBRIDE SKIN AT FRACTURE SITE, SKIN & SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
3611101001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC DEBRIDE SKIN AT FRACTURE SITE, SKIN,SUBCU TISSUE,FASCIA&MUSCLE
|
Facility
|
IP
|
$2,124.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
3611101101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,062.00 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,062.00
|
|
|
HC DEBRIDE SKIN AT FRACTURE SITE, SKIN,SUBCU TISSUE,FASCIA&MUSCLE
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
3611101101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$348.91 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$1,593.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| Rate for Payer: Group Health Inc Commercial |
$859.66
|
| Rate for Payer: Group Health Inc Medicare |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
