|
EQUINOXE HUM LONG STEM 12*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 8*175
|
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 8*175
|
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 8*215
|
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 8*215
|
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 STEM 10MM
|
Facility
|
IP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 10MM
|
Facility
|
OP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem Medicaid |
$4,727.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Humana KY Medicaid |
$4,727.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,775.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,822.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 12MM
|
Facility
|
IP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 12MM
|
Facility
|
OP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem Medicaid |
$4,727.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Humana KY Medicaid |
$4,727.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,775.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,822.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 6MM
|
Facility
|
IP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 6MM
|
Facility
|
OP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem Medicaid |
$4,727.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Humana KY Medicaid |
$4,727.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,775.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,822.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 8MM
|
Facility
|
OP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem Medicaid |
$4,727.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Humana KY Medicaid |
$4,727.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,775.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,822.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM 8MM
|
Facility
|
IP
|
$13,746.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,787.02 |
| Max. Negotiated Rate |
$13,196.45 |
| Rate for Payer: Aetna Commercial |
$10,584.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,722.11
|
| Rate for Payer: Cash Price |
$6,873.15
|
| Rate for Payer: Cigna Commercial |
$11,409.43
|
| Rate for Payer: First Health Commercial |
$13,058.98
|
| Rate for Payer: Humana Commercial |
$11,684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,271.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,144.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,123.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,096.74
|
| Rate for Payer: Ohio Health Group HMO |
$10,309.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,749.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,787.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,261.35
|
| Rate for Payer: PHCS Commercial |
$13,196.45
|
| Rate for Payer: United Healthcare All Payer |
$12,096.74
|
|
|
EQUINOXE HUM STEM SZ 11
|
Facility
|
OP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem Medicaid |
$3,675.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Humana KY Medicaid |
$3,675.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,712.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,749.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 11
|
Facility
|
IP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 13
|
Facility
|
IP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 13
|
Facility
|
OP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem Medicaid |
$3,675.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Humana KY Medicaid |
$3,675.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,712.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,749.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 15
|
Facility
|
OP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem Medicaid |
$3,675.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Humana KY Medicaid |
$3,675.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,712.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,749.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 15
|
Facility
|
IP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 17
|
Facility
|
IP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 17
|
Facility
|
OP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem Medicaid |
$3,675.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Humana KY Medicaid |
$3,675.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,712.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,749.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 19
|
Facility
|
OP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem Medicaid |
$3,675.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Humana KY Medicaid |
$3,675.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,712.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,749.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE HUM STEM SZ 19
|
Facility
|
IP
|
$10,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.39 |
| Max. Negotiated Rate |
$10,260.10 |
| Rate for Payer: Aetna Commercial |
$8,229.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,336.33
|
| Rate for Payer: Cash Price |
$5,343.80
|
| Rate for Payer: Cigna Commercial |
$8,870.71
|
| Rate for Payer: First Health Commercial |
$10,153.22
|
| Rate for Payer: Humana Commercial |
$9,084.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,763.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,887.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,206.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$8,015.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,389.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,313.16
|
| Rate for Payer: PHCS Commercial |
$10,260.10
|
| Rate for Payer: United Healthcare All Payer |
$9,405.09
|
|
|
EQUINOXE REP PLATE 1.5MM
|
Facility
|
OP
|
$5,675.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.82 |
| Max. Negotiated Rate |
$5,448.48 |
| Rate for Payer: Aetna Commercial |
$4,370.14
|
| Rate for Payer: Anthem Medicaid |
$1,951.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,426.89
|
| Rate for Payer: Cash Price |
$2,837.75
|
| Rate for Payer: Cigna Commercial |
$4,710.66
|
| Rate for Payer: First Health Commercial |
$5,391.72
|
| Rate for Payer: Humana Commercial |
$4,824.18
|
| Rate for Payer: Humana KY Medicaid |
$1,951.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,971.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,653.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,188.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,702.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,990.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,994.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,256.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,759.40
|
| Rate for Payer: PHCS Commercial |
$5,448.48
|
| Rate for Payer: United Healthcare All Payer |
$4,994.44
|
|
|
EQUINOXE REP PLATE 1.5MM
|
Facility
|
IP
|
$5,675.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.82 |
| Max. Negotiated Rate |
$5,448.48 |
| Rate for Payer: Aetna Commercial |
$4,370.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,426.89
|
| Rate for Payer: Cash Price |
$2,837.75
|
| Rate for Payer: Cigna Commercial |
$4,710.66
|
| Rate for Payer: First Health Commercial |
$5,391.72
|
| Rate for Payer: Humana Commercial |
$4,824.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,653.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,188.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,994.44
|
| Rate for Payer: Ohio Health Group HMO |
$4,256.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,135.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,759.40
|
| Rate for Payer: PHCS Commercial |
$5,448.48
|
| Rate for Payer: United Healthcare All Payer |
$4,994.44
|
|
