|
NJX PX DISCOGRAPHY LUMBAR
|
Professional
|
Both
|
$2,880.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
76102295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$277.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.15
|
| Rate for Payer: Anthem Medicaid |
$160.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,880.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Cigna Commercial |
$255.32
|
| Rate for Payer: Healthspan PPO |
$392.31
|
| Rate for Payer: Humana Medicaid |
$160.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$217.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.99
|
| Rate for Payer: Molina Healthcare Passport |
$160.77
|
| Rate for Payer: Multiplan PHCS |
$1,728.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,016.00
|
| Rate for Payer: UHCCP Medicaid |
$85.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.38
|
|
|
NJX PX DISCOGRAPHY LUMBAR(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
761P2295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$277.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.15
|
| Rate for Payer: Anthem Medicaid |
$160.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$255.32
|
| Rate for Payer: Healthspan PPO |
$392.31
|
| Rate for Payer: Humana Medicaid |
$160.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$217.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.99
|
| Rate for Payer: Molina Healthcare Passport |
$160.77
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$85.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.38
|
|
|
NJX PX DISCOGRAPHY LUMBAR(T
|
Facility
|
IP
|
$2,030.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
761T2295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$1,948.80 |
| Rate for Payer: Aetna Commercial |
$1,563.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.40
|
| Rate for Payer: Cash Price |
$1,015.00
|
| Rate for Payer: Cigna Commercial |
$1,684.90
|
| Rate for Payer: First Health Commercial |
$1,928.50
|
| Rate for Payer: Humana Commercial |
$1,725.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.30
|
| Rate for Payer: PHCS Commercial |
$1,948.80
|
| Rate for Payer: United Healthcare All Payer |
$1,786.40
|
|
|
NJX PX DISCOGRAPHY LUMBAR(T
|
Facility
|
OP
|
$2,030.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
761T2295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.90 |
| Max. Negotiated Rate |
$1,948.80 |
| Rate for Payer: Aetna Commercial |
$1,563.10
|
| Rate for Payer: Anthem Medicaid |
$698.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.40
|
| Rate for Payer: Cash Price |
$1,015.00
|
| Rate for Payer: Cigna Commercial |
$1,684.90
|
| Rate for Payer: First Health Commercial |
$1,928.50
|
| Rate for Payer: Humana Commercial |
$1,725.50
|
| Rate for Payer: Humana KY Medicaid |
$698.12
|
| Rate for Payer: Kentucky WC Medicaid |
$705.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.30
|
| Rate for Payer: PHCS Commercial |
$1,948.80
|
| Rate for Payer: United Healthcare All Payer |
$1,786.40
|
|
|
NJX PX NFROSGRM &/URTRGRM
|
Professional
|
Both
|
$4,017.00
|
|
|
Service Code
|
HCPCS 50430
|
| Hospital Charge Code |
76102892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.09 |
| Max. Negotiated Rate |
$4,017.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.09
|
| Rate for Payer: Anthem Medicaid |
$136.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,008.50
|
| Rate for Payer: Cash Price |
$2,008.50
|
| Rate for Payer: Cigna Commercial |
$827.67
|
| Rate for Payer: Humana Medicaid |
$136.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.02
|
| Rate for Payer: Molina Healthcare Passport |
$136.29
|
| Rate for Payer: Multiplan PHCS |
$2,410.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,811.90
|
| Rate for Payer: UHCCP Medicaid |
$141.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.65
|
|
|
NJX PX NFROSGRM &/URTRGRM
|
Facility
|
IP
|
$4,017.00
|
|
|
Service Code
|
HCPCS 50430
|
| Hospital Charge Code |
76102892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.21 |
| Max. Negotiated Rate |
$3,856.32 |
| Rate for Payer: Aetna Commercial |
$3,093.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,133.26
|
| Rate for Payer: Cash Price |
$2,008.50
|
| Rate for Payer: Cigna Commercial |
$3,334.11
|
| Rate for Payer: First Health Commercial |
$3,816.15
|
| Rate for Payer: Humana Commercial |
$3,414.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,293.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,205.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,534.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,012.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$803.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.27
|
| Rate for Payer: PHCS Commercial |
$3,856.32
|
| Rate for Payer: United Healthcare All Payer |
$3,534.96
|
|
|
NJX PX NFROSGRM &/URTRGRM
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
76102908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$827.01 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
NJX PX NFROSGRM &/URTRGRM
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
76102908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
NJX PX NFROSGRM &/URTRGRM
|
Professional
|
Both
|
$763.00
|
|
|
Service Code
|
HCPCS 50431
|
| Hospital Charge Code |
76102908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$763.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.32
|
| Rate for Payer: Anthem Medicaid |
$53.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.00
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$110.02
|
| Rate for Payer: Humana Medicaid |
$53.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.69
|
| Rate for Payer: Molina Healthcare Passport |
$53.62
|
| Rate for Payer: Multiplan PHCS |
$457.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$534.10
|
| Rate for Payer: UHCCP Medicaid |
$55.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.16
|
|
|
NJX PX NFROSGRM &/URTRGRM
|
Facility
|
OP
|
$4,017.00
|
|
|
Service Code
|
HCPCS 50430
|
| Hospital Charge Code |
76102892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.21 |
