|
EQUINOXE HUM HEAD TALL 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 TALL 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 TALL 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 TALL 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 TALL 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 TALL 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 TALL 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 TALL 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 TALL 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 LONG STEM 10*200
|
Facility
|
IP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 10*200
|
Facility
|
OP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem Medicaid |
$7,352.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Humana KY Medicaid |
$7,352.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,427.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,500.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 12*200
|
Facility
|
OP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem Medicaid |
$7,352.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Humana KY Medicaid |
$7,352.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,427.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,500.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 12*200
|
Facility
|
IP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 8*175
|
Facility
|
IP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 8*175
|
Facility
|
OP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem Medicaid |
$7,352.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Humana KY Medicaid |
$7,352.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,427.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,500.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 8*215
|
Facility
|
IP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM LONG STEM 8*215
|
Facility
|
OP
|
$21,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,414.00 |
| Max. Negotiated Rate |
$20,524.80 |
| Rate for Payer: Aetna Commercial |
$16,462.60
|
| Rate for Payer: Anthem Medicaid |
$7,352.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,676.40
|
| Rate for Payer: Cash Price |
$10,690.00
|
| Rate for Payer: Cigna Commercial |
$17,745.40
|
| Rate for Payer: First Health Commercial |
$20,311.00
|
| Rate for Payer: Humana Commercial |
$18,173.00
|
| Rate for Payer: Humana KY Medicaid |
$7,352.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,427.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,531.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,778.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,414.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,500.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,814.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,752.20
|
| Rate for Payer: PHCS Commercial |
$20,524.80
|
| Rate for Payer: United Healthcare All Payer |
$18,814.40
|
|
|
EQUINOXE HUM STEM 10MM
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 10MM
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 12MM
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 12MM
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 6MM
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 6MM
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 8MM
|
Facility
|
IP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
|
EQUINOXE HUM STEM 8MM
|
Facility
|
OP
|
$14,003.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,201.06 |
| Max. Negotiated Rate |
$13,443.40 |
| Rate for Payer: Aetna Commercial |
$10,782.73
|
| Rate for Payer: Anthem Medicaid |
$4,815.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,922.76
|
| Rate for Payer: Cash Price |
$7,001.77
|
| Rate for Payer: Cigna Commercial |
$11,622.94
|
| Rate for Payer: First Health Commercial |
$13,303.36
|
| Rate for Payer: Humana Commercial |
$11,903.01
|
| Rate for Payer: Humana KY Medicaid |
$4,815.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,864.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,334.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,201.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,912.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,323.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,502.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,202.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,183.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,662.44
|
| Rate for Payer: PHCS Commercial |
$13,443.40
|
| Rate for Payer: United Healthcare All Payer |
$12,323.12
|
|
