ENDRNT AAA ILIAC EXT 20*20*82
|
Facility
|
OP
|
$22,502.50
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,925.32 |
Max. Negotiated Rate |
$21,602.40 |
Rate for Payer: Aetna Commercial |
$17,326.92
|
Rate for Payer: Anthem Medicaid |
$7,738.61
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
Rate for Payer: Cash Price |
$11,251.25
|
Rate for Payer: Cigna Commercial |
$18,677.08
|
Rate for Payer: First Health Commercial |
$21,377.38
|
Rate for Payer: Humana Commercial |
$19,127.12
|
Rate for Payer: Humana KY Medicaid |
$7,738.61
|
Rate for Payer: Kentucky WC Medicaid |
$7,817.37
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
Rate for Payer: Molina Healthcare Medicaid |
$7,893.88
|
Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
Rate for Payer: PHCS Commercial |
$21,602.40
|
Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
ENDRNT AAA ILIAC EXT 24*24*82
|
Facility
|
IP
|
$22,776.25
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,960.91 |
Max. Negotiated Rate |
$21,865.20 |
Rate for Payer: Aetna Commercial |
$17,537.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17,765.48
|
Rate for Payer: Cash Price |
$11,388.12
|
Rate for Payer: Cigna Commercial |
$18,904.29
|
Rate for Payer: First Health Commercial |
$21,637.44
|
Rate for Payer: Humana Commercial |
$19,359.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18,676.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,808.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,832.88
|
Rate for Payer: Ohio Health Choice Commercial |
$20,043.10
|
Rate for Payer: Ohio Health Group HMO |
$17,082.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,555.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,960.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,060.64
|
Rate for Payer: PHCS Commercial |
$21,865.20
|
Rate for Payer: United Healthcare All Payer |
$20,043.10
|
|
ENDRNT AAA ILIAC EXT 24*24*82
|
Facility
|
OP
|
$22,776.25
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,960.91 |
Max. Negotiated Rate |
$21,865.20 |
Rate for Payer: Aetna Commercial |
$17,537.71
|
Rate for Payer: Anthem Medicaid |
$7,832.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17,765.48
|
Rate for Payer: Cash Price |
$11,388.12
|
Rate for Payer: Cigna Commercial |
$18,904.29
|
Rate for Payer: First Health Commercial |
$21,637.44
|
Rate for Payer: Humana Commercial |
$19,359.81
|
Rate for Payer: Humana KY Medicaid |
$7,832.75
|
Rate for Payer: Kentucky WC Medicaid |
$7,912.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18,676.52
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,808.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,832.88
|
Rate for Payer: Molina Healthcare Medicaid |
$7,989.91
|
Rate for Payer: Ohio Health Choice Commercial |
$20,043.10
|
Rate for Payer: Ohio Health Group HMO |
$17,082.19
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,555.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,960.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,060.64
|
Rate for Payer: PHCS Commercial |
$21,865.20
|
Rate for Payer: United Healthcare All Payer |
$20,043.10
|
|
ENDRNT AAA ILIAC EXT 28*28*82
|
Facility
|
OP
|
$22,958.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,984.64 |
Max. Negotiated Rate |
$22,040.40 |
Rate for Payer: Aetna Commercial |
$17,678.24
|
Rate for Payer: Anthem Medicaid |
$7,895.51
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
Rate for Payer: Cash Price |
$11,479.38
|
Rate for Payer: Cigna Commercial |
$19,055.76
|
Rate for Payer: First Health Commercial |
$21,810.81
|
Rate for Payer: Humana Commercial |
$19,514.94
|
Rate for Payer: Humana KY Medicaid |
$7,895.51
|
Rate for Payer: Kentucky WC Medicaid |
$7,975.87
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
Rate for Payer: Molina Healthcare Medicaid |
$8,053.93
|
Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
Rate for Payer: PHCS Commercial |
$22,040.40
|
Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
ENDRNT AAA ILIAC EXT 28*28*82
|
Facility
|
IP
|
$22,958.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,984.64 |
Max. Negotiated Rate |
$22,040.40 |
Rate for Payer: Aetna Commercial |
$17,678.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$17,907.82
|
Rate for Payer: Cash Price |
$11,479.38
|
Rate for Payer: Cigna Commercial |
$19,055.76
|
Rate for Payer: First Health Commercial |
$21,810.81
|
