|
HC SIMP WND REP, FACE/EAR/EYELID/NOSE/LIP, 7.6-12.5CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
3611201501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 12.6-20.0CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
3611200501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 12.6-20.0CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
3611200501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.83 |
| 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 |
$109.83
|
| 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 SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 20.1-30.0CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
3611200601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.53 |
| 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 |
$136.53
|
| 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 SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 20.1-30.0CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
3611200601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, <2.5CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3611200101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, <2.5CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3611200101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$52.02
|
| 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 SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 2.6-7.5CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
3611200201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 2.6-7.5CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
3611200201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$68.40
|
| 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 SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, >30.0CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
3611200701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$106.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.98
|
| 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 SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, >30.0CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
3611200701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 7.6-12.5CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
3611200401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC SIMP WND REP, SCALP/NECK/AXILLAE/GEN/TRUNK/EXT, 7.6-12.5CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
3611200401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$85.16
|
| 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 SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
3611527501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.95 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
3611527501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS (ADDON)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
3611527601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$90.00
|
| 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 |
$60.00
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.92
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS (ADDON)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
3611527601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS, CHILD
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
3611527701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS, CHILD
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
3611527701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$257.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS, CHILD (ADDON)
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
3611527801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$195.75
|
| 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 |
$130.50
|
| Rate for Payer: Group Health Inc Commercial |
$130.50
|
| Rate for Payer: Group Health Inc Medicare |
$91.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.29
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC SKIN SUB GRAFT FACE/NECK/HAND/FT/EAR/ORBIT/GEN/DIGITS, CHILD (ADDON)
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
3611527801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.50
|
|
|
HC SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
3611527101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC SKIN SUB GRAFT TRNK/ARM/LEG
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
3611527101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC SKIN SUB GRAFT TRNK/ARM/LEG (ADDON)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
3611527201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$90.00
|
| 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 |
$60.00
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.89
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC SKIN SUB GRAFT TRNK/ARM/LEG (ADDON)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
3611527201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
|
