|
BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GO
|
| Hospital Charge Code |
84201142
|
|
Hospital Revenue Code
|
439
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCH
|
| Hospital Charge Code |
74203095CH
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCH
|
| Hospital Charge Code |
84202020CH
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCH
|
| Hospital Charge Code |
74203095CH
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCH
|
| Hospital Charge Code |
84202020CH
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCI
|
| Hospital Charge Code |
74203095CI
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCI
|
| Hospital Charge Code |
84202020CI
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCI
|
| Hospital Charge Code |
74203095CI
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCI
|
| Hospital Charge Code |
84202020CI
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCJ
|
| Hospital Charge Code |
84202020CJ
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCJ
|
| Hospital Charge Code |
74203095CJ
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCJ
|
| Hospital Charge Code |
74203095CJ
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCJ
|
| Hospital Charge Code |
84202020CJ
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCK
|
| Hospital Charge Code |
84202020CK
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCK
|
| Hospital Charge Code |
74203095CK
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCK
|
| Hospital Charge Code |
74203095CK
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCK
|
| Hospital Charge Code |
84202020CK
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCL
|
| Hospital Charge Code |
84202020CL
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCL
|
| Hospital Charge Code |
74203095CL
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCL
|
| Hospital Charge Code |
84202020CL
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCL
|
| Hospital Charge Code |
74203095CL
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCM
|
| Hospital Charge Code |
84202020CM
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|
|
BODY POS GOAL STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GPCM
|
| Hospital Charge Code |
84202020CM
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCM
|
| Hospital Charge Code |
74203095CM
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCM
|
| Hospital Charge Code |
74203095CM
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$0.00
|
| Rate for Payer: Aetna Medicare Advantage |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.00
|
| 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 |
$0.00
|
| Rate for Payer: Cigna Commercial |
$0.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.00
|
| Rate for Payer: Oxford Commercial |
$604.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$1,060.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.00
|
|