Rate for Payer: Humana Commercial |
$19,514.94
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$18,826.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,943.56
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,887.62
|
Rate for Payer: Ohio Health Choice Commercial |
$20,203.70
|
Rate for Payer: Ohio Health Group HMO |
$17,219.06
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,591.75
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.64
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,117.21
|
Rate for Payer: PHCS Commercial |
$22,040.40
|
Rate for Payer: United Healthcare All Payer |
$20,203.70
|
|
ENDRNT AORTC EXT AAA 25*25*70
|
Facility
|
IP
|
$32,083.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,170.89 |
Max. Negotiated Rate |
$30,800.40 |
Rate for Payer: Aetna Commercial |
$24,704.49
|
Rate for Payer: Anthem POS/PPO/Traditional |
$25,025.32
|
Rate for Payer: Cash Price |
$16,041.88
|
Rate for Payer: Cigna Commercial |
$26,629.51
|
Rate for Payer: First Health Commercial |
$30,479.56
|
Rate for Payer: Humana Commercial |
$27,271.19
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$26,308.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,677.81
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9,625.12
|
Rate for Payer: Ohio Health Choice Commercial |
$28,233.70
|
Rate for Payer: Ohio Health Group HMO |
$24,062.81
|
Rate for Payer: Ohio Health Group PPO Differential |
$6,416.75
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.89
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,945.96
|
Rate for Payer: PHCS Commercial |
$30,800.40
|
Rate for Payer: United Healthcare All Payer |
$28,233.70
|
|
ENDRNT AORTC EXT AAA 25*25*70
|
Facility
|
OP
|
$32,083.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,170.89 |
Max. Negotiated Rate |
$30,800.40 |
Rate for Payer: Aetna Commercial |
$24,704.49
|
Rate for Payer: Anthem Medicaid |
$11,033.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$25,025.32
|
Rate for Payer: Cash Price |
$16,041.88
|
Rate for Payer: Cigna Commercial |
$26,629.51
|
Rate for Payer: First Health Commercial |
$30,479.56
|
Rate for Payer: Humana Commercial |
$27,271.19
|
Rate for Payer: Humana KY Medicaid |
$11,033.60
|
Rate for Payer: Kentucky WC Medicaid |
$11,145.89
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$26,308.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,677.81
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9,625.12
|
Rate for Payer: Molina Healthcare Medicaid |
$11,254.98
|
Rate for Payer: Ohio Health Choice Commercial |
$28,233.70
|
Rate for Payer: Ohio Health Group HMO |
$24,062.81
|
Rate for Payer: Ohio Health Group PPO Differential |
$6,416.75
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.89
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,945.96
|
Rate for Payer: PHCS Commercial |
$30,800.40
|
Rate for Payer: United Healthcare All Payer |
$28,233.70
|
|
ENDURANCE 20D 44*28
|
Facility
|
OP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem Medicaid |
$1,681.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Humana KY Medicaid |
$1,681.59
|
Rate for Payer: Kentucky WC Medicaid |
$1,698.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Molina Healthcare Medicaid |
$1,715.32
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 44*28
|
Facility
|
IP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 44*32
|
Facility
|
IP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 44*32
|
Facility
|
OP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem Medicaid |
$1,737.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Humana KY Medicaid |
$1,737.09
|
Rate for Payer: Kentucky WC Medicaid |
$1,754.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Molina Healthcare Medicaid |
$1,771.94
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 46*28
|
Facility
|
OP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem Medicaid |
$1,681.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Humana KY Medicaid |
$1,681.59
|
Rate for Payer: Kentucky WC Medicaid |
$1,698.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Molina Healthcare Medicaid |
$1,715.32
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 46*28
|
Facility
|
IP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 46*32
|
Facility
|
OP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem Medicaid |
$1,737.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Humana KY Medicaid |
