|
NJX ANES STELLTE GANG CRV SYMP
|
Facility
|
IP
|
$2,431.08
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
76102333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.04 |
| Max. Negotiated Rate |
$2,333.84 |
| Rate for Payer: Aetna Commercial |
$1,871.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,896.24
|
| Rate for Payer: Cash Price |
$1,215.54
|
| Rate for Payer: Cigna Commercial |
$2,017.80
|
| Rate for Payer: First Health Commercial |
$2,309.53
|
| Rate for Payer: Humana Commercial |
$2,066.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,993.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,794.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$729.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,139.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,823.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$486.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$316.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$753.63
|
| Rate for Payer: PHCS Commercial |
$2,333.84
|
| Rate for Payer: United Healthcare All Payer |
$2,139.35
|
|
|
NJX ANES STELLTE GANG CRV SYMP
|
Facility
|
IP
|
$1,981.08
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
761T2333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.54 |
| Max. Negotiated Rate |
$1,901.84 |
| Rate for Payer: Aetna Commercial |
$1,525.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.24
|
| Rate for Payer: Cash Price |
$990.54
|
| Rate for Payer: Cigna Commercial |
$1,644.30
|
| Rate for Payer: First Health Commercial |
$1,882.03
|
| Rate for Payer: Humana Commercial |
$1,683.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.13
|
| Rate for Payer: PHCS Commercial |
$1,901.84
|
| Rate for Payer: United Healthcare All Payer |
$1,743.35
|
|
|
NJX ANES STELLTE GANG CRV SYMP
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
761P2333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$108.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.93
|
| Rate for Payer: Anthem Medicaid |
$59.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$168.90
|
| Rate for Payer: Healthspan PPO |
$167.41
|
| Rate for Payer: Humana Medicaid |
$59.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.40
|
| Rate for Payer: Molina Healthcare Passport |
$59.22
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$40.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.81
|
|
|
NJX ANES STELLTE GANG CRV SYMP
|
Facility
|
OP
|
$1,981.08
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
761T2333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.54 |
| Max. Negotiated Rate |
$1,901.84 |
| Rate for Payer: Aetna Commercial |
$1,525.43
|
| Rate for Payer: Anthem Medicaid |
$681.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$990.54
|
| Rate for Payer: Cash Price |
$990.54
|
| Rate for Payer: Cigna Commercial |
$1,644.30
|
| Rate for Payer: First Health Commercial |
$1,882.03
|
| Rate for Payer: Humana Commercial |
$1,683.92
|
| Rate for Payer: Humana KY Medicaid |
$681.29
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$688.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,462.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.13
|
| Rate for Payer: PHCS Commercial |
$1,901.84
|
| Rate for Payer: United Healthcare All Payer |
$1,743.35
|
|
|
NJX ANES STELLTE GANG CRV SYMP
|
Professional
|
Both
|
$2,431.08
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
76102333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.93 |
| Max. Negotiated Rate |
$2,431.08 |
| Rate for Payer: Aetna Commercial |
$108.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.93
|
| Rate for Payer: Anthem Medicaid |
$59.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,431.08
|
| Rate for Payer: Cash Price |
$1,215.54
|
| Rate for Payer: Cash Price |
$1,215.54
|
| Rate for Payer: Cigna Commercial |
$168.90
|
| Rate for Payer: Healthspan PPO |
$167.41
|
| Rate for Payer: Humana Medicaid |
$59.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.40
|
| Rate for Payer: Molina Healthcare Passport |
$59.22
|
| Rate for Payer: Multiplan PHCS |
$1,458.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,701.76
|
| Rate for Payer: UHCCP Medicaid |
$40.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.81
|
|
|
NJX CTH SLCT P-ART ANGRP UNI
|
Facility
|
OP
|
$2,810.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
48100103
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$2,697.60 |
| Rate for Payer: Aetna Commercial |
$2,163.70
|
| Rate for Payer: Anthem Medicaid |
$966.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,191.80
|
| Rate for Payer: Cash Price |
$1,405.00
|
| Rate for Payer: Cigna Commercial |
$2,332.30
|
| Rate for Payer: First Health Commercial |
$2,669.50
|
| Rate for Payer: Humana Commercial |
$2,388.50
|
| Rate for Payer: Humana KY Medicaid |
$966.36
|
| Rate for Payer: Kentucky WC Medicaid |
