|
ANTHOLOGY C SO CLR HA SZ 11
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 12
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 12
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 2
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 2
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 3
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 3
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 4
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 4
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 5
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 5
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 6
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 6
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 7
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 7
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 8
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 8
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 9
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 9
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY HO POROUS SZ 1
|
Facility
|
OP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem Medicaid |
$8,384.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Humana KY Medicaid |
$8,384.28
|
| Rate for Payer: Kentucky WC Medicaid |
$8,469.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,552.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTHOLOGY HO POROUS SZ 1
|
Facility
|
IP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTHOLOGY HO POROUS SZ 10
|
Facility
|
OP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem Medicaid |
$8,384.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Humana KY Medicaid |
$8,384.28
|
| Rate for Payer: Kentucky WC Medicaid |
$8,469.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,552.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTHOLOGY HO POROUS SZ 10
|
Facility
|
IP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTHOLOGY HO POROUS SZ 11
|
Facility
|
IP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
|
ANTHOLOGY HO POROUS SZ 11
|
Facility
|
OP
|
$24,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,314.00 |
| Max. Negotiated Rate |
$23,404.80 |
| Rate for Payer: Aetna Commercial |
$18,772.60
|
| Rate for Payer: Anthem Medicaid |
$8,384.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,016.40
|
| Rate for Payer: Cash Price |
$12,190.00
|
| Rate for Payer: Cigna Commercial |
$20,235.40
|
| Rate for Payer: First Health Commercial |
$23,161.00
|
| Rate for Payer: Humana Commercial |
$20,723.00
|
| Rate for Payer: Humana KY Medicaid |
$8,384.28
|
| Rate for Payer: Kentucky WC Medicaid |
$8,469.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,991.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,992.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,314.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,552.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,454.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,822.20
|
| Rate for Payer: PHCS Commercial |
$23,404.80
|
| Rate for Payer: United Healthcare All Payer |
$21,454.40
|
|