$1,737.09
|
Rate for Payer: Kentucky WC Medicaid |
$1,754.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Molina Healthcare Medicaid |
$1,771.94
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 46*32
|
Facility
|
IP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 48*28
|
Facility
|
IP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 48*28
|
Facility
|
OP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem Medicaid |
$1,681.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Humana KY Medicaid |
$1,681.59
|
Rate for Payer: Kentucky WC Medicaid |
$1,698.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Molina Healthcare Medicaid |
$1,715.32
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 48*32
|
Facility
|
IP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 48*32
|
Facility
|
OP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem Medicaid |
$1,737.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Humana KY Medicaid |
$1,737.09
|
Rate for Payer: Kentucky WC Medicaid |
$1,754.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Molina Healthcare Medicaid |
$1,771.94
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 50*28
|
Facility
|
IP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 50*28
|
Facility
|
OP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem Medicaid |
$1,681.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Humana KY Medicaid |
$1,681.59
|
Rate for Payer: Kentucky WC Medicaid |
$1,698.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Molina Healthcare Medicaid |
$1,715.32
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 50*32
|
Facility
|
OP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem Medicaid |
$1,737.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Humana KY Medicaid |
$1,737.09
|
Rate for Payer: Kentucky WC Medicaid |
$1,754.77
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Molina Healthcare Medicaid |
$1,771.94
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 50*32
|
Facility
|
IP
|
$5,051.14
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$656.65 |
Max. Negotiated Rate |
$4,849.09 |
Rate for Payer: Aetna Commercial |
$3,889.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.89
|
Rate for Payer: Cash Price |
$2,525.57
|
Rate for Payer: Cigna Commercial |
$4,192.45
|
Rate for Payer: First Health Commercial |
$4,798.58
|
Rate for Payer: Humana Commercial |
$4,293.47
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.93
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.74
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.34
|
Rate for Payer: Ohio Health Choice Commercial |
$4,445.00
|
Rate for Payer: Ohio Health Group HMO |
$3,788.36
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,010.23
|
Rate for Payer: Ohio Health Group PPO No Differential |
$656.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.85
|
Rate for Payer: PHCS Commercial |
$4,849.09
|
Rate for Payer: United Healthcare All Payer |
$4,445.00
|
|
ENDURANCE 20D 52*28
|
Facility
|
OP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem Medicaid |
$1,681.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Humana KY Medicaid |
$1,681.59
|
Rate for Payer: Kentucky WC Medicaid |
$1,698.70
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Molina Healthcare Medicaid |
$1,715.32
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|
ENDURANCE 20D 52*28
|
Facility
|
IP
|
$4,889.75
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$635.67 |
Max. Negotiated Rate |
$4,694.16 |
Rate for Payer: Aetna Commercial |
$3,765.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.00
|
Rate for Payer: Cash Price |
$2,444.88
|
Rate for Payer: Cigna Commercial |
$4,058.49
|
Rate for Payer: First Health Commercial |
$4,645.26
|
Rate for Payer: Humana Commercial |
$4,156.29
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,009.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,608.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,466.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,302.98
|
Rate for Payer: Ohio Health Group HMO |
$3,667.31
|
Rate for Payer: Ohio Health Group PPO Differential |
$977.95
|
Rate for Payer: Ohio Health Group PPO No Differential |
$635.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.82
|
Rate for Payer: PHCS Commercial |
$4,694.16
|
Rate for Payer: United Healthcare All Payer |
$4,302.98
|
|