|
LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
|
IP
|
$11,372.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
76102476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,478.36 |
| Max. Negotiated Rate |
$10,917.12 |
| Rate for Payer: Aetna Commercial |
$8,756.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,870.16
|
| Rate for Payer: Cash Price |
$5,686.00
|
| Rate for Payer: Cigna Commercial |
$9,438.76
|
| Rate for Payer: First Health Commercial |
$10,803.40
|
| Rate for Payer: Humana Commercial |
$9,666.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,325.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,392.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,411.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,007.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,529.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,274.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,525.32
|
| Rate for Payer: PHCS Commercial |
$10,917.12
|
| Rate for Payer: United Healthcare All Payer |
$10,007.36
|
|
|
LEGION ART INSRT 15 SZ 5-6
|
Facility
|
IP
|
$7,713.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.71 |
| Max. Negotiated Rate |
$7,404.60 |
| Rate for Payer: Aetna Commercial |
$5,939.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.23
|
| Rate for Payer: Cash Price |
$3,856.56
|
| Rate for Payer: Cigna Commercial |
$6,401.89
|
| Rate for Payer: First Health Commercial |
$7,327.46
|
| Rate for Payer: Humana Commercial |
$6,556.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,787.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,784.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.07
|
| Rate for Payer: PHCS Commercial |
$7,404.60
|
| Rate for Payer: United Healthcare All Payer |
$6,787.55
|
|
|
LEGION ART INSRT 15 SZ 5-6
|
Facility
|
OP
|
$7,713.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.71 |
| Max. Negotiated Rate |
$7,404.60 |
| Rate for Payer: Aetna Commercial |
$5,939.10
|
| Rate for Payer: Anthem Medicaid |
$2,652.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.23
|
| Rate for Payer: Cash Price |
$3,856.56
|
| Rate for Payer: Cigna Commercial |
$6,401.89
|
| Rate for Payer: First Health Commercial |
$7,327.46
|
| Rate for Payer: Humana Commercial |
$6,556.15
|
| Rate for Payer: Humana KY Medicaid |
$2,652.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,679.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,787.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,784.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.07
|
| Rate for Payer: PHCS Commercial |
$7,404.60
|
| Rate for Payer: United Healthcare All Payer |
$6,787.55
|
|
|
LEGION ART INSRT 9 SZ 1-2
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
LEGION ART INSRT 9 SZ 1-2
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
LEGION ART INSRT 9 SZ 3-4
|
Facility
|
OP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem Medicaid |
$4,724.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Humana KY Medicaid |
$4,724.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,772.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,819.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
LEGION ART INSRT 9 SZ 3-4
|
Facility
|
IP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
LEGION ART INSRT 9 SZ 5-6
|
Facility
|
OP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem Medicaid |
$4,724.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Humana KY Medicaid |
$4,724.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,772.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,819.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
LEGION ART INSRT 9 SZ 5-6
|
Facility
|
IP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
LEGION ART INSRT 9 SZ 7-8
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
LEGION ART INSRT 9 SZ 7-8
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
LEGION CR NP FEM SZ 2 LT
|
Facility
|
OP
|
$10,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.78 |
| Max. Negotiated Rate |
$10,240.82 |
| Rate for Payer: Aetna Commercial |
$8,213.99
|
| Rate for Payer: Anthem Medicaid |
$3,668.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,320.67
|
| Rate for Payer: Cash Price |
$5,333.76
|
| Rate for Payer: Cigna Commercial |
$8,854.04
|
| Rate for Payer: First Health Commercial |
$10,134.14
|
| Rate for Payer: Humana Commercial |
$9,067.39
|
| Rate for Payer: Humana KY Medicaid |
$3,668.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,705.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,747.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,872.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,742.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,387.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,306.93
|
| Rate for Payer: PHCS Commercial |
$10,240.82
|
| Rate for Payer: United Healthcare All Payer |
$9,387.42
|
|
|
LEGION CR NP FEM SZ 2 LT
|
Facility
|
IP
|
$10,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.78 |
| Max. Negotiated Rate |
$10,240.82 |
| Rate for Payer: Aetna Commercial |
$8,213.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,320.67
|
| Rate for Payer: Cash Price |
$5,333.76
|
| Rate for Payer: Cigna Commercial |
$8,854.04
|
| Rate for Payer: First Health Commercial |
$10,134.14
|
| Rate for Payer: Humana Commercial |
$9,067.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,747.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,872.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,387.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,306.93
|
| Rate for Payer: PHCS Commercial |
$10,240.82
|
| Rate for Payer: United Healthcare All Payer |
$9,387.42
|
|
|
LEGION CR NP FEM SZ 2 RT
|
Facility
|
OP
|
$10,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.78 |
| Max. Negotiated Rate |
$10,240.82 |
| Rate for Payer: Aetna Commercial |
$8,213.99
|
| Rate for Payer: Anthem Medicaid |
$3,668.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,320.67
|
| Rate for Payer: Cash Price |
$5,333.76
|
| Rate for Payer: Cigna Commercial |
$8,854.04
|
| Rate for Payer: First Health Commercial |
$10,134.14
|
| Rate for Payer: Humana Commercial |
$9,067.39
|
| Rate for Payer: Humana KY Medicaid |
