|
EQUINOXE HUM HEAD SHORT 41MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 41MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 44MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 44MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 47MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 47MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD SHORT 50MM
|
Facility
|
IP
|
$11,249.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.46 |
| Max. Negotiated Rate |
$10,799.71 |
| Rate for Payer: Aetna Commercial |
$8,662.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,774.77
|
| Rate for Payer: Cash Price |
$5,624.85
|
| Rate for Payer: Cigna Commercial |
$9,337.25
|
| Rate for Payer: First Health Commercial |
$10,687.22
|
| Rate for Payer: Humana Commercial |
$9,562.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,224.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,302.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,374.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,899.74
|
| Rate for Payer: Ohio Health Group HMO |
$8,437.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,462.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.41
|
| Rate for Payer: PHCS Commercial |
$10,799.71
|
| Rate for Payer: United Healthcare All Payer |
$9,899.74
|
|
|
EQUINOXE HUM HEAD SHORT 50MM
|
Facility
|
OP
|
$11,249.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.46 |
| Max. Negotiated Rate |
$10,799.71 |
| Rate for Payer: Aetna Commercial |
$8,662.27
|
| Rate for Payer: Anthem Medicaid |
$3,868.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,774.77
|
| Rate for Payer: Cash Price |
$5,624.85
|
| Rate for Payer: Cigna Commercial |
$9,337.25
|
| Rate for Payer: First Health Commercial |
$10,687.22
|
| Rate for Payer: Humana Commercial |
$9,562.24
|
| Rate for Payer: Humana KY Medicaid |
$3,868.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,908.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,224.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,302.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,374.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,946.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,899.74
|
| Rate for Payer: Ohio Health Group HMO |
$8,437.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,462.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.41
|
| Rate for Payer: PHCS Commercial |
$10,799.71
|
| Rate for Payer: United Healthcare All Payer |
$9,899.74
|
|
|
EQUINOXE HUM HEAD SHORT 53MM
|
Facility
|
IP
|
$11,249.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.46 |
| Max. Negotiated Rate |
$10,799.71 |
| Rate for Payer: Aetna Commercial |
$8,662.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,774.77
|
| Rate for Payer: Cash Price |
$5,624.85
|
| Rate for Payer: Cigna Commercial |
$9,337.25
|
| Rate for Payer: First Health Commercial |
$10,687.22
|
| Rate for Payer: Humana Commercial |
$9,562.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,224.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,302.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,374.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,899.74
|
| Rate for Payer: Ohio Health Group HMO |
$8,437.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,462.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.41
|
| Rate for Payer: PHCS Commercial |
$10,799.71
|
| Rate for Payer: United Healthcare All Payer |
$9,899.74
|
|
|
EQUINOXE HUM HEAD SHORT 53MM
|
Facility
|
OP
|
$11,249.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.46 |
| Max. Negotiated Rate |
$10,799.71 |
| Rate for Payer: Aetna Commercial |
$8,662.27
|
| Rate for Payer: Anthem Medicaid |
$3,868.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,774.77
|
| Rate for Payer: Cash Price |
$5,624.85
|
| Rate for Payer: Cigna Commercial |
$9,337.25
|
| Rate for Payer: First Health Commercial |
$10,687.22
|
| Rate for Payer: Humana Commercial |
$9,562.24
|
| Rate for Payer: Humana KY Medicaid |
$3,868.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,908.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,224.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,302.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,374.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,946.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,899.74
|
| Rate for Payer: Ohio Health Group HMO |
$8,437.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,249.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,462.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.41
|
| Rate for Payer: PHCS Commercial |
$10,799.71
|
| Rate for Payer: United Healthcare All Payer |
$9,899.74
|
|
|
EQUINOXE HUM HEAD TALL 38MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 38MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 41MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 41MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 44MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 44MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 47MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 47MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 50MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 50MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 53MM
|
Facility
|
OP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem Medicaid |
$2,895.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Humana KY Medicaid |
$2,895.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM HEAD TALL 53MM
|
Facility
|
IP
|
$8,421.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.73 |
| Max. Negotiated Rate |
$8,084.16 |
| Rate for Payer: Aetna Commercial |
$6,484.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.38
|
| Rate for Payer: Cash Price |
$4,210.50
|
| Rate for Payer: Cigna Commercial |
$6,989.43
|
| Rate for Payer: First Health Commercial |
$7,999.95
|
| Rate for Payer: Humana Commercial |
$7,157.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,610.51
|
| Rate for Payer: PHCS Commercial |
$8,084.16
|
| Rate for Payer: United Healthcare All Payer |
$7,410.48
|
|
|
EQUINOXE HUM LONG STEM 10*200
|
Facility
|
IP
|
$20,743.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,696.62 |
| Max. Negotiated Rate |
$19,913.47 |
| Rate for Payer: Aetna Commercial |
$15,972.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,179.70
|
| Rate for Payer: Cash Price |
$10,371.60
|
| Rate for Payer: Cigna Commercial |
$17,216.86
|
| Rate for Payer: First Health Commercial |
$19,706.04
|
| Rate for Payer: Humana Commercial |
$17,631.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,009.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,222.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,254.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,430.39
|
| Rate for Payer: PHCS Commercial |
$19,913.47
|
| Rate for Payer: United Healthcare All Payer |
$18,254.02
|
|
|
EQUINOXE HUM LONG STEM 10*200
|
Facility
|
OP
|
$20,743.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,696.62 |
| Max. Negotiated Rate |
$19,913.47 |
| Rate for Payer: Aetna Commercial |
$15,972.26
|
| Rate for Payer: Anthem Medicaid |
$7,133.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,179.70
|
| Rate for Payer: Cash Price |
$10,371.60
|
| Rate for Payer: Cigna Commercial |
$17,216.86
|
| Rate for Payer: First Health Commercial |
$19,706.04
|
| Rate for Payer: Humana Commercial |
$17,631.72
|
| Rate for Payer: Humana KY Medicaid |
$7,133.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,206.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,009.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,222.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,276.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,254.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,430.39
|
| Rate for Payer: PHCS Commercial |
$19,913.47
|
| Rate for Payer: United Healthcare All Payer |
$18,254.02
|
|
|
EQUINOXE HUM LONG STEM 12*200
|
Facility
|
IP
|
$20,743.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,696.62 |
| Max. Negotiated Rate |
$19,913.47 |
| Rate for Payer: Aetna Commercial |
$15,972.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,179.70
|
| Rate for Payer: Cash Price |
$10,371.60
|
| Rate for Payer: Cigna Commercial |
$17,216.86
|
| Rate for Payer: First Health Commercial |
$19,706.04
|
| Rate for Payer: Humana Commercial |
$17,631.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,009.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,222.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,254.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,557.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,430.39
|
| Rate for Payer: PHCS Commercial |
$19,913.47
|
| Rate for Payer: United Healthcare All Payer |
$18,254.02
|
|
