Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEB MUSC/FASCIA ADD-ON =<20 SQ

Facility

$5,183.00

Service Code	HCPCS 11046
Hospital Charge Code	16000464
Hospital Revenue Code	360
Min. Negotiated Rate	$147.20
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,969.54
Rate for Payer: Aetna Medicare Advantage	$1,554.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.66
Rate for Payer: Cigna Commercial	$2,591.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,347.58
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$777.45
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.78
Rate for Payer: Wellpoint Medicaid Managed Care	$147.20

DEB MUSC/FASCIA ADD-ON =<20 SQ

Facility

$5,183.00

Service Code	HCPCS 11046
Hospital Charge Code	16000464
Hospital Revenue Code	360
Min. Negotiated Rate	$777.45
Max. Negotiated Rate	$777.45
Rate for Payer: Qualcare PPO/HMO/WC	$777.45

DEBRD SQ. MUSCLE & BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	5780001
Hospital Revenue Code	450
Min. Negotiated Rate	$1,191.51
Max. Negotiated Rate	$1,191.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51

DEBRD SQ. MUSCLE & BONE

Facility

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	5780001
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$7,117.66
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	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
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	$224.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
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	$2,065.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51
Rate for Payer: UnitedHealthcare Community & State	$140.00
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	$225.59

DEBRD SUBCUT TISS MUSC BONE

Facility

$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

$3,473.00

Service Code	HCPCS 11044
Hospital Charge Code	75190030
Hospital Revenue Code	761
Min. Negotiated Rate	$98.63
Max. Negotiated Rate	$7,117.66
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	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
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	$224.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
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	$902.98
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	$109.75
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	$98.63

DEBRD SUBCUT TISSUE & MUSCLE

Facility

$1,117.00

Service Code	HCPCS 11043
Hospital Charge Code	75190025
Hospital Revenue Code	761
Min. Negotiated Rate	$31.72
Max. Negotiated Rate	$3,185.09
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	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
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	$162.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,185.09
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	$290.42
Rate for Payer: Oxford Commercial	$223.40
Rate for Payer: Qualcare PPO/HMO/WC	$167.55
Rate for Payer: UnitedHealthcare Commercial	$223.40
Rate for Payer: UnitedHealthcare Community & State	$35.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$31.72

DEBRD SUBCUT TISSUE & MUSCLE

Facility

$1,117.00

Service Code	HCPCS 11043
Hospital Charge Code	75190025
Hospital Revenue Code	761
Min. Negotiated Rate	$167.55
Max. Negotiated Rate	$167.55
Rate for Payer: Qualcare PPO/HMO/WC	$167.55

DEBR EXZ/INF SKIN, 10%BS

Facility

$1,234.10

Service Code	HCPCS 11000
Hospital Charge Code	1600000362
Hospital Revenue Code	360
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$3,536.00
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$320.87
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$185.12
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$39.00
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

DEBR EXZ/INF SKIN, 10%BS

Facility

$1,234.10

Service Code	HCPCS 11000
Hospital Charge Code	1600000362
Hospital Revenue Code	360
Min. Negotiated Rate	$185.12
Max. Negotiated Rate	$185.12
Rate for Payer: Qualcare PPO/HMO/WC	$185.12

DEBRIDE INFECTED SKIN

Facility

$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

$2,827.76

Service Code	HCPCS 11000
Hospital Charge Code	412311000
Hospital Revenue Code	361
Min. Negotiated Rate	$89.36
Max. Negotiated Rate	$3,536.00
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	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
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	$735.22
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$424.16
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$89.36
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

$615.00

Service Code	HCPCS 11001
Hospital Charge Code	412311001
Hospital Revenue Code	361
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$3,536.00
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	$3,536.00
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	$159.90
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$19.43
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

DEBRIDE INFECTED SKIN ADD-ON

Facility

$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

$7,943.37

Service Code	HCPCS 11044
Hospital Charge Code	412311044
Hospital Revenue Code	361
Min. Negotiated Rate	$251.01
Max. Negotiated Rate	$7,117.66
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	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
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	$2,065.28
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,191.51
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$251.01
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

$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

$2,788.64

Service Code	HCPCS 11043
Hospital Charge Code	412311043
Hospital Revenue Code	361
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$3,536.00
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	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
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	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,185.09
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	$725.05
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$418.30
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$88.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$79.20

DEBRIDEMENT SKIN&SQ TIS,MUSCLE

Facility

$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

$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

$1,319.00

Service Code	HCPCS 97602GP
Hospital Charge Code	9100041
Hospital Revenue Code	420
Min. Negotiated Rate	$37.46
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	$69.00
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	$342.94
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$197.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$41.68
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

DEBRIDEMENT WOUND NON-SELECTIV

Facility

$1,319.00

Service Code	HCPCS 97602
Hospital Charge Code	84208230
Hospital Revenue Code	510
Min. Negotiated Rate	$37.46
Max. Negotiated Rate	$864.65
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	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
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	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
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	$342.94
Rate for Payer: Qualcare PPO/HMO/WC	$197.85
Rate for Payer: UnitedHealthcare Community & State	$41.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

DEBRIDEMENT WOUND NON-SELECTIV

Facility

$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

$1,319.00

Service Code	HCPCS 97602
Hospital Charge Code	84208225
Hospital Revenue Code	510
Min. Negotiated Rate	$37.46
Max. Negotiated Rate	$864.65
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	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
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	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
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	$342.94
Rate for Payer: Qualcare PPO/HMO/WC	$197.85
Rate for Payer: UnitedHealthcare Community & State	$41.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

DEBRIDEMENT WOUND NON-SELECTIV

Facility

$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

$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

Know your out-of-pocket cost for care.

All Charges