$976.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,304.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,073.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$985.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,472.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,107.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$871.10
|
| Rate for Payer: PHCS Commercial |
$2,697.60
|
| Rate for Payer: United Healthcare All Payer |
$2,472.80
|
|
|
NJX CTH SLCT P-ART ANGRP UNI
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
76102941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.64
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
NJX CTH SLCT P-ART ANGRP UNI
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
76102941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Anthem Medicaid |
$31.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Humana Medicaid |
$31.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.31
|
| Rate for Payer: Molina Healthcare Passport |
$31.68
|
| Rate for Payer: Multiplan PHCS |
$52.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.60
|
| Rate for Payer: UHCCP Medicaid |
$30.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.00
|
|
|
NJX CTH SLCT P-ART ANGRP UNI
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
76102941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$84.48 |
| Rate for Payer: Aetna Commercial |
$67.76
|
| Rate for Payer: Anthem Medicaid |
$30.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.64
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$73.04
|
| Rate for Payer: First Health Commercial |
$83.60
|
| Rate for Payer: Humana Commercial |
$74.80
|
| Rate for Payer: Humana KY Medicaid |
$30.26
|
| Rate for Payer: Kentucky WC Medicaid |
$30.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$77.44
|
| Rate for Payer: Ohio Health Group HMO |
$66.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.28
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
NJX CTH SLCT P-ART ANGRP UNI
|
Facility
|
IP
|
$2,810.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
48100103
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$2,697.60 |
| Rate for Payer: Aetna Commercial |
$2,163.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,191.80
|
| Rate for Payer: Cash Price |
$1,405.00
|
| Rate for Payer: Cigna Commercial |
$2,332.30
|
| Rate for Payer: First Health Commercial |
$2,669.50
|
| Rate for Payer: Humana Commercial |
$2,388.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,304.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,073.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$843.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,472.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,107.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$562.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$871.10
|
| Rate for Payer: PHCS Commercial |
$2,697.60
|
| Rate for Payer: United Healthcare All Payer |
$2,472.80
|
|
|
NJX CTH SLCT P-ART ANGRP UNI
|
Professional
|
Both
|
$2,810.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
48100103
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$2,810.00 |
| Rate for Payer: Anthem Medicaid |
$31.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,810.00
|
| Rate for Payer: Cash Price |
$1,405.00
|
| Rate for Payer: Cash Price |
$1,405.00
|
| Rate for Payer: Humana Medicaid |
$31.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.31
|
| Rate for Payer: Molina Healthcare Passport |
$31.68
|
| Rate for Payer: Multiplan PHCS |
$1,686.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,967.00
|
| Rate for Payer: UHCCP Medicaid |
$983.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.00
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$2,500.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
76102296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.07 |
| Max. Negotiated Rate |
$2,400.53 |
| Rate for Payer: Aetna Commercial |
$1,925.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.43
|
| Rate for Payer: Cash Price |
$1,250.28
|
| Rate for Payer: Cigna Commercial |
$2,075.46
|
| Rate for Payer: First Health Commercial |
$2,375.52
|
| Rate for Payer: Humana Commercial |
$2,125.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.17
|
| Rate for Payer: PHCS Commercial |
$2,400.53
|
| Rate for Payer: United Healthcare All Payer |
$2,200.48
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Professional
|
Both
|
$2,500.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
76102296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$2,500.55 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.70
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.55
|
| Rate for Payer: Cash Price |
$1,250.28
|
| Rate for Payer: Cash Price |
$1,250.28
|
| Rate for Payer: Cigna Commercial |
$191.10
|
| Rate for Payer: Humana Medicaid |
$89.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.85
|
| Rate for Payer: Molina Healthcare Passport |
$89.07
|
| Rate for Payer: Multiplan PHCS |
$1,500.33
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.38
|
| Rate for Payer: UHCCP Medicaid |
$93.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.96
