|
LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
|
IP
|
$11,372.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
76102476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,411.60 |
| Max. Negotiated Rate |
$10,917.12 |
| Rate for Payer: Aetna Commercial |
$8,756.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,870.16
|
| Rate for Payer: Cash Price |
$5,686.00
|
| Rate for Payer: Cigna Commercial |
$9,438.76
|
| Rate for Payer: First Health Commercial |
$10,803.40
|
| Rate for Payer: Humana Commercial |
$9,666.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,325.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,392.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,411.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,007.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,529.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,893.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,846.68
|
| Rate for Payer: PHCS Commercial |
$10,917.12
|
| Rate for Payer: United Healthcare All Payer |
$10,007.36
|
|
|
LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
|
OP
|
$11,372.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
76102476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$10,917.12 |
| Rate for Payer: Aetna Commercial |
$8,756.44
|
| Rate for Payer: Anthem Medicaid |
$3,910.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,870.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$5,686.00
|
| Rate for Payer: Cash Price |
$5,686.00
|
| Rate for Payer: Cigna Commercial |
$9,438.76
|
| Rate for Payer: First Health Commercial |
$10,803.40
|
| Rate for Payer: Humana Commercial |
$9,666.20
|
| Rate for Payer: Humana KY Medicaid |
$3,910.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,950.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,325.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,392.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,989.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,007.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,529.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,893.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,846.68
|
| Rate for Payer: PHCS Commercial |
$10,917.12
|
| Rate for Payer: United Healthcare All Payer |
$10,007.36
|
|
|
LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
|
OP
|
$11,611.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
48100063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$11,146.56 |
| Rate for Payer: Aetna Commercial |
$8,940.47
|
| Rate for Payer: Anthem Medicaid |
$3,993.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$5,805.50
|
| Rate for Payer: Cash Price |
$5,805.50
|
| Rate for Payer: Cigna Commercial |
$9,637.13
|
| Rate for Payer: First Health Commercial |
$11,030.45
|
| Rate for Payer: Humana Commercial |
$9,869.35
|
| Rate for Payer: Humana KY Medicaid |
$3,993.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,033.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,521.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,073.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.59
|
| Rate for Payer: PHCS Commercial |
$11,146.56
|
| Rate for Payer: United Healthcare All Payer |
$10,217.68
|
|
|
LEFT HRT CATH W/VENTRCLGRPHY
|
Facility
|
IP
|
$11,611.00
|
|
|
Service Code
|
HCPCS 93452
|
| Hospital Charge Code |
48100063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,483.30 |
| Max. Negotiated Rate |
$11,146.56 |
| Rate for Payer: Aetna Commercial |
$8,940.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.58
|
| Rate for Payer: Cash Price |
$5,805.50
|
| Rate for Payer: Cigna Commercial |
$9,637.13
|
| Rate for Payer: First Health Commercial |
$11,030.45
|
| Rate for Payer: Humana Commercial |
$9,869.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,521.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.59
|
| Rate for Payer: PHCS Commercial |
$11,146.56
|
| Rate for Payer: United Healthcare All Payer |
$10,217.68
|
|
|
LEGION ART INSRT 15 SZ 5-6
|
Facility
|
IP
|
$7,913.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.94 |
| Max. Negotiated Rate |
$7,596.60 |
| Rate for Payer: Aetna Commercial |
$6,093.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,172.23
|
| Rate for Payer: Cash Price |
$3,956.56
|
| Rate for Payer: Cigna Commercial |
$6,567.89
|
| Rate for Payer: First Health Commercial |
$7,517.46
|
| Rate for Payer: Humana Commercial |
$6,726.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,330.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,884.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,460.05
|
| Rate for Payer: PHCS Commercial |
$7,596.60
|
| Rate for Payer: United Healthcare All Payer |
$6,963.55
|
|
|
LEGION ART INSRT 15 SZ 5-6
|
Facility
|
OP
|
$7,913.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.94 |
| Max. Negotiated Rate |
$7,596.60 |
| Rate for Payer: Aetna Commercial |
$6,093.10
|
| Rate for Payer: Anthem Medicaid |
$2,721.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,172.23
|
| Rate for Payer: Cash Price |
$3,956.56
|
| Rate for Payer: Cigna Commercial |
$6,567.89
|
| Rate for Payer: First Health Commercial |
$7,517.46
|
| Rate for Payer: Humana Commercial |
$6,726.15
|
| Rate for Payer: Humana KY Medicaid |
$2,721.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,749.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,330.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,884.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,460.05
|
| Rate for Payer: PHCS Commercial |
$7,596.60
|
| Rate for Payer: United Healthcare All Payer |
$6,963.55
|
|
|
LEGION ART INSRT 9 SZ 1-2
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
LEGION ART INSRT 9 SZ 1-2
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
LEGION ART INSRT 9 SZ 3-4
|
Facility
|
OP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem Medicaid |
$4,813.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Humana KY Medicaid |
