|
VOICE D/C STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9173GNCN
|
| Hospital Charge Code |
74204087CN
|
|
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
|
|
|
VOICE GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GN
|
| Hospital Charge Code |
84201085
|
|
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
|
|
|
VOICE GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GN
|
| Hospital Charge Code |
84201085
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
VOICE GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GN
|
| Hospital Charge Code |
84201175
|
|
Hospital Revenue Code
|
449
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
VOICE GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GN
|
| Hospital Charge Code |
84201175
|
|
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
|
|
|
Voice Goal Status CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCH
|
| Hospital Charge Code |
74204085CH
|
|
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
|
|
|
Voice Goal Status CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCH
|
| Hospital Charge Code |
74204085CH
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Voice Goal Status CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCI
|
| Hospital Charge Code |
74204085CI
|
|
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
|
|
|
Voice Goal Status CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCI
|
| Hospital Charge Code |
74204085CI
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Voice Goal Status CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCJ
|
| Hospital Charge Code |
74204085CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Voice Goal Status CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCJ
|
| Hospital Charge Code |
74204085CJ
|
|
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
|
|
|
VOICE GOAL STATUS CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCK
|
| Hospital Charge Code |
74204085CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
VOICE GOAL STATUS CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCK
|
| Hospital Charge Code |
74204085CK
|
|
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
|
|
|
Voice Goal Status CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCL
|
| Hospital Charge Code |
74204085CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
Voice Goal Status CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCL
|
| Hospital Charge Code |
74204085CL
|
|
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
|
|
|
VOICE GOAL STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCM
|
| Hospital Charge Code |
74204085CM
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
VOICE GOAL STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCM
|
| Hospital Charge Code |
74204085CM
|
|
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
|
|
|
VOICE GOAL STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCN
|
| Hospital Charge Code |
74204085CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
VOICE GOAL STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9172GNCN
|
| Hospital Charge Code |
74204085CN
|
|
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
|
|
|
VOLAR DISTAL RADIUS PLATE 3 HO
|
Facility
|
OP
|
$4,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$2,046.88 |
| Rate for Payer: Aetna Commercial |
$1,228.12
|
| Rate for Payer: Aetna Medicare Advantage |
$1,228.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,043.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,043.91
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$818.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,043.91
|
| Rate for Payer: Cigna Commercial |
$2,046.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$990.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$614.06
|
|
|
VOLAR DISTAL RADIUS PLATE 3 HO
|
Facility
|
IP
|
$4,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270704872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$990.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$818.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$990.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$614.06
|
|
|
VOLATILES
|
Facility
|
OP
|
$190.45
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
3035089A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$57.13
|
| Rate for Payer: Aetna Medicare Advantage |
$57.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$48.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$48.56
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$48.56
|
| Rate for Payer: Cigna Commercial |
$95.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.76
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
|
VOLATILES
|
Facility
|
IP
|
$213.65
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
3035089C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$32.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.05
|
|
|
VOLATILES
|
Facility
|
IP
|
$190.45
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
3035089A
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.57 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$28.57
|
|
|
VOLATILES
|
Facility
|
OP
|
$213.65
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
3035089C
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.77 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare Advantage |
$64.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$54.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$54.48
|
| Rate for Payer: Cigna Commercial |
$106.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$27.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$32.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
