|
ENDURANT AAA BIFUR 28*16*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 28*16*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 28*16*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 28*16*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 28*20*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 28*20*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 28*20*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 28*20*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 28*20*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 28*20*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 32*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
|
|
|
ENDURANT AAA BIFUR 32*16*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 32*16*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 32*16*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 32*16*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 32*16*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 32*20*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 32*20*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 32*20*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 32*20*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 32*20*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 32*20*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 36*16*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 36*16*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 36*16*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
|
|