$4,813.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,862.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,909.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
LEGION ART INSRT 9 SZ 3-4
|
Facility
|
IP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
LEGION ART INSRT 9 SZ 5-6
|
Facility
|
IP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
LEGION ART INSRT 9 SZ 5-6
|
Facility
|
OP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem Medicaid |
$4,813.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Humana KY Medicaid |
$4,813.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,862.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,909.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
LEGION ART INSRT 9 SZ 7-8
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
LEGION ART INSRT 9 SZ 7-8
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
LEGION CR NP FEM SZ 2 LT
|
Facility
|
OP
|
$10,907.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.37 |
| Max. Negotiated Rate |
$10,471.58 |
| Rate for Payer: Aetna Commercial |
$8,399.08
|
| Rate for Payer: Anthem Medicaid |
$3,751.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.16
|
| Rate for Payer: Cash Price |
$5,453.95
|
| Rate for Payer: Cigna Commercial |
$9,053.56
|
| Rate for Payer: First Health Commercial |
$10,362.50
|
| Rate for Payer: Humana Commercial |
$9,271.72
|
| Rate for Payer: Humana KY Medicaid |
$3,751.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,944.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,598.95
|
| Rate for Payer: Ohio Health Group HMO |
$8,180.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,726.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,489.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,526.45
|
| Rate for Payer: PHCS Commercial |
$10,471.58
|
| Rate for Payer: United Healthcare All Payer |
$9,598.95
|
|
|
LEGION CR NP FEM SZ 2 LT
|
Facility
|
IP
|
$10,907.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.37 |
| Max. Negotiated Rate |
$10,471.58 |
| Rate for Payer: Aetna Commercial |
$8,399.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.16
|
| Rate for Payer: Cash Price |
$5,453.95
|
| Rate for Payer: Cigna Commercial |
$9,053.56
|
| Rate for Payer: First Health Commercial |
$10,362.50
|
| Rate for Payer: Humana Commercial |
$9,271.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,944.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,598.95
|
| Rate for Payer: Ohio Health Group HMO |
$8,180.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,726.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,489.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,526.45
|
| Rate for Payer: PHCS Commercial |
$10,471.58
|
| Rate for Payer: United Healthcare All Payer |
$9,598.95
|
|
|
LEGION CR NP FEM SZ 2 RT
|
Facility
|
IP
|
$10,907.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.37 |
| Max. Negotiated Rate |
$10,471.58 |
| Rate for Payer: Aetna Commercial |
$8,399.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.16
|
| Rate for Payer: Cash Price |
$5,453.95
|
| Rate for Payer: Cigna Commercial |
$9,053.56
|
| Rate for Payer: First Health Commercial |
$10,362.50
|
| Rate for Payer: Humana Commercial |
$9,271.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,944.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,598.95
|
| Rate for Payer: Ohio Health Group HMO |
$8,180.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,726.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,489.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,526.45
|
| Rate for Payer: PHCS Commercial |
$10,471.58
|
| Rate for Payer: United Healthcare All Payer |
$9,598.95
|
|
|
LEGION CR NP FEM SZ 2 RT
|
Facility
|
OP
|
$10,907.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,272.37 |
| Max. Negotiated Rate |
$10,471.58 |
| Rate for Payer: Aetna Commercial |
$8,399.08
|
| Rate for Payer: Anthem Medicaid |
$3,751.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,508.16
|
| Rate for Payer: Cash Price |
$5,453.95
|
| Rate for Payer: Cigna Commercial |
$9,053.56
|
| Rate for Payer: First Health Commercial |
$10,362.50
|
| Rate for Payer: Humana Commercial |
$9,271.72
|
| Rate for Payer: Humana KY Medicaid |
$3,751.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,789.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,944.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,050.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,272.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,826.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,598.95
|
| Rate for Payer: Ohio Health Group HMO |
$8,180.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,726.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,489.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,526.45
|
| Rate for Payer: PHCS Commercial |
$10,471.58
|
| Rate for Payer: United Healthcare All Payer |
$9,598.95
|
|
|
LEGION CR NP FEM SZ 3 LT
|
Facility
|
OP
|
$9,925.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.76 |
| Max. Negotiated Rate |
$9,528.84 |
| Rate for Payer: Aetna Commercial |
$7,642.93
|
| Rate for Payer: Anthem Medicaid |
$3,413.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,742.19
|
| Rate for Payer: Cash Price |
$4,962.94
|
| Rate for Payer: Cigna Commercial |
$8,238.48
|
| Rate for Payer: First Health Commercial |
$9,429.59
|
| Rate for Payer: Humana Commercial |
$8,437.00
|
| Rate for Payer: Humana KY Medicaid |
$3,413.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,448.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,139.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,325.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,734.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,444.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,635.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,848.86
|
| Rate for Payer: PHCS Commercial |
$9,528.84
|
| Rate for Payer: United Healthcare All Payer |
$8,734.77
|
|
|
LEGION CR NP FEM SZ 3 LT
|
Facility
|
IP
|
