|
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 |
$234.39 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Better Health Medicaid |
$386.54
|
| Rate for Payer: Aetna Commercial |
$1,041.90
|
| Rate for Payer: Aetna Medicare Advantage |
$1,041.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$885.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$885.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$234.39
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$885.62
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$451.49
|
| Rate for Payer: Oxford Commercial |
$1,736.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$520.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,736.50
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$394.27
|
|
|
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 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
|
|
|
DEBRD SUBCUT TISSUE & MUSCLE
|
Facility
|
OP
|
$1,147.40
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
75190025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.16 |
| Max. Negotiated Rate |
$1,760.02 |
| Rate for Payer: Aetna Commercial |
$344.22
|
| Rate for Payer: Aetna Medicare Advantage |
$344.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$292.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$292.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$292.59
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$149.16
|
| Rate for Payer: Oxford Commercial |
$573.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.11
|
| Rate for Payer: UnitedHealthcare Commercial |
$573.70
|
|
|
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 |
$160.56 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Better Health Medicaid |
$1,607.24
|
| Rate for Payer: Aetna Commercial |
$370.53
|
| Rate for Payer: Aetna Medicare Advantage |
$370.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$314.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$314.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$314.95
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.56
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$185.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$1,639.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,607.24
|
|
|
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
|
|
|
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 |
$367.61 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Better Health Medicaid |
$1,607.24
|
| Rate for Payer: Aetna Commercial |
$848.33
|
| Rate for Payer: Aetna Medicare Advantage |
$848.33
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$721.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$721.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$721.08
|
| Rate for Payer: Cigna Commercial |
$968.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$367.61
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$424.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
| 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 |
$13.69 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| 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 |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$156.82
|
| Rate for Payer: Cigna Commercial |
$13.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$79.95
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$92.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
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
|
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 BONE
|
Facility
|
OP
|
$7,943.37
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
412311044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$386.54 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Better Health Medicaid |
$386.54
|
| Rate for Payer: Aetna Commercial |
$2,383.01
|
| Rate for Payer: Aetna Medicare Advantage |
$2,383.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,025.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,025.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,025.56
|
| Rate for Payer: Cigna Commercial |
$3,933.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,032.64
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,191.51
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,575.00
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$394.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$386.54
|
|
|
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 |
$362.52 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$836.59
|
| Rate for Payer: Aetna Medicare Advantage |
$836.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$711.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$711.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$711.10
|
| Rate for Payer: Cigna Commercial |
$1,760.02
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$362.52
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$418.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
|
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
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602GP
|
| Hospital Charge Code |
9100041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$686.00 |
| Rate for Payer: Aetna Commercial |
$395.70
|
| 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 |
$90.00
|
| 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 |
$171.47
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
| Rate for Payer: UnitedHealthcare Commercial |
$686.00
|
|
|
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-SELECTIV
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
93950240
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna Commercial |
$395.70
|
| 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 |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$336.35
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.47
|
| 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 |
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
|
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
|
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 |
84208225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.55 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna Commercial |
$395.70
|
| 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 |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$336.35
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.47
|
| 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 |
$88.55 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna Commercial |
$395.70
|
| 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 |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$336.35
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.47
|
| 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 |
$88.55 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna Commercial |
$395.70
|
| 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 |
$88.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$336.35
|
| Rate for Payer: Cigna Commercial |
$477.79
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$171.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$197.85
|
|
|
DEBRIDE NAIL 1-5
|
Facility
|
OP
|
$328.10
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
412311720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.65 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$98.43
|
| Rate for Payer: Aetna Medicare Advantage |
$98.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$83.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$83.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,864.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$83.67
|
| Rate for Payer: Cigna Commercial |
$140.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$42.65
|
| Rate for Payer: Oxford Commercial |
$1,487.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,686.00
|
|
