|
ENDURANCE 20D 50*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 52*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 52*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 52*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 52*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 54*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 54*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 54*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 54*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 56*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 56*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 56*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 56*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 58*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 58*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 58*32
|
Facility
|
OP
|
$5,054.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.42 |
| Max. Negotiated Rate |
$4,852.56 |
| Rate for Payer: Aetna Commercial |
$3,892.16
|
| Rate for Payer: Anthem Medicaid |
$1,738.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.70
|
| Rate for Payer: Cash Price |
$2,527.38
|
| Rate for Payer: Cigna Commercial |
$4,195.44
|
| Rate for Payer: First Health Commercial |
$4,802.01
|
| Rate for Payer: Humana Commercial |
$4,296.54
|
| Rate for Payer: Humana KY Medicaid |
$1,738.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,756.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,773.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.78
|
| Rate for Payer: PHCS Commercial |
$4,852.56
|
| Rate for Payer: United Healthcare All Payer |
$4,448.18
|
|
|
ENDURANCE 20D 58*32
|
Facility
|
IP
|
$5,054.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.42 |
| Max. Negotiated Rate |
$4,852.56 |
| Rate for Payer: Aetna Commercial |
$3,892.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.70
|
| Rate for Payer: Cash Price |
$2,527.38
|
| Rate for Payer: Cigna Commercial |
$4,195.44
|
| Rate for Payer: First Health Commercial |
$4,802.01
|
| Rate for Payer: Humana Commercial |
$4,296.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.78
|
| Rate for Payer: PHCS Commercial |
$4,852.56
|
| Rate for Payer: United Healthcare All Payer |
$4,448.18
|
|
|
ENDURANCE 20D 60*28
|
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 60*28
|
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 60*32
|
Facility
|
OP
|
$5,054.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.42 |
| Max. Negotiated Rate |
$4,852.56 |
| Rate for Payer: Aetna Commercial |
$3,892.16
|
| Rate for Payer: Anthem Medicaid |
$1,738.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.70
|
| Rate for Payer: Cash Price |
$2,527.38
|
| Rate for Payer: Cigna Commercial |
$4,195.44
|
| Rate for Payer: First Health Commercial |
$4,802.01
|
| Rate for Payer: Humana Commercial |
$4,296.54
|
| Rate for Payer: Humana KY Medicaid |
$1,738.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,756.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,773.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.78
|
| Rate for Payer: PHCS Commercial |
$4,852.56
|
| Rate for Payer: United Healthcare All Payer |
$4,448.18
|
|
|
ENDURANCE 20D 60*32
|
Facility
|
IP
|
$5,054.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,516.42 |
| Max. Negotiated Rate |
$4,852.56 |
| Rate for Payer: Aetna Commercial |
$3,892.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,942.70
|
| Rate for Payer: Cash Price |
$2,527.38
|
| Rate for Payer: Cigna Commercial |
$4,195.44
|
| Rate for Payer: First Health Commercial |
$4,802.01
|
| Rate for Payer: Humana Commercial |
$4,296.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,144.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,730.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,516.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,448.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,791.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,043.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,397.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,487.78
|
| Rate for Payer: PHCS Commercial |
$4,852.56
|
| Rate for Payer: United Healthcare All Payer |
$4,448.18
|
|
|
ENDURANT AAA BIFUR 23*13*124
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*13*124
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*13*145
|
Facility
|
IP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
|
ENDURANT AAA BIFUR 23*13*145
|
Facility
|
OP
|
$42,406.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,721.88 |
| Max. Negotiated Rate |
$40,710.00 |
| Rate for Payer: Aetna Commercial |
$32,652.81
|
| Rate for Payer: Anthem Medicaid |
$14,583.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,076.88
|
| Rate for Payer: Cash Price |
$21,203.12
|
| Rate for Payer: Cigna Commercial |
$35,197.19
|
| Rate for Payer: First Health Commercial |
$40,285.94
|
| Rate for Payer: Humana Commercial |
$36,045.31
|
| Rate for Payer: Humana KY Medicaid |
$14,583.51
|
| Rate for Payer: Kentucky WC Medicaid |
$14,731.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,773.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,295.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,721.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,876.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,804.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,893.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,260.31
|
| Rate for Payer: PHCS Commercial |
$40,710.00
|
| Rate for Payer: United Healthcare All Payer |
$37,317.50
|
|