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$2,500.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
76102296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.07 |
| Max. Negotiated Rate |
$2,400.53 |
| Rate for Payer: Aetna Commercial |
$1,925.42
|
| Rate for Payer: Anthem Medicaid |
$859.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$1,250.28
|
| Rate for Payer: Cash Price |
$1,250.28
|
| Rate for Payer: Cigna Commercial |
$2,075.46
|
| Rate for Payer: First Health Commercial |
$2,375.52
|
| Rate for Payer: Humana Commercial |
$2,125.47
|
| Rate for Payer: Humana KY Medicaid |
$859.94
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$868.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.17
|
| Rate for Payer: PHCS Commercial |
$2,400.53
|
| Rate for Payer: United Healthcare All Payer |
$2,200.48
|
|
|
NJX INTERLAMINAR CRV/THRC(P
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
761P2296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.70
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$435.00
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$191.10
|
| Rate for Payer: Humana Medicaid |
$89.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.85
|
| Rate for Payer: Molina Healthcare Passport |
$89.07
|
| Rate for Payer: Multiplan PHCS |
$261.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.50
|
| Rate for Payer: UHCCP Medicaid |
$93.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.96
|
|
|
NJX INTERLAMINAR CRV/THRC(T
|
Facility
|
OP
|
$2,065.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
761T2296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$1,982.93 |
| Rate for Payer: Aetna Commercial |
$1,590.47
|
| Rate for Payer: Anthem Medicaid |
$710.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$1,032.78
|
| Rate for Payer: Cash Price |
$1,032.78
|
| Rate for Payer: Cigna Commercial |
$1,714.41
|
| Rate for Payer: First Health Commercial |
$1,962.27
|
| Rate for Payer: Humana Commercial |
$1,755.72
|
| Rate for Payer: Humana KY Medicaid |
$710.34
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$717.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,693.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,817.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.32
|
| Rate for Payer: PHCS Commercial |
$1,982.93
|
| Rate for Payer: United Healthcare All Payer |
$1,817.68
|
|
|
NJX INTERLAMINAR CRV/THRC(T
|
Facility
|
IP
|
$2,065.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
761T2296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.52 |
| Max. Negotiated Rate |
$1,982.93 |
| Rate for Payer: Aetna Commercial |
$1,590.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.13
|
| Rate for Payer: Cash Price |
$1,032.78
|
| Rate for Payer: Cigna Commercial |
$1,714.41
|
| Rate for Payer: First Health Commercial |
$1,962.27
|
| Rate for Payer: Humana Commercial |
$1,755.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,693.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,817.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.32
|
| Rate for Payer: PHCS Commercial |
$1,982.93
|
| Rate for Payer: United Healthcare All Payer |
$1,817.68
|
|
|
NJX INTLAMINAR LMBR/SAC WOIMG
|
Facility
|
OP
|
$2,979.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
76102299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.27 |
| Max. Negotiated Rate |
$2,859.84 |
| Rate for Payer: Aetna Commercial |
$2,293.83
|
| Rate for Payer: Anthem Medicaid |
$1,024.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna Commercial |
$2,472.57
|
| Rate for Payer: First Health Commercial |
$2,830.05
|
| Rate for Payer: Humana Commercial |
$2,532.15
|
| Rate for Payer: Humana KY Medicaid |
$1,024.48
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,045.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$923.49
|
| Rate for Payer: PHCS Commercial |
$2,859.84
|
| Rate for Payer: United Healthcare All Payer |
$2,621.52
|
|
|
NJX INTLAMINAR LMBR/SAC WOIMG
|
Professional
|
Both
|
$2,979.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
76102299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$2,979.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.00
|
| Rate for Payer: Anthem Medicaid |
$74.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,979.00
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna Commercial |
$159.22
|
| Rate for Payer: Humana Medicaid |
$74.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.96
|
| Rate for Payer: Molina Healthcare Passport |
$74.47
|
| Rate for Payer: Multiplan PHCS |
$1,787.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,085.30
|
| Rate for Payer: UHCCP Medicaid |
$77.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.21
|
|
|
NJX INTLAMINAR LMBR/SAC WOIMG
|
Facility
|
IP
|
$2,979.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
76102299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.27 |
| Max. Negotiated Rate |
$2,859.84 |
| Rate for Payer: Aetna Commercial |
$2,293.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.62
