|
EQUINOXE REV GLENOSHPERE 42MM
|
Facility
|
IP
|
$9,219.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,765.88 |
| Max. Negotiated Rate |
$8,850.82 |
| Rate for Payer: Aetna Commercial |
$7,099.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,191.29
|
| Rate for Payer: Cash Price |
$4,609.80
|
| Rate for Payer: Cigna Commercial |
$7,652.27
|
| Rate for Payer: First Health Commercial |
$8,758.62
|
| Rate for Payer: Humana Commercial |
$7,836.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,560.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,804.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,113.25
|
| Rate for Payer: Ohio Health Group HMO |
$6,914.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,375.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,021.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,361.52
|
| Rate for Payer: PHCS Commercial |
$8,850.82
|
| Rate for Payer: United Healthcare All Payer |
$8,113.25
|
|
|
EQUINOXE REV GLENOSHPERE 46MM
|
Facility
|
IP
|
$9,219.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,765.88 |
| Max. Negotiated Rate |
$8,850.82 |
| Rate for Payer: Aetna Commercial |
$7,099.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,191.29
|
| Rate for Payer: Cash Price |
$4,609.80
|
| Rate for Payer: Cigna Commercial |
$7,652.27
|
| Rate for Payer: First Health Commercial |
$8,758.62
|
| Rate for Payer: Humana Commercial |
$7,836.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,560.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,804.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,113.25
|
| Rate for Payer: Ohio Health Group HMO |
$6,914.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,375.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,021.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,361.52
|
| Rate for Payer: PHCS Commercial |
$8,850.82
|
| Rate for Payer: United Healthcare All Payer |
$8,113.25
|
|
|
EQUINOXE REV GLENOSHPERE 46MM
|
Facility
|
OP
|
$9,219.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,765.88 |
| Max. Negotiated Rate |
$8,850.82 |
| Rate for Payer: Aetna Commercial |
$7,099.09
|
| Rate for Payer: Anthem Medicaid |
$3,170.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,191.29
|
| Rate for Payer: Cash Price |
$4,609.80
|
| Rate for Payer: Cigna Commercial |
$7,652.27
|
| Rate for Payer: First Health Commercial |
$8,758.62
|
| Rate for Payer: Humana Commercial |
$7,836.66
|
| Rate for Payer: Humana KY Medicaid |
$3,170.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,560.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,804.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,234.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,113.25
|
| Rate for Payer: Ohio Health Group HMO |
$6,914.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,375.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,021.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,361.52
|
| Rate for Payer: PHCS Commercial |
$8,850.82
|
| Rate for Payer: United Healthcare All Payer |
$8,113.25
|
|
|
EQUINOXE REV HUM LINER 38MM +0
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINER 38MM +0
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINER 42MM +0
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINER 42MM +0
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINER 46MM +0
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINER 46MM +0
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINR 38MM+2.5
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINR 38MM+2.5
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINR 42MM+2.5
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINR 42MM+2.5
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINR 46MM+2.5
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LINR 46MM+2.5
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LNR CN 38M +0
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LNR CN 38M +0
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LNR CN 42MM+0
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LNR CN 42MM+0
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LNR CN 46M +0
|
Facility
|
OP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem Medicaid |
$1,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Humana KY Medicaid |
$1,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,959.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOXE REV HUM LNR CN 46M +0
|
Facility
|
IP
|
$5,641.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,692.38 |
| Max. Negotiated Rate |
$5,415.60 |
| Rate for Payer: Aetna Commercial |
$4,343.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,400.18
|
| Rate for Payer: Cash Price |
$2,820.62
|
| Rate for Payer: Cigna Commercial |
$4,682.24
|
| Rate for Payer: First Health Commercial |
$5,359.19
|
| Rate for Payer: Humana Commercial |
$4,795.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,625.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,163.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,692.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,964.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,230.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,907.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,892.46
|
| Rate for Payer: PHCS Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Payer |
$4,964.30
|
|
|
EQUINOX PLAT LG STEM L 6.5*200
|
Facility
|
OP
|
$25,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,631.25 |
| Max. Negotiated Rate |
$24,420.00 |
| Rate for Payer: Aetna Commercial |
$19,586.88
|
| Rate for Payer: Anthem Medicaid |
$8,747.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,841.25
|
| Rate for Payer: Cash Price |
$12,718.75
|
| Rate for Payer: Cigna Commercial |
$21,113.12
|
| Rate for Payer: First Health Commercial |
$24,165.62
|
| Rate for Payer: Humana Commercial |
$21,621.88
|
| Rate for Payer: Humana KY Medicaid |
$8,747.96
|
| Rate for Payer: Kentucky WC Medicaid |
$8,836.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,858.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,772.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,631.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,923.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,385.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,078.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,130.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,551.88
|
| Rate for Payer: PHCS Commercial |
$24,420.00
|
| Rate for Payer: United Healthcare All Payer |
$22,385.00
|
|
|
EQUINOX PLAT LG STEM L 6.5*200
|
Facility
|
IP
|
$25,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,631.25 |
| Max. Negotiated Rate |
$24,420.00 |
| Rate for Payer: Aetna Commercial |
$19,586.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,841.25
|
| Rate for Payer: Cash Price |
$12,718.75
|
| Rate for Payer: Cigna Commercial |
$21,113.12
|
| Rate for Payer: First Health Commercial |
$24,165.62
|
| Rate for Payer: Humana Commercial |
$21,621.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,858.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,772.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,631.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,385.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,078.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,130.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,551.88
|
| Rate for Payer: PHCS Commercial |
$24,420.00
|
| Rate for Payer: United Healthcare All Payer |
$22,385.00
|
|
|
EQUINOX PLAT LG STEM R 6.5*200
|
Facility
|
IP
|
$25,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,631.25 |
| Max. Negotiated Rate |
$24,420.00 |
| Rate for Payer: Aetna Commercial |
$19,586.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,841.25
|
| Rate for Payer: Cash Price |
$12,718.75
|
| Rate for Payer: Cigna Commercial |
$21,113.12
|
| Rate for Payer: First Health Commercial |
$24,165.62
|
| Rate for Payer: Humana Commercial |
$21,621.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,858.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,772.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,631.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,385.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,078.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,130.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,551.88
|
| Rate for Payer: PHCS Commercial |
$24,420.00
|
| Rate for Payer: United Healthcare All Payer |
$22,385.00
|
|
|
EQUINOX PLAT LG STEM R 6.5*200
|
Facility
|
OP
|
$25,437.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,631.25 |
| Max. Negotiated Rate |
$24,420.00 |
| Rate for Payer: Aetna Commercial |
$19,586.88
|
| Rate for Payer: Anthem Medicaid |
$8,747.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,841.25
|
| Rate for Payer: Cash Price |
$12,718.75
|
| Rate for Payer: Cigna Commercial |
$21,113.12
|
| Rate for Payer: First Health Commercial |
$24,165.62
|
| Rate for Payer: Humana Commercial |
$21,621.88
|
| Rate for Payer: Humana KY Medicaid |
$8,747.96
|
| Rate for Payer: Kentucky WC Medicaid |
$8,836.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,858.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,772.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,631.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,923.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,385.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,078.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,130.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,551.88
|
| Rate for Payer: PHCS Commercial |
$24,420.00
|
| Rate for Payer: United Healthcare All Payer |
$22,385.00
|
|