| Max. Negotiated Rate |
$3,856.32 |
| Rate for Payer: Aetna Commercial |
$3,093.09
|
| Rate for Payer: Anthem Medicaid |
$1,381.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,133.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$2,008.50
|
| Rate for Payer: Cash Price |
$2,008.50
|
| Rate for Payer: Cigna Commercial |
$3,334.11
|
| Rate for Payer: First Health Commercial |
$3,816.15
|
| Rate for Payer: Humana Commercial |
$3,414.45
|
| Rate for Payer: Humana KY Medicaid |
$1,381.45
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,395.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,293.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,409.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,534.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,012.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$803.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.27
|
| Rate for Payer: PHCS Commercial |
$3,856.32
|
| Rate for Payer: United Healthcare All Payer |
$3,534.96
|
|
|
NJX PX NFROSGRM &/URTRGRM (P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 50430
|
| Hospital Charge Code |
761P2892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.09 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.09
|
| Rate for Payer: Anthem Medicaid |
$136.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$827.67
|
| Rate for Payer: Humana Medicaid |
$136.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.02
|
| Rate for Payer: Molina Healthcare Passport |
$136.29
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$141.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.65
|
|
|
NJX PX NFROSGRM &/URTRGRM (T
|
Facility
|
IP
|
$2,517.00
|
|
|
Service Code
|
HCPCS 50430
|
| Hospital Charge Code |
761T2892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.21 |
| Max. Negotiated Rate |
$2,416.32 |
| Rate for Payer: Aetna Commercial |
$1,938.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,963.26
|
| Rate for Payer: Cash Price |
$1,258.50
|
| Rate for Payer: Cigna Commercial |
$2,089.11
|
| Rate for Payer: First Health Commercial |
$2,391.15
|
| Rate for Payer: Humana Commercial |
$2,139.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,063.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,857.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,214.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,887.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.27
|
| Rate for Payer: PHCS Commercial |
$2,416.32
|
| Rate for Payer: United Healthcare All Payer |
$2,214.96
|
|
|
NJX PX NFROSGRM &/URTRGRM (T
|
Facility
|
OP
|
$2,517.00
|
|
|
Service Code
|
HCPCS 50430
|
| Hospital Charge Code |
761T2892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.21 |
| Max. Negotiated Rate |
$2,416.32 |
| Rate for Payer: Aetna Commercial |
$1,938.09
|
| Rate for Payer: Anthem Medicaid |
$865.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,963.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$1,258.50
|
| Rate for Payer: Cash Price |
$1,258.50
|
| Rate for Payer: Cigna Commercial |
$2,089.11
|
| Rate for Payer: First Health Commercial |
$2,391.15
|
| Rate for Payer: Humana Commercial |
$2,139.45
|
| Rate for Payer: Humana KY Medicaid |
$865.60
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$874.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,063.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,857.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,214.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,887.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.27
|
| Rate for Payer: PHCS Commercial |
$2,416.32
|
| Rate for Payer: United Healthcare All Payer |
$2,214.96
|
|
|
NJX SBST INTLMNR LMBR/SAC WIMG
|
Facility
|
IP
|
$2,018.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
761T2298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.34 |
| Max. Negotiated Rate |
$1,937.28 |
| Rate for Payer: Aetna Commercial |
$1,553.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.04
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cigna Commercial |
$1,674.94
|
| Rate for Payer: First Health Commercial |
$1,917.10
|
| Rate for Payer: Humana Commercial |
$1,715.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.58
|
| Rate for Payer: PHCS Commercial |
$1,937.28
|
| Rate for Payer: United Healthcare All Payer |
$1,775.84
|
|
|
NJX SBST INTLMNR LMBR/SAC WIMG
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
76102298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.59 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem Medicaid |
$840.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Humana KY Medicaid |
$840.15
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$857.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.33
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
NJX SBST INTLMNR LMBR/SAC WIMG
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
76102298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.87 |
| Max. Negotiated Rate |
$2,443.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.87
|
| Rate for Payer: Anthem Medicaid |
$81.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,443.00
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$174.27
|
| Rate for Payer: Humana Medicaid |
$81.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$128.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.96
|
| Rate for Payer: Molina Healthcare Passport |
$81.33
|
| Rate for Payer: Multiplan PHCS |
$1,465.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,710.10
|
| Rate for Payer: UHCCP Medicaid |
$84.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.14
|
|
|
NJX SBST INTLMNR LMBR/SAC WIMG
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
76102298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$317.59 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$757.33
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
NJX SBST INTLMNR LMBR/SAC WIMG
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
761P2298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.87 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.87
