|
MOBILITY D/C STATUS CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCK
|
| Hospital Charge Code |
84202010CK
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCL
|
| Hospital Charge Code |
84202010CL
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCL
|
| Hospital Charge Code |
84202010CL
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY D/C STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GOCL
|
| Hospital Charge Code |
74203091CL
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY D/C STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GOCL
|
| Hospital Charge Code |
74203091CL
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GOCM
|
| Hospital Charge Code |
74203091CM
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GOCM
|
| Hospital Charge Code |
74203091CM
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY D/C STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCM
|
| Hospital Charge Code |
84202010CM
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCM
|
| Hospital Charge Code |
84202010CM
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY D/C STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCN
|
| Hospital Charge Code |
84202010CN
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GOCN
|
| Hospital Charge Code |
74203091CN
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY D/C STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GOCN
|
| Hospital Charge Code |
74203091CN
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY D/C STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8980GPCN
|
| Hospital Charge Code |
84202010CN
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GP
|
| Hospital Charge Code |
9109131
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GP
|
| Hospital Charge Code |
9109131
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GP
|
| Hospital Charge Code |
84201121
|
|
Hospital Revenue Code
|
429
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GP
|
| Hospital Charge Code |
84202005
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GP
|
| Hospital Charge Code |
84202005
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GO
|
| Hospital Charge Code |
84201139
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GO
|
| Hospital Charge Code |
84201139
|
|
Hospital Revenue Code
|
439
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GP
|
| Hospital Charge Code |
84201121
|
|
Hospital Revenue Code
|
429
|
| 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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GO
|
| Hospital Charge Code |
74203089
|
|
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 |
$69.00
|
| 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 |
$933.00
|
| 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
|
|
|
MOBILITY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GO
|
| Hospital Charge Code |
74203089
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY GOAL STATUS CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GPCH
|
| Hospital Charge Code |
84202005CH
|
|
Hospital Revenue Code
|
420
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
MOBILITY GOAL STATUS CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G8979GOCH
|
| Hospital Charge Code |
74203089CH
|
|
Hospital Revenue Code
|
430
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|