|
EQUINOXE GLENOID PEG BETA XL
|
Facility
|
IP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE GLENOID PEG BETA XL
|
Facility
|
OP
|
$8,354.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.36 |
| Max. Negotiated Rate |
$8,020.37 |
| Rate for Payer: Aetna Commercial |
$6,433.00
|
| Rate for Payer: Anthem Medicaid |
$2,873.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,516.55
|
| Rate for Payer: Cash Price |
$4,177.27
|
| Rate for Payer: Cigna Commercial |
$6,934.28
|
| Rate for Payer: First Health Commercial |
$7,936.82
|
| Rate for Payer: Humana Commercial |
$7,101.37
|
| Rate for Payer: Humana KY Medicaid |
$2,873.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,902.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,850.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,165.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,930.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,352.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,265.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,683.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,268.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,764.64
|
| Rate for Payer: PHCS Commercial |
$8,020.37
|
| Rate for Payer: United Healthcare All Payer |
$7,352.00
|
|
|
EQUINOXE HUMERAL TRAY +15MM
|
Facility
|
OP
|
$11,610.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.21 |
| Max. Negotiated Rate |
$11,146.27 |
| Rate for Payer: Aetna Commercial |
$8,940.24
|
| Rate for Payer: Anthem Medicaid |
$3,992.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.35
|
| Rate for Payer: Cash Price |
$5,805.35
|
| Rate for Payer: Cigna Commercial |
$9,636.88
|
| Rate for Payer: First Health Commercial |
$11,030.17
|
| Rate for Payer: Humana Commercial |
$9,869.09
|
| Rate for Payer: Humana KY Medicaid |
$3,992.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,033.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,520.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,073.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.38
|
| Rate for Payer: PHCS Commercial |
$11,146.27
|
| Rate for Payer: United Healthcare All Payer |
$10,217.42
|
|
|
EQUINOXE HUMERAL TRAY +15MM
|
Facility
|
IP
|
$11,610.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.21 |
| Max. Negotiated Rate |
$11,146.27 |
| Rate for Payer: Aetna Commercial |
$8,940.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.35
|
| Rate for Payer: Cash Price |
$5,805.35
|
| Rate for Payer: Cigna Commercial |
$9,636.88
|
| Rate for Payer: First Health Commercial |
$11,030.17
|
| Rate for Payer: Humana Commercial |
$9,869.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,520.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.38
|
| Rate for Payer: PHCS Commercial |
$11,146.27
|
| Rate for Payer: United Healthcare All Payer |
$10,217.42
|
|
|
EQUINOXE HUM HEAD EXPANDD 47MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 47MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 50MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 50MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 53MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD EXPANDD 53MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 38MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 38MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 41MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 41MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 44MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 44MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 47MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 47MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD SHORT 50MM
|
Facility
|
IP
|
$11,493.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.98 |
| Max. Negotiated Rate |
$11,033.53 |
| Rate for Payer: Aetna Commercial |
$8,849.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,964.74
|
| Rate for Payer: Cash Price |
$5,746.63
|
| Rate for Payer: Cigna Commercial |
$9,539.41
|
| Rate for Payer: First Health Commercial |
$10,918.60
|
| Rate for Payer: Humana Commercial |
$9,769.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,424.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,482.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,447.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,114.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,619.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,194.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,930.35
|
| Rate for Payer: PHCS Commercial |
$11,033.53
|
| Rate for Payer: United Healthcare All Payer |
$10,114.07
|
|
|
EQUINOXE HUM HEAD SHORT 50MM
|
Facility
|
OP
|
$11,493.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.98 |
| Max. Negotiated Rate |
$11,033.53 |
| Rate for Payer: Aetna Commercial |
$8,849.81
|
| Rate for Payer: Anthem Medicaid |
$3,952.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,964.74
|
| Rate for Payer: Cash Price |
$5,746.63
|
| Rate for Payer: Cigna Commercial |
$9,539.41
|
| Rate for Payer: First Health Commercial |
$10,918.60
|
| Rate for Payer: Humana Commercial |
$9,769.27
|
| Rate for Payer: Humana KY Medicaid |
$3,952.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,992.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,424.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,482.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,447.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,031.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,114.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,619.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,194.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,930.35
|
| Rate for Payer: PHCS Commercial |
$11,033.53
|
| Rate for Payer: United Healthcare All Payer |
$10,114.07
|
|
|
EQUINOXE HUM HEAD SHORT 53MM
|
Facility
|
IP
|
$11,493.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.98 |
| Max. Negotiated Rate |
$11,033.53 |
| Rate for Payer: Aetna Commercial |
$8,849.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,964.74
|
| Rate for Payer: Cash Price |
$5,746.63
|
| Rate for Payer: Cigna Commercial |
$9,539.41
|
| Rate for Payer: First Health Commercial |
$10,918.60
|
| Rate for Payer: Humana Commercial |
$9,769.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,424.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,482.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,447.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,114.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,619.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,194.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,930.35
|
| Rate for Payer: PHCS Commercial |
$11,033.53
|
| Rate for Payer: United Healthcare All Payer |
$10,114.07
|
|
|
EQUINOXE HUM HEAD SHORT 53MM
|
Facility
|
OP
|
$11,493.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.98 |
| Max. Negotiated Rate |
$11,033.53 |
| Rate for Payer: Aetna Commercial |
$8,849.81
|
| Rate for Payer: Anthem Medicaid |
$3,952.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,964.74
|
| Rate for Payer: Cash Price |
$5,746.63
|
| Rate for Payer: Cigna Commercial |
$9,539.41
|
| Rate for Payer: First Health Commercial |
$10,918.60
|
| Rate for Payer: Humana Commercial |
$9,769.27
|
| Rate for Payer: Humana KY Medicaid |
$3,952.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,992.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,424.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,482.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,447.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,031.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,114.07
|
| Rate for Payer: Ohio Health Group HMO |
$8,619.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,194.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,930.35
|
| Rate for Payer: PHCS Commercial |
$11,033.53
|
| Rate for Payer: United Healthcare All Payer |
$10,114.07
|
|
|
EQUINOXE HUM HEAD TALL 38MM
|
Facility
|
IP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD TALL 38MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
|
EQUINOXE HUM HEAD TALL 41MM
|
Facility
|
OP
|
$8,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.30 |
| Max. Negotiated Rate |
$8,276.16 |
| Rate for Payer: Aetna Commercial |
$6,638.17
|
| Rate for Payer: Anthem Medicaid |
$2,964.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.38
|
| Rate for Payer: Cash Price |
$4,310.50
|
| Rate for Payer: Cigna Commercial |
$7,155.43
|
| Rate for Payer: First Health Commercial |
$8,189.95
|
| Rate for Payer: Humana Commercial |
$7,327.85
|
| Rate for Payer: Humana KY Medicaid |
$2,964.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,994.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,586.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,465.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,896.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,500.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,948.49
|
| Rate for Payer: PHCS Commercial |
$8,276.16
|
| Rate for Payer: United Healthcare All Payer |
$7,586.48
|
|
