|
ATTENTION CURRENT STATUS CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCJ
|
| Hospital Charge Code |
74204071CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION CURRENT STATUS CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCJ
|
| Hospital Charge Code |
74204071CJ
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION CURRENT STATUS CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCK
|
| Hospital Charge Code |
74204071CK
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION CURRENT STATUS CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCK
|
| Hospital Charge Code |
74204071CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION CURRENT STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCL
|
| Hospital Charge Code |
74204071CL
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION CURRENT STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCL
|
| Hospital Charge Code |
74204071CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION CURRENT STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCM
|
| Hospital Charge Code |
74204071CM
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION CURRENT STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCM
|
| Hospital Charge Code |
74204071CM
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION CURRENT STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCN
|
| Hospital Charge Code |
74204071CN
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION CURRENT STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9165GNCN
|
| Hospital Charge Code |
74204071CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCH
|
| Hospital Charge Code |
74204075CH
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCH
|
| Hospital Charge Code |
74204075CH
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION D/C STATUS CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCI
|
| Hospital Charge Code |
74204075CI
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION D/C STATUS CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCI
|
| Hospital Charge Code |
74204075CI
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCJ
|
| Hospital Charge Code |
74204075CJ
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION D/C STATUS CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCJ
|
| Hospital Charge Code |
74204075CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCK
|
| Hospital Charge Code |
74204075CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCK
|
| Hospital Charge Code |
74204075CK
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION D/C STATUS CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCL
|
| Hospital Charge Code |
74204075CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCL
|
| Hospital Charge Code |
74204075CL
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION D/C STATUS CM
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCM
|
| Hospital Charge Code |
74204075CM
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CM
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCM
|
| Hospital Charge Code |
74204075CM
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION D/C STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCN
|
| Hospital Charge Code |
74204075CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
ATTENTION D/C STATUS CN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9167GNCN
|
| Hospital Charge Code |
74204075CN
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|
|
ATTENTION GOAL STATUS CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9166GNCH
|
| Hospital Charge Code |
74204073CH
|
|
Hospital Revenue Code
|
440
|
| 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) 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
|
|