|
LEGION CR OXIN FEM SZ 4 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 5 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 5 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 5 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 5 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 6 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 6 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 6 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 6 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 7 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 7 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 7 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 7 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 8 LT
|
Facility
|
OP
|
$11,837.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.86 |
| Max. Negotiated Rate |
$11,363.86 |
| Rate for Payer: Aetna Commercial |
$9,114.76
|
| Rate for Payer: Anthem Medicaid |
$4,070.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,233.13
|
| Rate for Payer: Cash Price |
$5,918.68
|
| Rate for Payer: Cigna Commercial |
$9,825.00
|
| Rate for Payer: First Health Commercial |
$11,245.48
|
| Rate for Payer: Humana Commercial |
$10,061.75
|
| Rate for Payer: Humana KY Medicaid |
$4,070.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,112.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,706.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,735.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,551.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,152.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,416.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,878.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,367.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,538.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,669.58
|
| Rate for Payer: PHCS Commercial |
$11,363.86
|
| Rate for Payer: United Healthcare All Payer |
$10,416.87
|
|
|
LEGION CR OXIN FEM SZ 8 LT
|
Facility
|
IP
|
$11,837.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.86 |
| Max. Negotiated Rate |
$11,363.86 |
| Rate for Payer: Aetna Commercial |
$9,114.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,233.13
|
| Rate for Payer: Cash Price |
$5,918.68
|
| Rate for Payer: Cigna Commercial |
$9,825.00
|
| Rate for Payer: First Health Commercial |
$11,245.48
|
| Rate for Payer: Humana Commercial |
$10,061.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,706.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,735.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,551.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,416.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,878.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,367.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,538.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,669.58
|
| Rate for Payer: PHCS Commercial |
$11,363.86
|
| Rate for Payer: United Healthcare All Payer |
$10,416.87
|
|
|
LEGION CR OXIN FEM SZ 8 RT
|
Facility
|
IP
|
$11,837.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.86 |
| Max. Negotiated Rate |
$11,363.86 |
| Rate for Payer: Aetna Commercial |
$9,114.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,233.13
|
| Rate for Payer: Cash Price |
$5,918.68
|
| Rate for Payer: Cigna Commercial |
$9,825.00
|
| Rate for Payer: First Health Commercial |
$11,245.48
|
| Rate for Payer: Humana Commercial |
$10,061.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,706.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,735.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,551.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,416.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,878.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,367.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,538.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,669.58
|
| Rate for Payer: PHCS Commercial |
$11,363.86
|
| Rate for Payer: United Healthcare All Payer |
$10,416.87
|
|
|
LEGION CR OXIN FEM SZ 8 RT
|
Facility
|
OP
|
$11,837.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.86 |
| Max. Negotiated Rate |
$11,363.86 |
| Rate for Payer: Aetna Commercial |
$9,114.76
|
| Rate for Payer: Anthem Medicaid |
$4,070.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,233.13
|
| Rate for Payer: Cash Price |
$5,918.68
|
| Rate for Payer: Cigna Commercial |
$9,825.00
|
| Rate for Payer: First Health Commercial |
$11,245.48
|
| Rate for Payer: Humana Commercial |
$10,061.75
|
| Rate for Payer: Humana KY Medicaid |
$4,070.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,112.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,706.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,735.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,551.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,152.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,416.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,878.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,367.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,538.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,669.58
|
| Rate for Payer: PHCS Commercial |
$11,363.86
|
| Rate for Payer: United Healthcare All Payer |
$10,416.87
|
|
|
LEGION CR XLPE SZ 7-8 13MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION CR XLPE SZ 7-8 13MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION CR XLPE SZ 7-8 15MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION CR XLPE SZ 7-8 15MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION CR XLPE SZ 7-8 18MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION CR XLPE SZ 7-8 18MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGIONELLA PNEUMOPHILA
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
30001382
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$193.39
|
| Rate for Payer: First Health Commercial |
$221.35
|
| Rate for Payer: Humana Commercial |
$198.05
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.04
|
| Rate for Payer: Ohio Health Group HMO |
$174.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.23
|
| Rate for Payer: PHCS Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Payer |
$205.04
|
|
|
LEGIONELLA PNEUMOPHILA
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
30001382
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.29 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.10
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$193.39
|
| Rate for Payer: First Health Commercial |
$221.35
|
| Rate for Payer: Humana Commercial |
$198.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.04
|
| Rate for Payer: Ohio Health Group HMO |
$174.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.23
|
| Rate for Payer: PHCS Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Payer |
$205.04
|
|
