|
ENDRNT AAA ILIAC EXT 13*13*82
|
Facility
|
OP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem Medicaid |
$7,716.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Humana KY Medicaid |
$7,716.26
|
| Rate for Payer: Kentucky WC Medicaid |
$7,794.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,871.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
|
ENDRNT AAA ILIAC EXT 13*13*82
|
Facility
|
IP
|
$22,437.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,731.25 |
| Max. Negotiated Rate |
$21,540.00 |
| Rate for Payer: Aetna Commercial |
$17,276.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,501.25
|
| Rate for Payer: Cash Price |
$11,218.75
|
| Rate for Payer: Cigna Commercial |
$18,623.12
|
| Rate for Payer: First Health Commercial |
$21,315.62
|
| Rate for Payer: Humana Commercial |
$19,071.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,398.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,731.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,745.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,828.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,520.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,481.88
|
| Rate for Payer: PHCS Commercial |
$21,540.00
|
| Rate for Payer: United Healthcare All Payer |
$19,745.00
|
|
|
ENDRNT AAA ILIAC EXT 20*20*82
|
Facility
|
IP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA ILIAC EXT 20*20*82
|
Facility
|
OP
|
$23,187.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.25 |
| Max. Negotiated Rate |
$22,260.00 |
| Rate for Payer: Aetna Commercial |
$17,854.38
|
| Rate for Payer: Anthem Medicaid |
$7,974.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,086.25
|
| Rate for Payer: Cash Price |
$11,593.75
|
| Rate for Payer: Cigna Commercial |
$19,245.62
|
| Rate for Payer: First Health Commercial |
$22,028.12
|
| Rate for Payer: Humana Commercial |
$19,709.38
|
| Rate for Payer: Humana KY Medicaid |
$7,974.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,112.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,134.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,405.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,173.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,999.38
|
| Rate for Payer: PHCS Commercial |
$22,260.00
|
| Rate for Payer: United Healthcare All Payer |
$20,405.00
|
|
|
ENDRNT AAA ILIAC EXT 24*24*82
|
Facility
|
OP
|
$23,468.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,040.62 |
| Max. Negotiated Rate |
$22,530.00 |
| Rate for Payer: Aetna Commercial |
$18,070.94
|
| Rate for Payer: Anthem Medicaid |
$8,070.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,305.62
|
| Rate for Payer: Cash Price |
$11,734.38
|
| Rate for Payer: Cigna Commercial |
$19,479.06
|
| Rate for Payer: First Health Commercial |
$22,295.31
|
| Rate for Payer: Humana Commercial |
$19,948.44
|
| Rate for Payer: Humana KY Medicaid |
$8,070.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,153.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,244.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,319.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,040.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,232.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,652.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,601.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,417.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,193.44
|
| Rate for Payer: PHCS Commercial |
$22,530.00
|
| Rate for Payer: United Healthcare All Payer |
$20,652.50
|
|
|
ENDRNT AAA ILIAC EXT 24*24*82
|
Facility
|
IP
|
$23,468.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,040.62 |
| Max. Negotiated Rate |
$22,530.00 |
| Rate for Payer: Aetna Commercial |
$18,070.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,305.62
|
| Rate for Payer: Cash Price |
$11,734.38
|
| Rate for Payer: Cigna Commercial |
$19,479.06
|
| Rate for Payer: First Health Commercial |
$22,295.31
|
| Rate for Payer: Humana Commercial |
$19,948.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,244.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,319.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,040.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,652.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,601.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,417.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,193.44
|
| Rate for Payer: PHCS Commercial |
$22,530.00
|
| Rate for Payer: United Healthcare All Payer |
$20,652.50
|
|
|
ENDRNT AAA ILIAC EXT 28*28*82
|
Facility
|
IP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
|
ENDRNT AAA ILIAC EXT 28*28*82
|
Facility
|
OP
|
$23,656.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,096.88 |
| Max. Negotiated Rate |
$22,710.00 |
| Rate for Payer: Aetna Commercial |
$18,215.31
|
| Rate for Payer: Anthem Medicaid |
$8,135.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,451.88
|
| Rate for Payer: Cash Price |
$11,828.12
|
| Rate for Payer: Cigna Commercial |
$19,634.69
|
| Rate for Payer: First Health Commercial |
$22,473.44
|
| Rate for Payer: Humana Commercial |
$20,107.81
|
| Rate for Payer: Humana KY Medicaid |
$8,135.38
|
| Rate for Payer: Kentucky WC Medicaid |
$8,218.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,398.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,458.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,096.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,298.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,817.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,742.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,580.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,322.81
|
| Rate for Payer: PHCS Commercial |
$22,710.00
|
| Rate for Payer: United Healthcare All Payer |
$20,817.50
|
|
|
ENDRNT AORTC EXT AAA 25*25*70
|
Facility
|
OP
|
$33,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,909.38 |
| Max. Negotiated Rate |
$31,710.00 |