|
| Rate for Payer: Cash Price |
$1,489.50
|
| Rate for Payer: Cigna Commercial |
$2,472.57
|
| Rate for Payer: First Health Commercial |
$2,830.05
|
| Rate for Payer: Humana Commercial |
$2,532.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$923.49
|
| Rate for Payer: PHCS Commercial |
$2,859.84
|
| Rate for Payer: United Healthcare All Payer |
$2,621.52
|
|
|
NJX INTLAMINAR LMBR/SAC WOIM(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
761P2299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.00
|
| Rate for Payer: Anthem Medicaid |
$74.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$159.22
|
| Rate for Payer: Humana Medicaid |
$74.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.96
|
| Rate for Payer: Molina Healthcare Passport |
$74.47
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$77.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.21
|
|
|
NJX INTLAMINAR LMBR/SAC WOIM(T
|
Facility
|
IP
|
$2,614.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
761T2299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.82 |
| Max. Negotiated Rate |
$2,509.44 |
| Rate for Payer: Aetna Commercial |
$2,012.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,038.92
|
| Rate for Payer: Cash Price |
$1,307.00
|
| Rate for Payer: Cigna Commercial |
$2,169.62
|
| Rate for Payer: First Health Commercial |
$2,483.30
|
| Rate for Payer: Humana Commercial |
$2,221.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,143.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,929.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$784.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,300.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,960.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$522.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.34
|
| Rate for Payer: PHCS Commercial |
$2,509.44
|
| Rate for Payer: United Healthcare All Payer |
$2,300.32
|
|
|
NJX INTLAMINAR LMBR/SAC WOIM(T
|
Facility
|
OP
|
$2,614.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
761T2299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.82 |
| Max. Negotiated Rate |
$2,509.44 |
| Rate for Payer: Aetna Commercial |
$2,012.78
|
| Rate for Payer: Anthem Medicaid |
$898.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,038.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,307.00
|
| Rate for Payer: Cash Price |
$1,307.00
|
| Rate for Payer: Cigna Commercial |
$2,169.62
|
| Rate for Payer: First Health Commercial |
$2,483.30
|
| Rate for Payer: Humana Commercial |
$2,221.90
|
| Rate for Payer: Humana KY Medicaid |
$898.95
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$908.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,143.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,929.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$916.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,300.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,960.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$522.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.34
|
| Rate for Payer: PHCS Commercial |
$2,509.44
|
| Rate for Payer: United Healthcare All Payer |
$2,300.32
|
|
|
NJX PX DISCOGRAPHY LUMBAR
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
76102295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$2,764.80 |
| Rate for Payer: Aetna Commercial |
$2,217.60
|
| Rate for Payer: Anthem Medicaid |
$990.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,246.40
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cigna Commercial |
$2,390.40
|
| Rate for Payer: First Health Commercial |
$2,736.00
|
| Rate for Payer: Humana Commercial |
$2,448.00
|
| Rate for Payer: Humana KY Medicaid |
$990.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,000.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,361.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,125.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,010.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,534.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.80
|
| Rate for Payer: PHCS Commercial |
$2,764.80
|
| Rate for Payer: United Healthcare All Payer |
$2,534.40
|
|
|
NJX PX DISCOGRAPHY LUMBAR
|
Facility
|
IP
|
$2,880.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
76102295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$2,764.80 |
| Rate for Payer: Aetna Commercial |
$2,217.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,246.40
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cigna Commercial |
$2,390.40
|
| Rate for Payer: First Health Commercial |
$2,736.00
|
| Rate for Payer: Humana Commercial |
$2,448.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,361.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,125.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$864.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,534.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.80
|
| Rate for Payer: PHCS Commercial |
$2,764.80
|
| Rate for Payer: United Healthcare All Payer |
$2,534.40
|
|