|
| Rate for Payer: Anthem Medicaid |
$81.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$174.27
|
| Rate for Payer: Humana Medicaid |
$81.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$128.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.96
|
| Rate for Payer: Molina Healthcare Passport |
$81.33
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$84.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.14
|
|
|
NJX SBST INTLMNR LMBR/SAC WIMG
|
Facility
|
OP
|
$2,018.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
761T2298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.34 |
| Max. Negotiated Rate |
$1,937.28 |
| Rate for Payer: Aetna Commercial |
$1,553.86
|
| Rate for Payer: Anthem Medicaid |
$693.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cigna Commercial |
$1,674.94
|
| Rate for Payer: First Health Commercial |
$1,917.10
|
| Rate for Payer: Humana Commercial |
$1,715.30
|
| Rate for Payer: Humana KY Medicaid |
$693.99
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$701.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.58
|
| Rate for Payer: PHCS Commercial |
$1,937.28
|
| Rate for Payer: United Healthcare All Payer |
$1,775.84
|
|
|
NJX SBST INTLMNR LMBRSAC WOIMG
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
761P2297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.75
|
| Rate for Payer: Anthem Medicaid |
$71.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$290.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$152.46
|
| Rate for Payer: Humana Medicaid |
$71.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.51
|
| Rate for Payer: Molina Healthcare Passport |
$71.09
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$74.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.80
|
|
|
NJX SBST INTLMNR LMBRSAC WOIMG
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
761T2297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$1,854.72 |
| Rate for Payer: Aetna Commercial |
$1,487.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.96
|
| Rate for Payer: Cash Price |
$966.00
|
| Rate for Payer: Cigna Commercial |
$1,603.56
|
| Rate for Payer: First Health Commercial |
$1,835.40
|
| Rate for Payer: Humana Commercial |
$1,642.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.92
|
| Rate for Payer: PHCS Commercial |
$1,854.72
|
| Rate for Payer: United Healthcare All Payer |
$1,700.16
|
|
|
NJX SBST INTLMNR LMBRSAC WOIMG
|
Facility
|
OP
|
$2,222.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
76102297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.86 |
| Max. Negotiated Rate |
$2,133.12 |
| Rate for Payer: Aetna Commercial |
$1,710.94
|
| Rate for Payer: Anthem Medicaid |
$764.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.16
|
| 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 |
$1,111.00
|
| Rate for Payer: Cash Price |
$1,111.00
|
| Rate for Payer: Cigna Commercial |
$1,844.26
|
| Rate for Payer: First Health Commercial |
$2,110.90
|
| Rate for Payer: Humana Commercial |
$1,888.70
|
| Rate for Payer: Humana KY Medicaid |
$764.15
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$771.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,639.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$779.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,955.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,666.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$688.82
|
| Rate for Payer: PHCS Commercial |
$2,133.12
|
| Rate for Payer: United Healthcare All Payer |
$1,955.36
|
|
|
NJX SBST INTLMNR LMBRSAC WOIMG
|
Professional
|
Both
|
$2,222.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
76102297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.75 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.75
|
| Rate for Payer: Anthem Medicaid |
$71.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,222.00
|
| Rate for Payer: Cash Price |
$1,111.00
|
| Rate for Payer: Cash Price |
$1,111.00
|
| Rate for Payer: Cigna Commercial |
$152.46
|
| Rate for Payer: Humana Medicaid |
$71.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.51
|
| Rate for Payer: Molina Healthcare Passport |
$71.09
|
| Rate for Payer: Multiplan PHCS |
$1,333.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,555.40
|
| Rate for Payer: UHCCP Medicaid |
$74.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.80
|
|
|
NJX SBST INTLMNR LMBRSAC WOIMG
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
761T2297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$1,854.72 |
| Rate for Payer: Aetna Commercial |
$1,487.64
|
| Rate for Payer: Anthem Medicaid |
$664.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.96
|
| 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 |
$966.00
|
| Rate for Payer: Cash Price |
$966.00
|
| Rate for Payer: Cigna Commercial |
$1,603.56
|
| Rate for Payer: First Health Commercial |
$1,835.40
|
| Rate for Payer: Humana Commercial |
$1,642.20
|
| Rate for Payer: Humana KY Medicaid |
$664.41
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$671.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.92
|
| Rate for Payer: PHCS Commercial |
$1,854.72
|
| Rate for Payer: United Healthcare All Payer |
$1,700.16
|
|
|
NJX SBST INTLMNR LMBRSAC WOIMG
|
Facility
|
IP
|
$2,222.00
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
76102297
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.86 |
| Max. Negotiated Rate |
$2,133.12 |
| Rate for Payer: Aetna Commercial |
$1,710.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.16
|
| Rate for Payer: Cash Price |
$1,111.00
|
| Rate for Payer: Cigna Commercial |
$1,844.26
|
| Rate for Payer: First Health Commercial |
$2,110.90
|
| Rate for Payer: Humana Commercial |
$1,888.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,639.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,955.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,666.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$688.82
|
| Rate for Payer: PHCS Commercial |
$2,133.12
|
| Rate for Payer: United Healthcare All Payer |
$1,955.36
|
|
