|
ASPHERE HEAD 11/13 36 0
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 0
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 -3
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 -3
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 3
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 3
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 6
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 36 6
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 0
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 0
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 -3
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 -3
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 3
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 3
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 6
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 40 6
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 0
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 0
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 -3
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 -3
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 3
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 3
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 6
|
Facility
|
OP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem Medicaid |
$6,357.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Humana KY Medicaid |
$6,357.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,422.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,485.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 11/13 44 6
|
Facility
|
IP
|
$18,487.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.32 |
| Max. Negotiated Rate |
$17,747.62 |
| Rate for Payer: Aetna Commercial |
$14,235.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,419.94
|
| Rate for Payer: Cash Price |
$9,243.55
|
| Rate for Payer: Cigna Commercial |
$15,344.29
|
| Rate for Payer: First Health Commercial |
$17,562.74
|
| Rate for Payer: Humana Commercial |
$15,714.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,159.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,643.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,546.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,268.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,865.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,697.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,403.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,731.00
|
| Rate for Payer: PHCS Commercial |
$17,747.62
|
| Rate for Payer: United Healthcare All Payer |
$16,268.65
|
|
|
ASPHERE HEAD 12/14 36 1.5
|
Facility
|
IP
|
$12,856.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.34 |
| Max. Negotiated Rate |
$12,342.17 |
| Rate for Payer: Aetna Commercial |
$9,899.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,028.02
|
| Rate for Payer: Cash Price |
$6,428.22
|
| Rate for Payer: Cigna Commercial |
$10,670.84
|
| Rate for Payer: First Health Commercial |
$12,213.61
|
| Rate for Payer: Humana Commercial |
$10,927.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,542.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,488.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,856.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,313.66
|
| Rate for Payer: Ohio Health Group HMO |
$9,642.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,571.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,671.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,985.49
|
| Rate for Payer: PHCS Commercial |
$12,342.17
|
| Rate for Payer: United Healthcare All Payer |
$11,313.66
|
|
