|
ASPHERE HEAD 11/13 36 3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 36 6
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 36 6
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 0
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 0
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 -3
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 -3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 3
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 6
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 40 6
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 0
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 0
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 -3
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 -3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 3
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 3
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 6
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 11/13 44 6
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 12/14 36 1.5
|
Facility
|
OP
|
$13,108.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,932.64 |
| Max. Negotiated Rate |
$12,584.44 |
| Rate for Payer: Aetna Commercial |
$10,093.77
|
| Rate for Payer: Anthem Medicaid |
$4,508.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,224.86
|
| Rate for Payer: Cash Price |
$6,554.40
|
| Rate for Payer: Cigna Commercial |
$10,880.30
|
| Rate for Payer: First Health Commercial |
$12,453.35
|
| Rate for Payer: Humana Commercial |
$11,142.47
|
| Rate for Payer: Humana KY Medicaid |
$4,508.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4,553.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,749.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,674.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,932.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,598.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,535.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,831.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,487.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,404.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,045.07
|
| Rate for Payer: PHCS Commercial |
$12,584.44
|
| Rate for Payer: United Healthcare All Payer |
$11,535.74
|
|
|
ASPHERE HEAD 12/14 36 1.5
|
Facility
|
IP
|
$13,108.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,932.64 |
| Max. Negotiated Rate |
$12,584.44 |
| Rate for Payer: Aetna Commercial |
$10,093.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,224.86
|
| Rate for Payer: Cash Price |
$6,554.40
|
| Rate for Payer: Cigna Commercial |
$10,880.30
|
| Rate for Payer: First Health Commercial |
$12,453.35
|
| Rate for Payer: Humana Commercial |
$11,142.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,749.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,674.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,932.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,535.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,831.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,487.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,404.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,045.07
|
| Rate for Payer: PHCS Commercial |
$12,584.44
|
| Rate for Payer: United Healthcare All Payer |
$11,535.74
|
|
|
ASPHERE HEAD 12/14 36 -2
|
Facility
|
OP
|
$13,493.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,048.02 |
| Max. Negotiated Rate |
$12,953.67 |
| Rate for Payer: Aetna Commercial |
$10,389.93
|
| Rate for Payer: Anthem Medicaid |
$4,640.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,524.86
|
| Rate for Payer: Cash Price |
$6,746.70
|
| Rate for Payer: Cigna Commercial |
$11,199.53
|
| Rate for Payer: First Health Commercial |
$12,818.74
|
| Rate for Payer: Humana Commercial |
$11,469.40
|
| Rate for Payer: Humana KY Medicaid |
$4,640.38
|
| Rate for Payer: Kentucky WC Medicaid |
$4,687.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,064.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,958.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,048.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,733.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,874.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,120.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,794.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,739.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,310.45
|
| Rate for Payer: PHCS Commercial |
$12,953.67
|
| Rate for Payer: United Healthcare All Payer |
$11,874.20
|
|
|
ASPHERE HEAD 12/14 36 -2
|
Facility
|
IP
|
$13,493.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,048.02 |
| Max. Negotiated Rate |
$12,953.67 |
| Rate for Payer: Aetna Commercial |
$10,389.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,524.86
|
| Rate for Payer: Cash Price |
$6,746.70
|
| Rate for Payer: Cigna Commercial |
$11,199.53
|
| Rate for Payer: First Health Commercial |
$12,818.74
|
| Rate for Payer: Humana Commercial |
$11,469.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,064.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,958.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,048.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,874.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,120.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,794.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,739.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,310.45
|
| Rate for Payer: PHCS Commercial |
$12,953.67
|
| Rate for Payer: United Healthcare All Payer |
$11,874.20
|
|
|
ASPHERE HEAD 12/14 36 5
|
Facility
|
IP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
|
ASPHERE HEAD 12/14 36 5
|
Facility
|
OP
|
$19,083.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,725.19 |
| Max. Negotiated Rate |
$18,320.61 |
| Rate for Payer: Aetna Commercial |
$14,694.66
|
| Rate for Payer: Anthem Medicaid |
$6,562.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,885.50
|
| Rate for Payer: Cash Price |
$9,541.98
|
| Rate for Payer: Cigna Commercial |
$15,839.70
|
| Rate for Payer: First Health Commercial |
$18,129.77
|
| Rate for Payer: Humana Commercial |
$16,221.37
|
| Rate for Payer: Humana KY Medicaid |
$6,562.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,629.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,648.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,083.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,725.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,694.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,793.89
|
| Rate for Payer: Ohio Health Group HMO |
$14,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,267.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,603.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,167.94
|
| Rate for Payer: PHCS Commercial |
$18,320.61
|
| Rate for Payer: United Healthcare All Payer |
$16,793.89
|
|