| Rate for Payer: Aetna Commercial |
$25,434.06
|
| Rate for Payer: Anthem Medicaid |
$11,359.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,764.38
|
| Rate for Payer: Cash Price |
$16,515.62
|
| Rate for Payer: Cigna Commercial |
$27,415.94
|
| Rate for Payer: First Health Commercial |
$31,379.69
|
| Rate for Payer: Humana Commercial |
$28,076.56
|
| Rate for Payer: Humana KY Medicaid |
$11,359.45
|
| Rate for Payer: Kentucky WC Medicaid |
$11,475.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,085.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,377.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,587.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,067.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,791.56
|
| Rate for Payer: PHCS Commercial |
$31,710.00
|
| Rate for Payer: United Healthcare All Payer |
$29,067.50
|
|
|
ENDRNT AORTC EXT AAA 25*25*70
|
Facility
|
IP
|
$33,031.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,909.38 |
| Max. Negotiated Rate |
$31,710.00 |
| Rate for Payer: Aetna Commercial |
$25,434.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,764.38
|
| Rate for Payer: Cash Price |
$16,515.62
|
| Rate for Payer: Cigna Commercial |
$27,415.94
|
| Rate for Payer: First Health Commercial |
$31,379.69
|
| Rate for Payer: Humana Commercial |
$28,076.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,085.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,377.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,909.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,067.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,773.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,737.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,791.56
|
| Rate for Payer: PHCS Commercial |
$31,710.00
|
| Rate for Payer: United Healthcare All Payer |
$29,067.50
|
|
|
ENDURANCE 20D 44*28
|
Facility
|
OP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem Medicaid |
$1,678.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Humana KY Medicaid |
$1,678.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,695.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 44*28
|
Facility
|
IP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 44*32
|
Facility
|
IP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
|
ENDURANCE 20D 44*32
|
Facility
|
OP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem Medicaid |
$1,738.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Humana KY Medicaid |
$1,738.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,756.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,773.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
|
ENDURANCE 20D 46*28
|
Facility
|
OP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem Medicaid |
$1,678.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Humana KY Medicaid |
$1,678.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,695.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 46*28
|
Facility
|
IP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 46*32
|
Facility
|
OP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem Medicaid |
$1,738.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Humana KY Medicaid |
$1,738.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,756.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,773.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
|
ENDURANCE 20D 46*32
|
Facility
|
IP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
|
ENDURANCE 20D 48*28
|
Facility
|
OP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem Medicaid |
$1,678.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Humana KY Medicaid |
$1,678.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,695.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 48*28
|
Facility
|
IP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 48*32
|
Facility
|
OP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem Medicaid |
$1,738.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Humana KY Medicaid |
$1,738.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,756.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,773.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
|
ENDURANCE 20D 48*32
|
Facility
|
IP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
|
ENDURANCE 20D 50*28
|
Facility
|
IP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 50*28
|
Facility
|
OP
|
$4,881.88
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.56 |
| Max. Negotiated Rate |
$4,686.60 |
| Rate for Payer: Aetna Commercial |
$3,759.05
|
| Rate for Payer: Anthem Medicaid |
$1,678.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.87
|
| Rate for Payer: Cash Price |
$2,440.94
|
| Rate for Payer: Cigna Commercial |
$4,051.96
|
| Rate for Payer: First Health Commercial |
$4,637.79
|
| Rate for Payer: Humana Commercial |
$4,149.60
|
| Rate for Payer: Humana KY Medicaid |
$1,678.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,695.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,247.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.50
|
| Rate for Payer: PHCS Commercial |
$4,686.60
|
| Rate for Payer: United Healthcare All Payer |
$4,296.05
|
|
|
ENDURANCE 20D 50*32
|
Facility
|
OP
|
$5,054.79
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.44 |
| Max. Negotiated Rate |
$4,852.60 |
| Rate for Payer: Aetna Commercial |
$3,892.19
|
| Rate for Payer: Anthem Medicaid |
$1,738.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.74
|
| Rate for Payer: Cash Price |
$2,527.39
|
| Rate for Payer: Cigna Commercial |
$4,195.48
|
| Rate for Payer: First Health Commercial |
$4,802.05
|
| Rate for Payer: Humana Commercial |
$4,296.57
|
| Rate for Payer: Humana KY Medicaid |
$1,738.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,756.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,773.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.81
|
| Rate for Payer: PHCS Commercial |
$4,852.60
|
| Rate for Payer: United Healthcare All Payer |
$4,448.22
|
|
