|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
OP
|
$2,500.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
76102296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.87 |
| 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 |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| 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 |
$639.87
|
| 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 |
$767.84
|
| 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 |
$2,000.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.38
|
| Rate for Payer: PHCS Commercial |
$2,400.53
|
| Rate for Payer: United Healthcare All Payer |
$2,200.48
|
|
|
NJX INTERLAMINAR CRV/THRC
|
Facility
|
IP
|
$2,500.55
|
|
|
Service Code
|
HCPCS 62321
|
| Hospital Charge Code |
76102296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.16 |
| 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 |
$2,000.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.38
|
| 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
|
$550.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
320P1027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$330.00 |
| 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 |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| 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 |
$330.00
|
| 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(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 |
$261.00 |
| 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 |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| 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 |
$261.00
|
| 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
|
|
|
NJX INTERLAMINAR CRV/THRC (T
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
320T1027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
NJX INTERLAMINAR CRV/THRC (T
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
320T1027
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| 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 |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
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 |
$619.66 |
| 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 |
$1,652.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.23
|
| Rate for Payer: PHCS Commercial |
$1,982.93
|
| Rate for Payer: United Healthcare All Payer |
$1,817.68
|
|
|
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 |
$639.87 |
| 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 |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| 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 |
$639.87
|
| 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 |
$767.84
|
| 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 |
$1,652.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.23
|
| Rate for Payer: PHCS Commercial |
$1,982.93
|
| Rate for Payer: United Healthcare All Payer |
$1,817.68
|
|
|
NJX INTERLAMINAR LMBR/SAC
|
Professional
|
Both
|
$4,185.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
32001028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$2,511.00 |
| Rate for Payer: Ambetter Exchange |
$100.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.75
|
| Rate for Payer: Anthem Medicaid |
$172.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.31
|
| Rate for Payer: Cash Price |
$2,092.50
|
| Rate for Payer: Cash Price |
$2,092.50
|
| Rate for Payer: Cigna Commercial |
$169.54
|
| Rate for Payer: Humana Medicaid |
$172.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.79
|
| Rate for Payer: Molina Healthcare Passport |
$172.34
|
| Rate for Payer: Multiplan PHCS |
$2,511.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.34
|
| Rate for Payer: UHCCP Medicaid |
$86.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.26
|
|
|
NJX INTERLAMINAR LMBR/SAC
|
Facility
|
OP
|
$4,185.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
32001028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna Commercial |
$3,222.45
|
| Rate for Payer: Anthem Medicaid |
$1,439.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,264.30
|
| 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 |
$2,092.50
|
| Rate for Payer: Cash Price |
$2,092.50
|
| Rate for Payer: Cigna Commercial |
$3,473.55
|
| Rate for Payer: First Health Commercial |
$3,975.75
|
| Rate for Payer: Humana Commercial |
$3,557.25
|
| Rate for Payer: Humana KY Medicaid |
$1,439.22
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,453.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,431.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,088.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,468.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,682.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,640.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.65
|
| Rate for Payer: PHCS Commercial |
$4,017.60
|
| Rate for Payer: United Healthcare All Payer |
$3,682.80
|
|
|
NJX INTERLAMINAR LMBR/SAC
|
Facility
|
IP
|
$4,185.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
32001028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,255.50 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna Commercial |
$3,222.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,264.30
|
| Rate for Payer: Cash Price |
$2,092.50
|
| Rate for Payer: Cigna Commercial |
$3,473.55
|
| Rate for Payer: First Health Commercial |
$3,975.75
|
| Rate for Payer: Humana Commercial |
$3,557.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,431.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,088.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,255.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,682.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,138.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,640.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.65
|
| Rate for Payer: PHCS Commercial |
$4,017.60
|
| Rate for Payer: United Healthcare All Payer |
$3,682.80
|
|
|
NJX INTERLAMINAR LMBR/SAC (P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
320P1028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.75 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Ambetter Exchange |
$100.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.75
|
| Rate for Payer: Anthem Medicaid |
$172.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.31
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$169.54
|
| Rate for Payer: Humana Medicaid |
$172.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.79
|
| Rate for Payer: Molina Healthcare Passport |
$172.34
