|
EQUINOXE REV HUM LINR 42MM+2.5
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LINR 46MM+2.5
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LINR 46MM+2.5
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LNR CN 38M +0
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LNR CN 38M +0
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LNR CN 42MM+0
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LNR CN 42MM+0
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LNR CN 46M +0
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOXE REV HUM LNR CN 46M +0
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOX PLAT LG STEM L 6.5*200
|
Facility
|
IP
|
$24,692.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,210.02 |
| Max. Negotiated Rate |
$23,704.80 |
| Rate for Payer: Aetna Commercial |
$19,013.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,260.15
|
| Rate for Payer: Cash Price |
$12,346.25
|
| Rate for Payer: Cigna Commercial |
$20,494.78
|
| Rate for Payer: First Health Commercial |
$23,457.88
|
| Rate for Payer: Humana Commercial |
$20,988.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,247.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,223.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,407.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,729.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,938.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,654.68
|
| Rate for Payer: PHCS Commercial |
$23,704.80
|
| Rate for Payer: United Healthcare All Payer |
$21,729.40
|
|
|
EQUINOX PLAT LG STEM L 6.5*200
|
Facility
|
OP
|
$24,692.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,210.02 |
| Max. Negotiated Rate |
$23,704.80 |
| Rate for Payer: Aetna Commercial |
$19,013.22
|
| Rate for Payer: Anthem Medicaid |
$8,491.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,260.15
|
| Rate for Payer: Cash Price |
$12,346.25
|
| Rate for Payer: Cigna Commercial |
$20,494.78
|
| Rate for Payer: First Health Commercial |
$23,457.88
|
| Rate for Payer: Humana Commercial |
$20,988.62
|
| Rate for Payer: Humana KY Medicaid |
$8,491.75
|
| Rate for Payer: Kentucky WC Medicaid |
$8,578.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,247.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,223.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,407.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,662.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,729.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,938.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,654.68
|
| Rate for Payer: PHCS Commercial |
$23,704.80
|
| Rate for Payer: United Healthcare All Payer |
$21,729.40
|
|
|
EQUINOX PLAT LG STEM R 6.5*200
|
Facility
|
IP
|
$24,692.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,210.02 |
| Max. Negotiated Rate |
$23,704.80 |
| Rate for Payer: Aetna Commercial |
$19,013.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,260.15
|
| Rate for Payer: Cash Price |
$12,346.25
|
| Rate for Payer: Cigna Commercial |
$20,494.78
|
| Rate for Payer: First Health Commercial |
$23,457.88
|
| Rate for Payer: Humana Commercial |
$20,988.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,247.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,223.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,407.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,729.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,938.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,654.68
|
| Rate for Payer: PHCS Commercial |
$23,704.80
|
| Rate for Payer: United Healthcare All Payer |
$21,729.40
|
|
|
EQUINOX PLAT LG STEM R 6.5*200
|
Facility
|
OP
|
$24,692.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,210.02 |
| Max. Negotiated Rate |
$23,704.80 |
| Rate for Payer: Aetna Commercial |
$19,013.22
|
| Rate for Payer: Anthem Medicaid |
$8,491.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,260.15
|
| Rate for Payer: Cash Price |
$12,346.25
|
| Rate for Payer: Cigna Commercial |
$20,494.78
|
| Rate for Payer: First Health Commercial |
$23,457.88
|
| Rate for Payer: Humana Commercial |
$20,988.62
|
| Rate for Payer: Humana KY Medicaid |
$8,491.75
|
| Rate for Payer: Kentucky WC Medicaid |
$8,578.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,247.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,223.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,407.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,662.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,729.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,938.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,654.68
|
| Rate for Payer: PHCS Commercial |
$23,704.80
|
| Rate for Payer: United Healthcare All Payer |
$21,729.40
|
|
|
EQUINOX REV HUM LNR CN 38M+2.5
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOX REV HUM LNR CN 38M+2.5
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOX REV HUM LNR CN 42M+2.5
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOX REV HUM LNR CN 42M+2.5
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOX REV HUM LNR CN 46M+2.5
|
Facility
|
IP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
EQUINOX REV HUM LNR CN 46M+2.5
|
Facility
|
OP
|
$5,598.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.80 |
| Max. Negotiated Rate |
$5,374.56 |
| Rate for Payer: Aetna Commercial |
$4,310.84
|
| Rate for Payer: Anthem Medicaid |
$1,925.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,366.83
|
| Rate for Payer: Cash Price |
$2,799.25
|
| Rate for Payer: Cigna Commercial |
$4,646.76
|
| Rate for Payer: First Health Commercial |
