|
SLP COMP GOAL STATUS CN
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9160GNCN
|
| Hospital Charge Code |
74204061CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCK
|
| Hospital Charge Code |
74204065CK
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCH
|
| Hospital Charge Code |
74204065CH
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCK
|
| Hospital Charge Code |
74204065CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCI
|
| Hospital Charge Code |
74204065CI
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCH
|
| Hospital Charge Code |
74204065CH
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCJ
|
| Hospital Charge Code |
74204065CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCN
|
| Hospital Charge Code |
74204065CN
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCL
|
| Hospital Charge Code |
74204065CL
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCI
|
| Hospital Charge Code |
74204065CI
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCN
|
| Hospital Charge Code |
74204065CN
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCM
|
| Hospital Charge Code |
74204065CM
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCM
|
| Hospital Charge Code |
74204065CM
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression Current Status
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCJ
|
| Hospital Charge Code |
74204065CJ
|
|
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
|
|
|
SLP Expression Current Status
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9162GNCL
|
| Hospital Charge Code |
74204065CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression D/C Status CH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCH
|
| Hospital Charge Code |
74204069CH
|
|
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
|
|
|
SLP Expression D/C Status CH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCH
|
| Hospital Charge Code |
74204069CH
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression D/C Status CI
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCI
|
| Hospital Charge Code |
74204069CI
|
|
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
|
|
|
SLP Expression D/C Status CI
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCI
|
| Hospital Charge Code |
74204069CI
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression D/C Status CJ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCJ
|
| Hospital Charge Code |
74204069CJ
|
|
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
|
|
|
SLP Expression D/C Status CJ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCJ
|
| Hospital Charge Code |
74204069CJ
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression D/C Status CK
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCK
|
| Hospital Charge Code |
74204069CK
|
|
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
|
|
|
SLP Expression D/C Status CK
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCK
|
| Hospital Charge Code |
74204069CK
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|
|
SLP Expression D/C Status CL
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCL
|
| Hospital Charge Code |
74204069CL
|
|
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
|
|
|
SLP Expression D/C Status CL
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G9164GNCL
|
| Hospital Charge Code |
74204069CL
|
|
Hospital Revenue Code
|
440
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.00
|
|