|
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
|
|
|
DEBRIDE NAIL 6 OR MORE
|
Facility
|
OP
|
$328.10
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
412311721
|
|
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: Wellcare New Jersey Medicaid/Family Care |
$197.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.50
|
|
|
DEBRIDE NAIL 6 OR MORE
|
Facility
|
IP
|
$328.10
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
412311721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.22 |
| Max. Negotiated Rate |
$49.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.22
|
|
|
DEBRIDE NAILS 6 OR MORE
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
5792296
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.10
|
|
|
DEBRIDE NAILS 6 OR MORE
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
5792296
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$850.00 |
| 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 |
$45.86
|
| 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 |
$106.20
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$53.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$197.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.38
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$4,221.55
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5700411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.23 |
| Max. Negotiated Rate |
$633.23 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$633.23
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$7,992.92
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
1600000807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.63 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,397.88
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,198.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$192.63
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,950.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,912.33
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
OP
|
$4,221.55
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5700411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.87 |
| Max. Negotiated Rate |
$3,036.77 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$486.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,266.46
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$850.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$633.23
|
| Rate for Payer: UnitedHealthcare Community & State |
$140.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,950.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$111.87
|
|
|
DEBRIDE SKIN AT FX SITE
|
Facility
|
IP
|
$7,992.92
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
1600000807
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,198.94 |
| Max. Negotiated Rate |
$1,198.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,198.94
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Facility
|
IP
|
$3,609.90
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
16000491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$541.49 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$541.49
|
|
|
DEBRIDE SKIN MUSC AT FX SITE
|
Facility
|
OP
|
$3,609.90
|
|
|
Service Code
|
HCPCS 11011
|
| Hospital Charge Code |
16000491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,288.28
|
| Rate for Payer: Aetna Medicare Advantage |
$2,725.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,036.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$841.28
|
| 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 |
$3,036.77
|
| Rate for Payer: Cigna Commercial |
$1,686.34
|
| Rate for Payer: Cigna Medicare Advantage |
$841.28
|
| Rate for Payer: Clover Medicare Advantage |
$799.22
|
| Rate for Payer: EmblemHealth Commercial |
$2,523.84
|
| Rate for Payer: Humana Medicare Advantage |
$866.52
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$841.28
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,082.97
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$541.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.66
|
|
|
DEBRIDE SKIN & SQ TISSUE
|
Facility
|
OP
|
$1,447.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
421011042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$1,743.30 |
| 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 |
$75.56
|
| 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 |
$434.10
|
| Rate for Payer: Oxford Commercial |
$289.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$289.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.87
|
| 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 |
$1,058.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.35
|
|
|
DEBRIDE SKIN & SQ TISSUE
|
Facility
|
IP
|
$1,447.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
421011042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.05 |
| Max. Negotiated Rate |
$217.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.05
|
|
|
DEBRID SKIN FIRST 20SQ CM
|
Facility
|
IP
|
$623.14
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
93950230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.47 |
| Max. Negotiated Rate |
$93.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.47
|
|
|
DEBRID SKIN FIRST 20SQ CM
|
Facility
|
OP
|
$623.14
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
93950230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.02 |
| 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 |
$629.20
|
| 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 |
$186.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.02
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.51
|
|
|
DEBRID SKIN FIRST ADDITIONAL 2
|
Facility
|
IP
|
$623.14
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
93950235
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.47 |
| Max. Negotiated Rate |
$93.47 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.47
|
|
|
DEBRID SKIN FIRST ADDITIONAL 2
|
Facility
|
OP
|
$623.14
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
93950235
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$774.40 |
| Rate for Payer: Aetna Commercial |
$236.79
|
| Rate for Payer: Aetna Medicare Advantage |
$186.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$158.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$158.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$774.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$158.90
|
| Rate for Payer: Cigna Commercial |
$311.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.51
|
|
|
DEBRID SUBCUT TISSUE & MUSCLE
|
Facility
|
IP
|
$1,147.40
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
93950220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.11 |
| Max. Negotiated Rate |
$172.11 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.11
|
|
|
DEBRID SUBCUT TISSUE & MUSCLE
|
Facility
|
OP
|
$1,147.40
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
93950220
|
|
Hospital Revenue Code
|
510
|
| 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: Qualcare PPO/HMO/WC |
$172.11
|
| 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
|
|
|
DEBRID SUBCUT TISSUE, MUSCLE,
|
Facility
|
IP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
93950225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$520.95 |
| Max. Negotiated Rate |
$520.95 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.95
|
|
|
DEBRID SUBCUT TISSUE, MUSCLE,
|
Facility
|
OP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
93950225
|
|
Hospital Revenue Code
|
510
|
| 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: Qualcare PPO/HMO/WC |
$520.95
|
| 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
|
|
|
DEBRISAN/4GM
|
Facility
|
OP
|
$17.00
|
|
| Hospital Charge Code |
60632780
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$6.46
|
| Rate for Payer: Aetna Medicare Advantage |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.33
|
| Rate for Payer: Cigna Commercial |
$8.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.10
|
| Rate for Payer: Oxford Commercial |
$3.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.41
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.45
|
|
|
DEBRISAN/4GM
|
Facility
|
IP
|
$17.00
|
|
| Hospital Charge Code |
60632780
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.55
|
|
|
DEBRISAN PASTE
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
60635144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.15
|
|
|
DEBRISAN PASTE
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
60635144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Aetna Medicare Advantage |
$18.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15.55
|
| Rate for Payer: Cigna Commercial |
$30.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$18.30
|
| Rate for Payer: Oxford Commercial |
$12.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$12.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.47
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.62
|
|