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.34
|
| Rate for Payer: UHCCP Medicaid |
$86.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.26
|
|
|
NJX INTERLAMINAR LMBR/SAC (T
|
Facility
|
OP
|
$3,585.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
320T1028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$3,441.60 |
| Rate for Payer: Aetna Commercial |
$2,760.45
|
| Rate for Payer: Anthem Medicaid |
$1,232.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,796.30
|
| 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 |
$1,792.50
|
| Rate for Payer: Cash Price |
$1,792.50
|
| Rate for Payer: Cigna Commercial |
$2,975.55
|
| Rate for Payer: First Health Commercial |
$3,405.75
|
| Rate for Payer: Humana Commercial |
$3,047.25
|
| Rate for Payer: Humana KY Medicaid |
$1,232.88
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,245.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,939.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,645.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,257.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,154.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.65
|
| Rate for Payer: PHCS Commercial |
$3,441.60
|
| Rate for Payer: United Healthcare All Payer |
$3,154.80
|
|
|
NJX INTERLAMINAR LMBR/SAC (T
|
Facility
|
IP
|
$3,585.00
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
320T1028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,075.50 |
| Max. Negotiated Rate |
$3,441.60 |
| Rate for Payer: Aetna Commercial |
$2,760.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,796.30
|
| Rate for Payer: Cash Price |
$1,792.50
|
| Rate for Payer: Cigna Commercial |
$2,975.55
|
| Rate for Payer: First Health Commercial |
$3,405.75
|
| Rate for Payer: Humana Commercial |
$3,047.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,939.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,645.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,154.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.65
|
| Rate for Payer: PHCS Commercial |
$3,441.60
|
| Rate for Payer: United Healthcare All Payer |
$3,154.80
|
|
|
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 |
$822.61 |
| 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 |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.62
|
| 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 |
$1,489.50
|
| 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 |
$822.61
|
| 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 |
$987.13
|
| 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 |
$2,383.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.51
|
| 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 |
$1,787.40 |
| Rate for Payer: Ambetter Exchange |
$80.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.00
|
| Rate for Payer: Anthem Medicaid |
$119.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.08
|
| 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 |
$119.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.83
|
| Rate for Payer: Molina Healthcare Passport |
$119.44
|
| Rate for Payer: Multiplan PHCS |
$1,787.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.17
|
| Rate for Payer: UHCCP Medicaid |
$77.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.90
|
|
|
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 |
$893.70 |
| 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 |
$2,383.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.51
|
| 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 |
$219.00 |
| Rate for Payer: Ambetter Exchange |
$80.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.00
|
| Rate for Payer: Anthem Medicaid |
$119.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.08
|
| 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 |
$119.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.83
|
| Rate for Payer: Molina Healthcare Passport |
$119.44
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.17
|
| Rate for Payer: UHCCP Medicaid |
$77.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.90
|
|
|
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 |
$822.61 |
| 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 |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,038.92
|
| 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 |
$1,307.00
|
| 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 |
$822.61
|
| 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 |
$987.13
|
| 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 |
$2,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,274.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,803.66
|
| 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
|
IP
|
$2,614.00
|
|
|
Service Code
|
HCPCS 62326
|
| Hospital Charge Code |
761T2299
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.20 |
| 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 |
$2,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,274.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,803.66
|
| Rate for Payer: PHCS Commercial |
$2,509.44
|
| Rate for Payer: United Healthcare All Payer |
$2,300.32
|
|
|
NJX PLATELET PLASMA
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
76102965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
|
|
NJX PLATELET PLASMA
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
76102965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
NJX PLATELET PLASMA
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
76102965
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
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 |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$277.01
|
| Rate for Payer: Ambetter Exchange |
$147.65
|
| 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 Individual/Medicaid |
$147.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$177.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$147.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.65
|
| 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 |
$191.94
|
| Rate for Payer: UHCCP Medicaid |
$85.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.65
|
|
|
NJX PX DISCOGRAPHY LUMBAR
|
Facility
|
OP
|
$2,880.00
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
76102295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$864.00 |
| 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 |
$2,304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,505.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,987.20
|
| Rate for Payer: PHCS Commercial |
$2,764.80
|
| Rate for Payer: United Healthcare All Payer |
$2,534.40
|
|
