|
ANTHOLOGY HO POROUS SZ 10
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 11
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 11
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 12
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 12
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 13
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
ANTHOLOGY HO POROUS SZ 13
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
ANTHOLOGY HO POROUS SZ 14
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 14
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 2
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 2
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 3
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 3
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 4
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 4
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 5
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 5
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 6
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 6
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 7
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 7
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 8
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 8
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 9
|
Facility
|
IP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
|
ANTHOLOGY HO POROUS SZ 9
|
Facility
|
OP
|
$23,663.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,076.22 |
| Max. Negotiated Rate |
$22,716.67 |
| Rate for Payer: Aetna Commercial |
$18,220.66
|
| Rate for Payer: Anthem Medicaid |
$8,137.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,457.30
|
| Rate for Payer: Cash Price |
$11,831.60
|
| Rate for Payer: Cigna Commercial |
$19,640.46
|
| Rate for Payer: First Health Commercial |
$22,480.04
|
| Rate for Payer: Humana Commercial |
$20,113.72
|
| Rate for Payer: Humana KY Medicaid |
$8,137.77
|
| Rate for Payer: Kentucky WC Medicaid |
$8,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,403.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,463.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,098.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,301.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,823.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,747.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,732.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,076.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,335.59
|
| Rate for Payer: PHCS Commercial |
$22,716.67
|
| Rate for Payer: United Healthcare All Payer |
$20,823.62
|
|
