|
DEBRIDEMENT WOUND NON-SELECTIV
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
93950240
|
|
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
|
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 |
9808334
|
|
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
|
|
|
DEBRIDE NAIL 1-5
|
Facility
|
IP
|
$328.10
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
412311720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.22 |
| Max. Negotiated Rate |
$49.22 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.22
|
|
|
DEBRIDE NAIL 1-5
|
Facility
|
OP
|
$328.10
|
|
|
Service Code
|
HCPCS 11720
|
| Hospital Charge Code |
412311720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$3,536.00 |
| 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 |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.22
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.22
|
| 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 |
$85.31
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.37
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.32
|
|
|
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 NAIL 6 OR MORE
|
Facility
|
OP
|
$328.10
|
|
|
Service Code
|
HCPCS 11721
|
| Hospital Charge Code |
412311721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$3,536.00 |
| 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 |
$254.22
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$254.22
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$254.22
|
| 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 |
$85.31
|
| Rate for Payer: Oxford Commercial |
$2,297.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$49.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,256.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.37
|
| 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 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 AT FX SITE
|
Facility
|
OP
|
$4,221.55
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5700411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.89 |
| Max. Negotiated Rate |
$3,051.74 |
| 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 |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| 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 |
$276.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,051.74
|
| 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 |
$1,097.60
|
| 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 |
$119.89
|
|
|
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 |
$252.58 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,051.74
|
| 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 |
$2,078.16
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,198.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$252.58
|
| 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
|
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 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 |
$102.52 |
| Max. Negotiated Rate |
$3,629.00 |
| 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 |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| 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 |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,051.74
|
| 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 |
$938.57
|
| Rate for Payer: Oxford Commercial |
$3,505.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$541.49
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,629.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$114.07
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.28
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$102.52
|
|
|
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
|
|
|
DEBRIDE SKIN & SQ TISSUE
|
Facility
|
OP
|
$1,447.00
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
421011042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$1,751.90 |
| 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 |
$42.93
|
| 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 |
$376.22
|
| 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 |
$45.73
|
| 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 |
$41.09
|
|
|
DEBRID SKIN FIRST 20SQ CM
|
Facility
|
OP
|
$623.14
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
93950230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.70 |
| 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 |
$357.50
|
| 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 |
$162.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.69
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$238.36
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.70
|
|
|
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 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 |
$17.70 |
| Max. Negotiated Rate |
$440.00 |
| 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 |
$440.00
|
| 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 |
$162.02
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$93.47
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.70
|
|
|
DEBRID SUBCUT TISSUE & MUSCLE
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
93950220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.57 |
| 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 |
$298.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$36.25
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$878.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.57
|
|
|
DEBRID SUBCUT TISSUE & MUSCLE
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
HCPCS 11043
|
| Hospital Charge Code |
93950220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.05 |
| Max. Negotiated Rate |
$172.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$172.05
|
|
|
DEBRID SUBCUT TISSUE, MUSCLE,
|
Facility
|
OP
|
$3,473.00
|
|
|
Service Code
|
HCPCS 11044
|
| Hospital Charge Code |
93950225
|
|
Hospital Revenue Code
|
510
|
| 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: Qualcare PPO/HMO/WC |
$520.95
|
| 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
|
|
|
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
|
|
|
DEBRMT SKN SQ TISS OPEN FX
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5770015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$3,051.74 |
| 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 |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,051.74
|
| 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 |
$276.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,051.74
|
| 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 |
$541.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$312.15
|
| 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 |
$59.10
|
|
|
DEBRMT SKN SQ TISS OPEN FX
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
HCPCS 11010
|
| Hospital Charge Code |
5770015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$312.15 |
| Max. Negotiated Rate |
$312.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$312.15
|
|
