|
LEGION FEM COMP OX SZ 3 R
|
Facility
|
OP
|
$12,315.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.02 |
| Max. Negotiated Rate |
$11,822.88 |
| Rate for Payer: Aetna Commercial |
$9,482.94
|
| Rate for Payer: Anthem Medicaid |
$4,235.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,606.09
|
| Rate for Payer: Cash Price |
$6,157.75
|
| Rate for Payer: Cigna Commercial |
$10,221.86
|
| Rate for Payer: First Health Commercial |
$11,699.72
|
| Rate for Payer: Humana Commercial |
$10,468.18
|
| Rate for Payer: Humana KY Medicaid |
$4,235.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,098.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,088.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,694.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,837.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,236.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,463.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,817.80
|
| Rate for Payer: PHCS Commercial |
$11,822.88
|
| Rate for Payer: United Healthcare All Payer |
$10,837.64
|
|
|
LEGION FEM COMP OX SZ 3 R
|
Facility
|
IP
|
$12,315.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.02 |
| Max. Negotiated Rate |
$11,822.88 |
| Rate for Payer: Aetna Commercial |
$9,482.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,606.09
|
| Rate for Payer: Cash Price |
$6,157.75
|
| Rate for Payer: Cigna Commercial |
$10,221.86
|
| Rate for Payer: First Health Commercial |
$11,699.72
|
| Rate for Payer: Humana Commercial |
$10,468.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,098.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,088.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,694.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,837.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,236.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,463.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,817.80
|
| Rate for Payer: PHCS Commercial |
$11,822.88
|
| Rate for Payer: United Healthcare All Payer |
$10,837.64
|
|
|
LEGION FEM COMP SZ 5LT
|
Facility
|
OP
|
$12,315.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.02 |
| Max. Negotiated Rate |
$11,822.88 |
| Rate for Payer: Aetna Commercial |
$9,482.94
|
| Rate for Payer: Anthem Medicaid |
$4,235.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,606.09
|
| Rate for Payer: Cash Price |
$6,157.75
|
| Rate for Payer: Cigna Commercial |
$10,221.86
|
| Rate for Payer: First Health Commercial |
$11,699.72
|
| Rate for Payer: Humana Commercial |
$10,468.18
|
| Rate for Payer: Humana KY Medicaid |
$4,235.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,098.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,088.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,694.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,837.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,236.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,463.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,817.80
|
| Rate for Payer: PHCS Commercial |
$11,822.88
|
| Rate for Payer: United Healthcare All Payer |
$10,837.64
|
|
|
LEGION FEM COMP SZ 5LT
|
Facility
|
IP
|
$12,315.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.02 |
| Max. Negotiated Rate |
$11,822.88 |
| Rate for Payer: Aetna Commercial |
$9,482.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,606.09
|
| Rate for Payer: Cash Price |
$6,157.75
|
| Rate for Payer: Cigna Commercial |
$10,221.86
|
| Rate for Payer: First Health Commercial |
$11,699.72
|
| Rate for Payer: Humana Commercial |
$10,468.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,098.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,088.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,694.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,837.64
|
| Rate for Payer: Ohio Health Group HMO |
$9,236.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,463.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,817.80
|
| Rate for Payer: PHCS Commercial |
$11,822.88
|
| Rate for Payer: United Healthcare All Payer |
$10,837.64
|
|
|
LEGION FEM PSTRIOR STAB SZ6 LT
|
Facility
|
IP
|
$13,217.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.22 |
| Max. Negotiated Rate |
$12,688.37 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,309.30
|
| Rate for Payer: Cash Price |
$6,608.52
|
| Rate for Payer: Cigna Commercial |
$10,970.15
|
| Rate for Payer: First Health Commercial |
$12,556.20
|
| Rate for Payer: Humana Commercial |
$11,234.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,837.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,754.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,965.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,631.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,643.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,718.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,097.29
|
| Rate for Payer: PHCS Commercial |
$12,688.37
|
| Rate for Payer: United Healthcare All Payer |
$11,631.00
|
|
|
LEGION FEM PSTRIOR STAB SZ6 LT
|
Facility
|
OP
|
$13,217.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.22 |
| Max. Negotiated Rate |
$12,688.37 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Anthem Medicaid |
$4,545.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,309.30
|
| Rate for Payer: Cash Price |
$6,608.52
|
| Rate for Payer: Cigna Commercial |
$10,970.15
|
| Rate for Payer: First Health Commercial |
$12,556.20
|
| Rate for Payer: Humana Commercial |
$11,234.49
|
| Rate for Payer: Humana KY Medicaid |
$4,545.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,591.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,837.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,754.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,965.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,636.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,631.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,643.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,718.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,097.29
|
| Rate for Payer: PHCS Commercial |
$12,688.37
|
| Rate for Payer: United Healthcare All Payer |
$11,631.00
|
|
|
LEGION FEM WED SZ 1-2 LNG 10MM
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 1-2 LNG 10MM
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 1-2 LONG 5MM
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 1-2 LONG 5MM
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 3-4 LNG 10MM
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 3-4 LNG 10MM
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 3-4 LONG 5MM
|
Facility
|
OP
|
$8,986.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.28 |
| Max. Negotiated Rate |
$8,627.28 |
| Rate for Payer: Aetna Commercial |
$6,919.80
|
| Rate for Payer: Anthem Medicaid |
$3,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.66
|
| Rate for Payer: Cash Price |
$4,493.38
|