$3,668.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,705.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,747.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,872.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,742.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,387.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,306.93
|
| Rate for Payer: PHCS Commercial |
$10,240.82
|
| Rate for Payer: United Healthcare All Payer |
$9,387.42
|
|
|
LEGION CR NP FEM SZ 2 RT
|
Facility
|
IP
|
$10,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.78 |
| Max. Negotiated Rate |
$10,240.82 |
| Rate for Payer: Aetna Commercial |
$8,213.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,320.67
|
| Rate for Payer: Cash Price |
$5,333.76
|
| Rate for Payer: Cigna Commercial |
$8,854.04
|
| Rate for Payer: First Health Commercial |
$10,134.14
|
| Rate for Payer: Humana Commercial |
$9,067.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,747.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,872.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,387.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,306.93
|
| Rate for Payer: PHCS Commercial |
$10,240.82
|
| Rate for Payer: United Healthcare All Payer |
$9,387.42
|
|
|
LEGION CR NP FEM SZ 3 LT
|
Facility
|
IP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION CR NP FEM SZ 3 LT
|
Facility
|
OP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem Medicaid |
$3,344.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Humana KY Medicaid |
$3,344.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION CR NP FEM SZ 3 RT
|
Facility
|
IP
|
$16,419.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.59 |
| Max. Negotiated Rate |
$15,763.11 |
| Rate for Payer: Aetna Commercial |
$12,643.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,807.53
|
| Rate for Payer: Cash Price |
$8,209.96
|
| Rate for Payer: Cigna Commercial |
$13,628.53
|
| Rate for Payer: First Health Commercial |
$15,598.91
|
| Rate for Payer: Humana Commercial |
$13,956.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,464.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,117.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,925.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,449.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,314.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.17
|
| Rate for Payer: PHCS Commercial |
$15,763.11
|
| Rate for Payer: United Healthcare All Payer |
$14,449.52
|
|
|
LEGION CR NP FEM SZ 3 RT
|
Facility
|
OP
|
$16,419.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.59 |
| Max. Negotiated Rate |
$15,763.11 |
| Rate for Payer: Aetna Commercial |
$12,643.33
|
| Rate for Payer: Anthem Medicaid |
$5,646.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,807.53
|
| Rate for Payer: Cash Price |
$8,209.96
|
| Rate for Payer: Cigna Commercial |
$13,628.53
|
| Rate for Payer: First Health Commercial |
$15,598.91
|
| Rate for Payer: Humana Commercial |
$13,956.92
|
| Rate for Payer: Humana KY Medicaid |
$5,646.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,704.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,464.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,117.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,925.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,760.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,449.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,314.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.17
|
| Rate for Payer: PHCS Commercial |
$15,763.11
|
| Rate for Payer: United Healthcare All Payer |
$14,449.52
|
|
|
LEGION CR NP FEM SZ 4 LT
|
Facility
|
IP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION CR NP FEM SZ 4 LT
|
Facility
|
OP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem Medicaid |
$3,344.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Humana KY Medicaid |
$3,344.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION CR NP FEM SZ 4 RT
|
Facility
|
IP
|
$16,419.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.59 |
| Max. Negotiated Rate |
$15,763.11 |
| Rate for Payer: Aetna Commercial |
$12,643.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,807.53
|
| Rate for Payer: Cash Price |
$8,209.96
|
| Rate for Payer: Cigna Commercial |
$13,628.53
|
| Rate for Payer: First Health Commercial |
$15,598.91
|
| Rate for Payer: Humana Commercial |
$13,956.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,464.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,117.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,925.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,449.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,314.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.17
|
| Rate for Payer: PHCS Commercial |
$15,763.11
|
| Rate for Payer: United Healthcare All Payer |
$14,449.52
|
|
|
LEGION CR NP FEM SZ 4 RT
|
Facility
|
OP
|
$16,419.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,134.59 |
| Max. Negotiated Rate |
$15,763.11 |
| Rate for Payer: Aetna Commercial |
$12,643.33
|
| Rate for Payer: Anthem Medicaid |
$5,646.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,807.53
|
| Rate for Payer: Cash Price |
$8,209.96
|
| Rate for Payer: Cigna Commercial |
$13,628.53
|
| Rate for Payer: First Health Commercial |
$15,598.91
|
| Rate for Payer: Humana Commercial |
$13,956.92
|
| Rate for Payer: Humana KY Medicaid |
$5,646.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,704.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,464.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,117.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,925.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,760.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,449.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,314.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,283.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,134.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.17
|
| Rate for Payer: PHCS Commercial |
$15,763.11
|
| Rate for Payer: United Healthcare All Payer |
$14,449.52
|
|
|
LEGION CR NP FEM SZ 5 LT
|
Facility
|
OP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem Medicaid |
$3,344.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Humana KY Medicaid |
$3,344.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION CR NP FEM SZ 5 LT
|
Facility
|
IP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
