|
LEGION CR NP FEM SZ 5 RT
|
Facility
|
IP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 5 RT
|
Facility
|
OP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem Medicaid |
$3,344.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Humana KY Medicaid |
$3,344.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 6 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 6 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 6 RT
|
Facility
|
IP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 6 RT
|
Facility
|
OP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem Medicaid |
$3,344.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Humana KY Medicaid |
$3,344.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 7LT
|
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 7LT
|
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 7 RT
|
Facility
|
IP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 7 RT
|
Facility
|
OP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem Medicaid |
$3,344.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Humana KY Medicaid |
$3,344.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 8 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 8 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 8 RT
|
Facility
|
IP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR NP FEM SZ 8 RT
|
Facility
|
OP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem Medicaid |
$3,344.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Humana KY Medicaid |
$3,344.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION CR OXIN FEM SZ 2 LT
|
Facility
|
IP
|
$11,348.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.27 |
| Max. Negotiated Rate |
$10,894.32 |
| Rate for Payer: Aetna Commercial |
$8,738.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,851.64
|
| Rate for Payer: Cash Price |
$5,674.12
|
| Rate for Payer: Cigna Commercial |
$9,419.05
|
| Rate for Payer: First Health Commercial |
$10,780.84
|
| Rate for Payer: Humana Commercial |
$9,646.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,305.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,375.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,404.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,986.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,511.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,269.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,475.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,517.96
|
| Rate for Payer: PHCS Commercial |
$10,894.32
|
| Rate for Payer: United Healthcare All Payer |
$9,986.46
|
|
|
LEGION CR OXIN FEM SZ 2 LT
|
Facility
|
OP
|
$11,348.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.27 |
| Max. Negotiated Rate |
$10,894.32 |
| Rate for Payer: Aetna Commercial |
$8,738.15
|
| Rate for Payer: Anthem Medicaid |
$3,902.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,851.64
|
| Rate for Payer: Cash Price |
$5,674.12
|
| Rate for Payer: Cigna Commercial |
$9,419.05
|
| Rate for Payer: First Health Commercial |
$10,780.84
|
| Rate for Payer: Humana Commercial |
$9,646.01
|
| Rate for Payer: Humana KY Medicaid |
$3,902.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,942.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,305.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,375.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,404.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,980.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,986.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,511.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,269.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,475.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,517.96
|
| Rate for Payer: PHCS Commercial |
$10,894.32
|
| Rate for Payer: United Healthcare All Payer |
$9,986.46
|
|
|
LEGION CR OXIN FEM SZ 2 RT
|
Facility
|
IP
|
$11,348.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.27 |
| Max. Negotiated Rate |
$10,894.32 |
| Rate for Payer: Aetna Commercial |
$8,738.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,851.64
|
| Rate for Payer: Cash Price |
$5,674.12
|
| Rate for Payer: Cigna Commercial |
$9,419.05
|
| Rate for Payer: First Health Commercial |
$10,780.84
|
| Rate for Payer: Humana Commercial |
$9,646.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,305.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,375.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,404.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,986.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,511.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,269.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,475.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,517.96
|
| Rate for Payer: PHCS Commercial |
$10,894.32
|
| Rate for Payer: United Healthcare All Payer |
$9,986.46
|
|
|
LEGION CR OXIN FEM SZ 2 RT
|
Facility
|
OP
|
$11,348.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.27 |
| Max. Negotiated Rate |
$10,894.32 |
| Rate for Payer: Aetna Commercial |
$8,738.15
|
| Rate for Payer: Anthem Medicaid |
$3,902.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,851.64
|
| Rate for Payer: Cash Price |
$5,674.12
|
| Rate for Payer: Cigna Commercial |
$9,419.05
|
| Rate for Payer: First Health Commercial |
$10,780.84
|
| Rate for Payer: Humana Commercial |
$9,646.01
|
| Rate for Payer: Humana KY Medicaid |
$3,902.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,942.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,305.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,375.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,404.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,980.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,986.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,511.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,269.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,475.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,517.96
|
| Rate for Payer: PHCS Commercial |
$10,894.32
|
| Rate for Payer: United Healthcare All Payer |
$9,986.46
|
|
|
LEGION CR OXIN FEM SZ 3 LT
|
Facility
|
OP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem Medicaid |
$6,248.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Humana KY Medicaid |
$6,248.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,311.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,373.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION CR OXIN FEM SZ 3 LT
|
Facility
|
IP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION CR OXIN FEM SZ 3 RT
|
Facility
|
OP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem Medicaid |
$6,248.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Humana KY Medicaid |
$6,248.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,311.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,373.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION CR OXIN FEM SZ 3 RT
|
Facility
|
IP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION CR OXIN FEM SZ 4 LT
|
Facility
|
IP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION CR OXIN FEM SZ 4 LT
|
Facility
|
OP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem Medicaid |
$6,248.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Humana KY Medicaid |
$6,248.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,311.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,373.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION CR OXIN FEM SZ 4 RT
|
Facility
|
IP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