| Rate for Payer: Cigna Commercial |
$7,459.00
|
| Rate for Payer: First Health Commercial |
$8,537.41
|
| Rate for Payer: Humana Commercial |
$7,638.74
|
| Rate for Payer: Humana KY Medicaid |
$3,090.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,369.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,632.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,696.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,908.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,740.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.89
|
| Rate for Payer: PHCS Commercial |
$8,627.28
|
| Rate for Payer: United Healthcare All Payer |
$7,908.34
|
|
|
LEGION FEM WED SZ 3-4 LONG 5MM
|
Facility
|
IP
|
$8,986.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.28 |
| Max. Negotiated Rate |
$8,627.28 |
| Rate for Payer: Aetna Commercial |
$6,919.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.66
|
| Rate for Payer: Cash Price |
$4,493.38
|
| Rate for Payer: Cigna Commercial |
$7,459.00
|
| Rate for Payer: First Health Commercial |
$8,537.41
|
| Rate for Payer: Humana Commercial |
$7,638.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,369.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,632.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,696.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,908.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,740.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.89
|
| Rate for Payer: PHCS Commercial |
$8,627.28
|
| Rate for Payer: United Healthcare All Payer |
$7,908.34
|
|
|
LEGION FEM WED SZ 5-6 LNG 10MM
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 5-6 LNG 10MM
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 5-6 LONG 5MM
|
Facility
|
IP
|
$8,892.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.04 |
| Max. Negotiated Rate |
$8,536.88 |
| Rate for Payer: Aetna Commercial |
$6,847.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,936.21
|
| Rate for Payer: Cash Price |
$4,446.29
|
| Rate for Payer: Cigna Commercial |
$7,380.84
|
| Rate for Payer: First Health Commercial |
$8,447.95
|
| Rate for Payer: Humana Commercial |
$7,558.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,291.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,562.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,825.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,669.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,156.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,756.70
|
| Rate for Payer: PHCS Commercial |
$8,536.88
|
| Rate for Payer: United Healthcare All Payer |
$7,825.47
|
|
|
LEGION FEM WED SZ 5-6 LONG 5MM
|
Facility
|
OP
|
$8,892.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.04 |
| Max. Negotiated Rate |
$8,536.88 |
| Rate for Payer: Aetna Commercial |
$6,847.29
|
| Rate for Payer: Anthem Medicaid |
$3,058.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,936.21
|
| Rate for Payer: Cash Price |
$4,446.29
|
| Rate for Payer: Cigna Commercial |
$7,380.84
|
| Rate for Payer: First Health Commercial |
$8,447.95
|
| Rate for Payer: Humana Commercial |
$7,558.69
|
| Rate for Payer: Humana KY Medicaid |
$3,058.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,089.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,291.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,562.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,825.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,669.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,156.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,756.70
|
| Rate for Payer: PHCS Commercial |
$8,536.88
|
| Rate for Payer: United Healthcare All Payer |
$7,825.47
|
|
|
LEGION FEM WED SZ 7-8 LNG 10MM
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 7-8 LNG 10MM
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION FEM WED SZ 7-8 LONG 5MM
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
LEGION FEM WED SZ 7-8 LONG 5MM
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
LEGION HF ART INSERT SZ 7-8 11
|
Facility
|
OP
|
$12,002.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.35 |
| Max. Negotiated Rate |
$11,522.58 |
| Rate for Payer: Aetna Commercial |
$9,242.07
|
| Rate for Payer: Anthem Medicaid |
$4,127.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,362.10
|
| Rate for Payer: Cash Price |
$6,001.35
|
| Rate for Payer: Cigna Commercial |
$9,962.23
|
| Rate for Payer: First Health Commercial |
$11,402.56
|
| Rate for Payer: Humana Commercial |
$10,202.29
|
| Rate for Payer: Humana KY Medicaid |
$4,127.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,169.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,842.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,562.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,002.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.83
|
| Rate for Payer: PHCS Commercial |
$11,522.58
|
| Rate for Payer: United Healthcare All Payer |
$10,562.37
|
|
|
LEGION HF ART INSERT SZ 7-8 11
|
Facility
|
IP
|
$12,002.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.35 |
| Max. Negotiated Rate |
$11,522.58 |
| Rate for Payer: Aetna Commercial |
$9,242.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,362.10
|
| Rate for Payer: Cash Price |
$6,001.35
|
| Rate for Payer: Cigna Commercial |
$9,962.23
|
| Rate for Payer: First Health Commercial |
$11,402.56
|
| Rate for Payer: Humana Commercial |
$10,202.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,842.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,562.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,002.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.83
|
| Rate for Payer: PHCS Commercial |
$11,522.58
|
| Rate for Payer: United Healthcare All Payer |
$10,562.37
|
|
|
LEGION HF ART INSRT SZ3-4*15MM
|
Facility
|
OP
|
$9,439.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.10 |
| Max. Negotiated Rate |
$9,061.67 |
| Rate for Payer: Aetna Commercial |
$7,268.21
|
| Rate for Payer: Anthem Medicaid |
$3,246.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,362.61
|
| Rate for Payer: Cash Price |
$4,719.62
|
| Rate for Payer: Cigna Commercial |
$7,834.57
|
| Rate for Payer: First Health Commercial |
$8,967.28
|
| Rate for Payer: Humana Commercial |
$8,023.35
|
| Rate for Payer: Humana KY Medicaid |
$3,246.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,279.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,740.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,966.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,831.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,311.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,306.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,079.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,887.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,926.16
|
| Rate for Payer: PHCS Commercial |
$9,061.67
|
| Rate for Payer: United Healthcare All Payer |
$8,306.53
|
|
