|
MOTOR SPEECH D/C STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9158GNCL
|
| Hospital Charge Code |
74204057CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTOR SPEECH D/C STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9158GNCL
|
| Hospital Charge Code |
74204057CL
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
Motor Speech D/C Status CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9158GNCM
|
| Hospital Charge Code |
74204057CM
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech D/C Status CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9158GNCM
|
| Hospital Charge Code |
74204057CM
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
Motor Speech D/C Status CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9158GNCN
|
| Hospital Charge Code |
74204057CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech D/C Status CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9158GNCN
|
| Hospital Charge Code |
74204057CN
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GN
|
| Hospital Charge Code |
84201110
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GN
|
| Hospital Charge Code |
84201160
|
|
Hospital Revenue Code
|
449
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
MOTOR SPEECH GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GN
|
| Hospital Charge Code |
84201110
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
MOTOR SPEECH GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GN
|
| Hospital Charge Code |
84201160
|
|
Hospital Revenue Code
|
449
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Goal Status CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCH
|
| Hospital Charge Code |
74204055CH
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
Motor Speech Goal Status CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCH
|
| Hospital Charge Code |
74204055CH
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Goal Status CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCI
|
| Hospital Charge Code |
74204055CI
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
Motor Speech Goal Status CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCI
|
| Hospital Charge Code |
74204055CI
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Goal Status CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCJ
|
| Hospital Charge Code |
74204055CJ
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
Motor Speech Goal Status CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCJ
|
| Hospital Charge Code |
74204055CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Goal Status CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCK
|
| Hospital Charge Code |
74204055CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Goal Status CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCK
|
| Hospital Charge Code |
74204055CK
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
MOTOR SPEECH GOAL STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCL
|
| Hospital Charge Code |
74204055CL
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
MOTOR SPEECH GOAL STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCL
|
| Hospital Charge Code |
74204055CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Motor Speech Goal Status CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCM
|
| Hospital Charge Code |
74204055CM
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
Motor Speech Goal Status CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCM
|
| Hospital Charge Code |
74204055CM
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTOR SPEECH GOAL STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCN
|
| Hospital Charge Code |
74204055CN
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$686.00 |
| 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) 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 |
$686.00
|
|
|
MOTOR SPEECH GOAL STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9186GNCN
|
| Hospital Charge Code |
74204055CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOTRIN/300MG/TAB
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634328
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|