|
LEGION OFFSET COUPLER ANGLED
|
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 OFFSET COUPLER ANGLED
|
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 OX CONS FEM 2 LT
|
Facility
|
IP
|
$26,221.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.77 |
| Max. Negotiated Rate |
$25,172.45 |
| Rate for Payer: Aetna Commercial |
$20,190.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,452.61
|
| Rate for Payer: Cash Price |
$13,110.65
|
| Rate for Payer: Cigna Commercial |
$21,763.68
|
| Rate for Payer: First Health Commercial |
$24,910.24
|
| Rate for Payer: Humana Commercial |
$22,288.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,501.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,351.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,866.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,074.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,665.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,244.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,408.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,128.60
|
| Rate for Payer: PHCS Commercial |
$25,172.45
|
| Rate for Payer: United Healthcare All Payer |
$23,074.74
|
|
|
LEGION OX CONS FEM 2 LT
|
Facility
|
OP
|
$26,221.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.77 |
| Max. Negotiated Rate |
$25,172.45 |
| Rate for Payer: Aetna Commercial |
$20,190.40
|
| Rate for Payer: Anthem Medicaid |
$9,017.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,452.61
|
| Rate for Payer: Cash Price |
$13,110.65
|
| Rate for Payer: Cigna Commercial |
$21,763.68
|
| Rate for Payer: First Health Commercial |
$24,910.24
|
| Rate for Payer: Humana Commercial |
$22,288.10
|
| Rate for Payer: Humana KY Medicaid |
$9,017.51
|
| Rate for Payer: Kentucky WC Medicaid |
$9,109.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,501.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,351.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,866.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,198.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,074.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,665.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,244.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,408.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,128.60
|
| Rate for Payer: PHCS Commercial |
$25,172.45
|
| Rate for Payer: United Healthcare All Payer |
$23,074.74
|
|
|
LEGION OX CONS FEM 2 RT
|
Facility
|
IP
|
$26,221.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.77 |
| Max. Negotiated Rate |
$25,172.45 |
| Rate for Payer: Aetna Commercial |
$20,190.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,452.61
|
| Rate for Payer: Cash Price |
$13,110.65
|
| Rate for Payer: Cigna Commercial |
$21,763.68
|
| Rate for Payer: First Health Commercial |
$24,910.24
|
| Rate for Payer: Humana Commercial |
$22,288.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,501.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,351.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,866.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,074.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,665.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,244.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,408.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,128.60
|
| Rate for Payer: PHCS Commercial |
$25,172.45
|
| Rate for Payer: United Healthcare All Payer |
$23,074.74
|
|
|
LEGION OX CONS FEM 2 RT
|
Facility
|
OP
|
$26,221.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.77 |
| Max. Negotiated Rate |
$25,172.45 |
| Rate for Payer: Aetna Commercial |
$20,190.40
|
| Rate for Payer: Anthem Medicaid |
$9,017.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,452.61
|
| Rate for Payer: Cash Price |
$13,110.65
|
| Rate for Payer: Cigna Commercial |
$21,763.68
|
| Rate for Payer: First Health Commercial |
$24,910.24
|
| Rate for Payer: Humana Commercial |
$22,288.10
|
| Rate for Payer: Humana KY Medicaid |
$9,017.51
|
| Rate for Payer: Kentucky WC Medicaid |
$9,109.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,501.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,351.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,866.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,198.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,074.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,665.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,244.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,408.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,128.60
|
| Rate for Payer: PHCS Commercial |
$25,172.45
|
| Rate for Payer: United Healthcare All Payer |
$23,074.74
|
|
|
LEGION OX CONS FEM 3 LT
|
Facility
|
IP
|
$26,221.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.77 |
| Max. Negotiated Rate |
$25,172.45 |
| Rate for Payer: Aetna Commercial |
$20,190.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,452.61
|
| Rate for Payer: Cash Price |
$13,110.65
|
| Rate for Payer: Cigna Commercial |
$21,763.68
|
| Rate for Payer: First Health Commercial |
$24,910.24
|
| Rate for Payer: Humana Commercial |
$22,288.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,501.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,351.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,866.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,074.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,665.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,244.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,408.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,128.60
|
| Rate for Payer: PHCS Commercial |
$25,172.45
|
| Rate for Payer: United Healthcare All Payer |
$23,074.74
|
|
|
LEGION OX CONS FEM 3 LT
|
Facility
|
OP
|
$26,221.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.77 |
| Max. Negotiated Rate |
$25,172.45 |
| Rate for Payer: Aetna Commercial |
$20,190.40
|
| Rate for Payer: Anthem Medicaid |
$9,017.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,452.61
|
| Rate for Payer: Cash Price |
$13,110.65
|
| Rate for Payer: Cigna Commercial |
$21,763.68
|
| Rate for Payer: First Health Commercial |
$24,910.24
|
| Rate for Payer: Humana Commercial |
$22,288.10
|
| Rate for Payer: Humana KY Medicaid |
$9,017.51
|
| Rate for Payer: Kentucky WC Medicaid |
$9,109.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,501.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,351.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,866.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,198.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,074.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,665.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,244.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,408.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,128.60
|
| Rate for Payer: PHCS Commercial |
$25,172.45
|
| Rate for Payer: United Healthcare All Payer |
$23,074.74
|
|
|
LEGION OX CONS FEM 3 RT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 3 RT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 4 LT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 4 LT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 4 RT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 4 RT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 5 LT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 5 LT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 5 RT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 5 RT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 6 LT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 6 LT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 6 RT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 6 RT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 7 LT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 7 LT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 7 RT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
