|
NJX AA&/STRD GNCLR NRV BRNCH
|
Professional
|
Both
|
$2,240.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
76102817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Ambetter Exchange |
$77.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.29
|
| Rate for Payer: Anthem Medicaid |
$161.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.30
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Humana Medicaid |
$161.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.93
|
| Rate for Payer: Molina Healthcare Passport |
$161.70
|
| Rate for Payer: Multiplan PHCS |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.08
|
| Rate for Payer: UHCCP Medicaid |
$69.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.75
|
|
|
NJX AA&/STRD GNCLR NRV BRNCH
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
76102817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.60
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
NJX AA&/STRD GNCLR NRV BRNCH
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
76102817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.87 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem Medicaid |
$770.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Humana KY Medicaid |
$770.34
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$785.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.60
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
NJX AA&/STRD GNCLR NRV BRNCH(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
761P2817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.29 |
| Max. Negotiated Rate |
$164.93 |
| Rate for Payer: Ambetter Exchange |
$77.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.29
|
| Rate for Payer: Anthem Medicaid |
$161.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.30
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Humana Medicaid |
$161.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.93
|
| Rate for Payer: Molina Healthcare Passport |
$161.70
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.08
|
| Rate for Payer: UHCCP Medicaid |
$69.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.75
|
|
|
NJX AA&/STRD GNCLR NRV BRNCH(T
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
761T2817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.87 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna Commercial |
$1,536.15
|
| Rate for Payer: Anthem Medicaid |
$686.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,556.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cigna Commercial |
$1,655.85
|
| Rate for Payer: First Health Commercial |
$1,895.25
|
| Rate for Payer: Humana Commercial |
$1,695.75
|
| Rate for Payer: Humana KY Medicaid |
$686.08
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$693.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,635.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,472.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,755.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,496.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,735.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,376.55
|
| Rate for Payer: PHCS Commercial |
$1,915.20
|
| Rate for Payer: United Healthcare All Payer |
$1,755.60
|
|
|
NJX AA&/STRD GNCLR NRV BRNCH(T
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
761T2817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$598.50 |
| Max. Negotiated Rate |
$1,915.20 |
| Rate for Payer: Aetna Commercial |
$1,536.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,556.10
|
| Rate for Payer: Cash Price |
$997.50
|
| Rate for Payer: Cigna Commercial |
$1,655.85
|
| Rate for Payer: First Health Commercial |
$1,895.25
|
| Rate for Payer: Humana Commercial |
$1,695.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,635.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,472.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,755.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,496.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,735.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,376.55
|
| Rate for Payer: PHCS Commercial |
$1,915.20
|
| Rate for Payer: United Healthcare All Payer |
$1,755.60
|
|
|
NJX AA&/STRD NRV NRVTG SI JT
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
76102706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
NJX AA&/STRD NRV NRVTG SI JT
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
76102706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.44 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Ambetter Exchange |
$77.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.44
|
| Rate for Payer: Anthem Medicaid |
$160.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.95
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Humana Medicaid |
$160.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.35
|
| Rate for Payer: Molina Healthcare Passport |
$160.15
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.70
|
| Rate for Payer: UHCCP Medicaid |
$67.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.46
|
|
|
NJX AA&/STRD NRV NRVTG SI JT
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
HCPCS 64451
|
| Hospital Charge Code |
76102706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.44 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem Medicaid |
$144.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Humana KY Medicaid |
$144.44
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$145.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
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 |
$270.00 |
| Rate for Payer: Aetna Commercial |
$108.05
|
| Rate for Payer: Ambetter Exchange |
$71.47
|
| 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 Individual/Medicaid |
$71.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$71.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.47
|
| 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 |
$92.91
|
| Rate for Payer: UHCCP Medicaid |
$40.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.47
|
|
|
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 |
$729.32 |
| 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 |
$1,944.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,677.45
|
| 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 |
$594.32 |
| 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 |
$1,584.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,723.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.95
|
| Rate for Payer: PHCS Commercial |
$1,901.84
|
| Rate for Payer: United Healthcare All Payer |
$1,743.35
|
|
|
