|
DEBRD SUBCUT TISS MUSC BONE
|
Facility
|
IP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
75190030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.95 |
| Max. Negotiated Rate |
$520.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.95
|
|
|
DEBRD SUBCUT TISS MUSC BONE
|
Facility
|
OP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
75190030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.70 |
| Max. Negotiated Rate |
$7,082.74 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$394.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,082.74
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,041.90
|
| Rate for Payer: Oxford Commercial |
$694.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$694.60
|
| Rate for Payer: UnitedHealthcare Community & State |
$83.70
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$394.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$92.03
|
|
|
DEBRD SUBCUT TISSUE & MUSCLE
|
Facility
|
OP
|
$1,147.40
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
75190025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.65 |
| Max. Negotiated Rate |
$3,169.46 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,169.46
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$344.22
|
| Rate for Payer: Oxford Commercial |
$229.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$229.48
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.65
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$30.41
|
|
|
DEBRD SUBCUT TISSUE & MUSCLE
|
Facility
|
IP
|
$1,147.40
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
75190025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.11 |
| Max. Negotiated Rate |
$172.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.11
|
|
|
DEBR EXZ/INF SKIN, 10%BS
|
Facility
|
IP
|
$1,235.10
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
1600000362
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.26 |
| Max. Negotiated Rate |
$185.26 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$185.26
|
|
|
DEBR EXZ/INF SKIN, 10%BS
|
Facility
|
OP
|
$1,235.10
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
1600000362
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$370.53
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$185.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.77
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,607.24
|
|
|
DEBRIDE INFECTED SKIN
|
Facility
|
IP
|
$2,827.76
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
412311000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$424.16 |
| Max. Negotiated Rate |
$424.16 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$424.16
|
|
|
DEBRIDE INFECTED SKIN
|
Facility
|
OP
|
$2,827.76
|
|
|
Service Code
|
HCPCS 11000
|
| Hospital Charge Code |
412311000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.15 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$1,313.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,564.76
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,743.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$482.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,743.30
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: Cigna Medicare Advantage |
$482.95
|
| Rate for Payer: Clover Medicare Advantage |
$458.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,448.85
|
| Rate for Payer: Humana Medicare Advantage |
$497.44
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$482.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$848.33
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$424.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$68.15
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.95
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,607.24
|
|
|
DEBRIDE INFECTED SKIN ADD-ON
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
412311001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$233.70
|
| Rate for Payer: Aetna Medicare Advantage |
$184.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$156.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$156.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.82
|
| Rate for Payer: Cigna Commercial |
$307.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.50
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.30
|
|
|
DEBRIDE INFECTED SKIN ADD-ON
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 11001
|
| Hospital Charge Code |
412311001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.25
|
|
|
DEBRIDEMENT BONE
|
Facility
|
OP
|
$7,943.37
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
412311044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$7,082.74 |
| Rate for Payer: Aetna Commercial |
$5,337.02
|
| Rate for Payer: Aetna Medicare Advantage |
$6,357.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$7,082.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$1,962.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$7,082.74
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: Cigna Medicare Advantage |
$1,962.14
|
| Rate for Payer: Clover Medicare Advantage |
$1,864.03
|
| Rate for Payer: EmblemHealth Commercial |
$5,886.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,021.00
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$1,962.14
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,383.01
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,191.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$191.44
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,962.14
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$394.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$386.54
|
|
|
DEBRIDEMENT BONE
|
Facility
|
IP
|
$7,943.37
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
412311044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.51 |
| Max. Negotiated Rate |
$1,191.51 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,191.51
|
|
|
DEBRIDEMENT SKIN&SQ TIS,MUSCLE
|
Facility
|
OP
|
$2,788.64
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
412311043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$3,169.46 |
| Rate for Payer: Aetna Commercial |
$2,388.27
|
| Rate for Payer: Aetna Medicare Advantage |
$2,844.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,169.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$878.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,016.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,169.46
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: Cigna Medicare Advantage |
$878.04
|
| Rate for Payer: Clover Medicare Advantage |
$834.14
|
| Rate for Payer: EmblemHealth Commercial |
$2,634.12
|
| Rate for Payer: Humana Medicare Advantage |
$904.38
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$878.04
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$836.59
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$418.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$67.21
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$73.90
|
|
|
DEBRIDEMENT SKIN&SQ TIS,MUSCLE
|
Facility
|
IP
|
$2,788.64
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
412311043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.30 |
| Max. Negotiated Rate |
$418.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$418.30
|
|
|
DEBRIDEMENT WOUND NON-SELECT
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602GP
|
| Hospital Charge Code |
9100041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$197.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
DEBRIDEMENT WOUND NON-SELECT
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602GP
|
| Hospital Charge Code |
9100041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$501.22
|
| Rate for Payer: Aetna Medicare Advantage |
$395.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$336.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$116.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$336.35
|
| Rate for Payer: Cigna Commercial |
$659.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$395.70
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.95
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
84208225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$395.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.95
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
84208230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$197.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
84208225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$197.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
84208230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$395.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.95
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
9808334
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$197.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
93950240
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$395.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.95
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
93950240
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.85 |
| Max. Negotiated Rate |
$197.85 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
9808334
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$860.41 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Aetna Medicare Advantage |
$772.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$238.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$149.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.41
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: Cigna Medicare Advantage |
$238.36
|
| Rate for Payer: Clover Medicare Advantage |
$226.44
|
| Rate for Payer: EmblemHealth Commercial |
$715.08
|
| Rate for Payer: Humana Medicare Advantage |
$245.51
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$238.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$395.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.79
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.95
|
|
|
DEBRIDE NAIL 1-5
|
Facility
|
OP
|
$328.10
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
412311720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$2,220.00 |
| Rate for Payer: Aetna Commercial |
$190.62
|
| Rate for Payer: Aetna Medicare Advantage |
$227.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$252.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$252.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$252.97
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: Cigna Medicare Advantage |
$70.08
|
| Rate for Payer: Clover Medicare Advantage |
$66.58
|
| Rate for Payer: EmblemHealth Commercial |
$210.24
|
| Rate for Payer: Humana Medicare Advantage |
$72.18
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$70.08
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$98.43
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,220.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$7.91
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.69
|
|