$5,318.58
|
| Rate for Payer: Humana Commercial |
$4,758.72
|
| Rate for Payer: Humana KY Medicaid |
$1,925.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,944.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,590.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,131.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,679.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,963.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,926.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,198.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,735.54
|
| Rate for Payer: PHCS Commercial |
$5,374.56
|
| Rate for Payer: United Healthcare All Payer |
$4,926.68
|
|
|
ERASE IT KIT
|
Professional
|
Both
|
$190.00
|
|
| Hospital Charge Code |
22200134
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$190.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.00
|
| Rate for Payer: UHCCP Medicaid |
$66.50
|
|
|
ERAVACYCLINE 1MG (100MG SDV)
|
Facility
|
OP
|
$599.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
25004226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$575.52 |
| Rate for Payer: Aetna Commercial |
$461.62
|
| Rate for Payer: Anthem Medicaid |
$206.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.38
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Cigna Commercial |
$497.58
|
| Rate for Payer: First Health Commercial |
$569.52
|
| Rate for Payer: Humana Commercial |
$509.58
|
| Rate for Payer: Humana KY Medicaid |
$206.17
|
| Rate for Payer: Humana Medicare Advantage |
$1.02
|
| Rate for Payer: Kentucky WC Medicaid |
$208.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.56
|
| Rate for Payer: Ohio Health Group HMO |
$449.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.84
|
| Rate for Payer: PHCS Commercial |
$575.52
|
| Rate for Payer: United Healthcare All Payer |
$527.56
|
|
|
ERAVACYCLINE 1MG (100MG SDV)
|
Facility
|
IP
|
$599.50
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
25004226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.94 |
| Max. Negotiated Rate |
$575.52 |
| Rate for Payer: Aetna Commercial |
$461.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.61
|
| Rate for Payer: Cash Price |
$299.75
|
| Rate for Payer: Cigna Commercial |
$497.58
|
| Rate for Payer: First Health Commercial |
$569.52
|
| Rate for Payer: Humana Commercial |
$509.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.56
|
| Rate for Payer: Ohio Health Group HMO |
$449.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.84
|
| Rate for Payer: PHCS Commercial |
$575.52
|
| Rate for Payer: United Healthcare All Payer |
$527.56
|
|
|
ERAVACYCLINE 1mg (50mg SDV)
|
Facility
|
OP
|
$267.05
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
25003945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$256.37 |
| Rate for Payer: Aetna Commercial |
$205.63
|
| Rate for Payer: Anthem Medicaid |
$91.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.38
|
| Rate for Payer: Cash Price |
$133.52
|
| Rate for Payer: Cash Price |
$133.52
|
| Rate for Payer: Cigna Commercial |
$221.65
|
| Rate for Payer: First Health Commercial |
$253.70
|
| Rate for Payer: Humana Commercial |
$226.99
|
| Rate for Payer: Humana KY Medicaid |
$91.84
|
| Rate for Payer: Humana Medicare Advantage |
$1.02
|
| Rate for Payer: Kentucky WC Medicaid |
$92.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.00
|
| Rate for Payer: Ohio Health Group HMO |
$200.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.79
|
| Rate for Payer: PHCS Commercial |
$256.37
|
| Rate for Payer: United Healthcare All Payer |
$235.00
|
|
|
ERAVACYCLINE 1mg (50mg SDV)
|
Facility
|
IP
|
$267.05
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
25003945
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$256.37 |
| Rate for Payer: Aetna Commercial |
$205.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.30
|
| Rate for Payer: Cash Price |
$133.52
|
| Rate for Payer: Cigna Commercial |
$221.65
|
| Rate for Payer: First Health Commercial |
$253.70
|
| Rate for Payer: Humana Commercial |
$226.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.00
|
| Rate for Payer: Ohio Health Group HMO |
$200.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.79
|
| Rate for Payer: PHCS Commercial |
$256.37
|
| Rate for Payer: United Healthcare All Payer |
$235.00
|
|
|
ERBE HYBRID KNIFE
|
Facility
|
OP
|
$12,224.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,589.15 |
| Max. Negotiated Rate |
$11,735.28 |
| Rate for Payer: Aetna Commercial |
$9,412.67
|
| Rate for Payer: Anthem Medicaid |
$4,203.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,534.92
|
| Rate for Payer: Cash Price |
$6,112.12
|
| Rate for Payer: Cigna Commercial |
$10,146.13
|
| Rate for Payer: First Health Commercial |
$11,613.04
|
| Rate for Payer: Humana Commercial |
$10,390.61
|
| Rate for Payer: Humana KY Medicaid |
$4,203.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,246.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,023.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,021.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,667.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,288.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,757.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,168.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,444.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,589.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,789.52
|
| Rate for Payer: PHCS Commercial |
$11,735.28
|
| Rate for Payer: United Healthcare All Payer |
$10,757.34
|
|