NJX ANES STELLTE GANG CRV SYMP
|
Facility
|
OP
|
$2,431.08
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
76102333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$2,333.84 |
| Rate for Payer: Aetna Commercial |
$1,871.93
|
| Rate for Payer: Anthem Medicaid |
$836.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,896.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Cash Price |
$1,215.54
|
| 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: Humana KY Medicaid |
$836.05
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$844.56
|
| 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 |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.82
|
| 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 |
$1,944.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,677.45
|
| 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
|
OP
|
$1,981.08
|
|
|
Service Code
|
HCPCS 64510
|
| Hospital Charge Code |
761T2333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.29 |
| 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 |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| 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 |
$822.61
|
| 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 |
$987.13
|
| 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 |
$1,584.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,723.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.95
|
| 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 |
$1,458.65 |
| Rate for Payer: Aetna Commercial |
$108.05
|
| Rate for Payer: Ambetter Exchange |
$71.47
|
| 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 Individual/Medicaid |
$71.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$71.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.47
|
| 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 |
$92.91
|
| Rate for Payer: UHCCP Medicaid |
$40.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.47
|
|
|
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 |
$52.80 |
| Rate for Payer: Ambetter Exchange |
$34.86
|
| Rate for Payer: Anthem Medicaid |
$31.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.83
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Humana Medicaid |
$31.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.86
|
| 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 |
$45.32
|
| Rate for Payer: UHCCP Medicaid |
$30.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.86
|
|
|
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 |
$843.00 |
| 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 |
$2,248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,444.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,938.90
|
| 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
|
OP
|
$2,810.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
48100103
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$843.00 |
| 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 |
$2,248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,444.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,938.90
|
| 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 |
$26.40 |
| 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 |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.72
|
| Rate for Payer: PHCS Commercial |
$84.48
|
| Rate for Payer: United Healthcare All Payer |
$77.44
|
|
|
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 |
$26.40 |
| 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 |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.72
|
| 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
|
$2,810.00
|
|
|
Service Code
|
HCPCS 93569
|
| Hospital Charge Code |
48100103
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$1,686.00 |
| Rate for Payer: Ambetter Exchange |
$34.86
|
| Rate for Payer: Anthem Medicaid |
$31.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$34.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.86
|
| 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 |
$45.32
|
| Rate for Payer: UHCCP Medicaid |
$983.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.86
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
32001027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem Medicaid |
$1,152.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Humana KY Medicaid |
$1,152.07
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,175.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
32001027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$3,216.00 |
| Rate for Payer: Aetna Commercial |
$2,579.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,613.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$2,780.50
|
| Rate for Payer: First Health Commercial |
$3,182.50
|
| Rate for Payer: Humana Commercial |
$2,847.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,747.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,948.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,512.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,914.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.50
|
| Rate for Payer: PHCS Commercial |
$3,216.00
|
| Rate for Payer: United Healthcare All Payer |
$2,948.00
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
32001027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$2,010.00 |
| Rate for Payer: Ambetter Exchange |
$102.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.01
|
| Rate for Payer: Anthem Medicaid |
$170.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$123.37
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna Commercial |
$186.98
|
| Rate for Payer: Humana Medicaid |
$170.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.62
|
| Rate for Payer: Molina Healthcare Passport |
$170.22
|
| Rate for Payer: Multiplan PHCS |
$2,010.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.65
|
| Rate for Payer: UHCCP Medicaid |
$91.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.81
|
|
|
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 |
$1,500.33 |
| Rate for Payer: Ambetter Exchange |
$100.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.70
|
| Rate for Payer: Anthem Medicaid |
$190.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.10
|
| 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 |
$190.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.98
|
| Rate for Payer: Molina Healthcare Passport |
$190.18
|
| Rate for Payer: Multiplan PHCS |
$1,500.33
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.20
|
| Rate for Payer: UHCCP Medicaid |
$93.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.92
|
|
