|
BODY POS D/C STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GOCL
|
| Hospital Charge Code |
74203097CL
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS D/C STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GPCL
|
| Hospital Charge Code |
84202025CL
|
|
Hospital Revenue Code
|
420
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS D/C STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GOCM
|
| Hospital Charge Code |
74203097CM
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS D/C STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GPCM
|
| Hospital Charge Code |
84202025CM
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS D/C STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GPCM
|
| Hospital Charge Code |
84202025CM
|
|
Hospital Revenue Code
|
420
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS D/C STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GOCM
|
| Hospital Charge Code |
74203097CM
|
|
Hospital Revenue Code
|
430
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS D/C STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GOCN
|
| Hospital Charge Code |
74203097CN
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS D/C STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GOCN
|
| Hospital Charge Code |
74203097CN
|
|
Hospital Revenue Code
|
430
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS D/C STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GPCN
|
| Hospital Charge Code |
84202025CN
|
|
Hospital Revenue Code
|
420
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS D/C STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8983GPCN
|
| Hospital Charge Code |
84202025CN
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GP
|
| Hospital Charge Code |
9109134
|
|
Hospital Revenue Code
|
420
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GP
|
| Hospital Charge Code |
84202020
|
|
Hospital Revenue Code
|
420
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GO
|
| Hospital Charge Code |
84201142
|
|
Hospital Revenue Code
|
439
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GP
|
| Hospital Charge Code |
9109134
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GP
|
| Hospital Charge Code |
84201124
|
|
Hospital Revenue Code
|
429
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GP
|
| Hospital Charge Code |
84202020
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GP
|
| Hospital Charge Code |
84201124
|
|
Hospital Revenue Code
|
429
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GO
|
| Hospital Charge Code |
74203095
|
|
Hospital Revenue Code
|
430
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GO
|
| Hospital Charge Code |
84201142
|
|
Hospital Revenue Code
|
439
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GO
|
| Hospital Charge Code |
74203095
|
|
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 |
$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) NJ Health |
$90.00
|
| 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
|
|
|
BODY POS GOAL STATUS CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8982GOCH
|
| Hospital Charge Code |
74203095CH
|
|
Hospital Revenue Code
|
430
|
| 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) NJ Health |
$90.00
|
| 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
|
|
|
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
|
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 |
$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) NJ Health |
$90.00
|
| 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
|
|