|
ENDURANCE 20D 52*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*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 54*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 54*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 54*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 54*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 56*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 56*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 56*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 56*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 58*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 58*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 58*32
|
Facility
|
IP
|
$5,051.10
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.64 |
| Max. Negotiated Rate |
$4,849.06 |
| Rate for Payer: Aetna Commercial |
$3,889.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.86
|
| Rate for Payer: Cash Price |
$2,525.55
|
| Rate for Payer: Cigna Commercial |
$4,192.41
|
| Rate for Payer: First Health Commercial |
$4,798.54
|
| Rate for Payer: Humana Commercial |
$4,293.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,010.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.84
|
| Rate for Payer: PHCS Commercial |
$4,849.06
|
| Rate for Payer: United Healthcare All Payer |
$4,444.97
|
|
|
ENDURANCE 20D 58*32
|
Facility
|
OP
|
$5,051.10
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.64 |
| Max. Negotiated Rate |
$4,849.06 |
| Rate for Payer: Aetna Commercial |
$3,889.35
|
| Rate for Payer: Anthem Medicaid |
$1,737.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.86
|
| Rate for Payer: Cash Price |
$2,525.55
|
| Rate for Payer: Cigna Commercial |
$4,192.41
|
| Rate for Payer: First Health Commercial |
$4,798.54
|
| Rate for Payer: Humana Commercial |
$4,293.44
|
| Rate for Payer: Humana KY Medicaid |
$1,737.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,010.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.84
|
| Rate for Payer: PHCS Commercial |
$4,849.06
|
| Rate for Payer: United Healthcare All Payer |
$4,444.97
|
|
|
ENDURANCE 20D 60*28
|
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 60*28
|
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 60*32
|
Facility
|
IP
|
$5,051.10
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.64 |
| Max. Negotiated Rate |
$4,849.06 |
| Rate for Payer: Aetna Commercial |
$3,889.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.86
|
| Rate for Payer: Cash Price |
$2,525.55
|
| Rate for Payer: Cigna Commercial |
$4,192.41
|
| Rate for Payer: First Health Commercial |
$4,798.54
|
| Rate for Payer: Humana Commercial |
$4,293.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,010.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.84
|
| Rate for Payer: PHCS Commercial |
$4,849.06
|
| Rate for Payer: United Healthcare All Payer |
$4,444.97
|
|
|
ENDURANCE 20D 60*32
|
Facility
|
OP
|
$5,051.10
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.64 |
| Max. Negotiated Rate |
$4,849.06 |
| Rate for Payer: Aetna Commercial |
$3,889.35
|
| Rate for Payer: Anthem Medicaid |
$1,737.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.86
|
| Rate for Payer: Cash Price |
$2,525.55
|
| Rate for Payer: Cigna Commercial |
$4,192.41
|
| Rate for Payer: First Health Commercial |
$4,798.54
|
| Rate for Payer: Humana Commercial |
$4,293.44
|
| Rate for Payer: Humana KY Medicaid |
$1,737.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,010.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.84
|
| Rate for Payer: PHCS Commercial |
$4,849.06
|
| Rate for Payer: United Healthcare All Payer |
$4,444.97
|
|
|
ENDURANT AAA BIFUR 23*13*124
|
Facility
|
OP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem Medicaid |
$14,171.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Humana KY Medicaid |
$14,171.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,315.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,456.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
ENDURANT AAA BIFUR 23*13*124
|
Facility
|
IP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
ENDURANT AAA BIFUR 23*13*145
|
Facility
|
IP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
ENDURANT AAA BIFUR 23*13*145
|
Facility
|
OP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem Medicaid |
$14,171.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Humana KY Medicaid |
$14,171.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,315.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,456.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
ENDURANT AAA BIFUR 23*13*166
|
Facility
|
OP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem Medicaid |
$14,171.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Humana KY Medicaid |
$14,171.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,315.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,456.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
ENDURANT AAA BIFUR 23*13*166
|
Facility
|
IP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
|
ENDURANT AAA BIFUR 23*16*124
|
Facility
|
OP
|
$41,208.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,357.14 |
| Max. Negotiated Rate |
$39,560.40 |
| Rate for Payer: Aetna Commercial |
$31,730.74
|
| Rate for Payer: Anthem Medicaid |
$14,171.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,142.82
|
| Rate for Payer: Cash Price |
$20,604.38
|
| Rate for Payer: Cigna Commercial |
$34,203.26
|
| Rate for Payer: First Health Commercial |
$39,148.31
|
| Rate for Payer: Humana Commercial |
$35,027.44
|
| Rate for Payer: Humana KY Medicaid |
$14,171.69
|
| Rate for Payer: Kentucky WC Medicaid |
$14,315.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,791.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,412.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,456.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,263.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,241.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,357.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,774.71
|
| Rate for Payer: PHCS Commercial |
$39,560.40
|
| Rate for Payer: United Healthcare All Payer |
$36,263.70
|
|