$9,925.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.76 |
| Max. Negotiated Rate |
$9,528.84 |
| Rate for Payer: Aetna Commercial |
$7,642.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,742.19
|
| Rate for Payer: Cash Price |
$4,962.94
|
| Rate for Payer: Cigna Commercial |
$8,238.48
|
| Rate for Payer: First Health Commercial |
$9,429.59
|
| Rate for Payer: Humana Commercial |
$8,437.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,139.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,325.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,734.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,444.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,635.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,848.86
|
| Rate for Payer: PHCS Commercial |
$9,528.84
|
| Rate for Payer: United Healthcare All Payer |
$8,734.77
|
|
|
LEGION CR NP FEM SZ 3 RT
|
Facility
|
OP
|
$16,959.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,087.81 |
| Max. Negotiated Rate |
$16,280.98 |
| Rate for Payer: Aetna Commercial |
$13,058.70
|
| Rate for Payer: Anthem Medicaid |
$5,832.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,228.29
|
| Rate for Payer: Cash Price |
$8,479.68
|
| Rate for Payer: Cigna Commercial |
$14,076.26
|
| Rate for Payer: First Health Commercial |
$16,111.38
|
| Rate for Payer: Humana Commercial |
$14,415.45
|
| Rate for Payer: Humana KY Medicaid |
$5,832.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,891.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,906.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,516.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,087.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,949.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,924.23
|
| Rate for Payer: Ohio Health Group HMO |
$12,719.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,567.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,754.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,701.95
|
| Rate for Payer: PHCS Commercial |
$16,280.98
|
| Rate for Payer: United Healthcare All Payer |
$14,924.23
|
|
|
LEGION CR NP FEM SZ 3 RT
|
Facility
|
IP
|
$16,959.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,087.81 |
| Max. Negotiated Rate |
$16,280.98 |
| Rate for Payer: Aetna Commercial |
$13,058.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,228.29
|
| Rate for Payer: Cash Price |
$8,479.68
|
| Rate for Payer: Cigna Commercial |
$14,076.26
|
| Rate for Payer: First Health Commercial |
$16,111.38
|
| Rate for Payer: Humana Commercial |
$14,415.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,906.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,516.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,087.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,924.23
|
| Rate for Payer: Ohio Health Group HMO |
$12,719.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,567.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,754.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,701.95
|
| Rate for Payer: PHCS Commercial |
$16,280.98
|
| Rate for Payer: United Healthcare All Payer |
$14,924.23
|
|
|
LEGION CR NP FEM SZ 4 LT
|
Facility
|
OP
|
$9,925.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.76 |
| Max. Negotiated Rate |
$9,528.84 |
| Rate for Payer: Aetna Commercial |
$7,642.93
|
| Rate for Payer: Anthem Medicaid |
$3,413.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,742.19
|
| Rate for Payer: Cash Price |
$4,962.94
|
| Rate for Payer: Cigna Commercial |
$8,238.48
|
| Rate for Payer: First Health Commercial |
$9,429.59
|
| Rate for Payer: Humana Commercial |
$8,437.00
|
| Rate for Payer: Humana KY Medicaid |
$3,413.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,448.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,139.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,325.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,734.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,444.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,635.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,848.86
|
| Rate for Payer: PHCS Commercial |
$9,528.84
|
| Rate for Payer: United Healthcare All Payer |
$8,734.77
|
|
|
LEGION CR NP FEM SZ 4 LT
|
Facility
|
IP
|
$9,925.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.76 |
| Max. Negotiated Rate |
$9,528.84 |
| Rate for Payer: Aetna Commercial |
$7,642.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,742.19
|
| Rate for Payer: Cash Price |
$4,962.94
|
| Rate for Payer: Cigna Commercial |
$8,238.48
|
| Rate for Payer: First Health Commercial |
$9,429.59
|
| Rate for Payer: Humana Commercial |
$8,437.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,139.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,325.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,734.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,444.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,635.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,848.86
|
| Rate for Payer: PHCS Commercial |
$9,528.84
|
| Rate for Payer: United Healthcare All Payer |
$8,734.77
|
|
|
LEGION CR NP FEM SZ 4 RT
|
Facility
|
OP
|
$16,959.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,087.81 |
| Max. Negotiated Rate |
$16,280.98 |
| Rate for Payer: Aetna Commercial |
$13,058.70
|
| Rate for Payer: Anthem Medicaid |
$5,832.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,228.29
|
| Rate for Payer: Cash Price |
$8,479.68
|
| Rate for Payer: Cigna Commercial |
$14,076.26
|
| Rate for Payer: First Health Commercial |
$16,111.38
|
| Rate for Payer: Humana Commercial |
$14,415.45
|
| Rate for Payer: Humana KY Medicaid |
$5,832.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,891.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,906.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,516.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,087.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,949.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,924.23
|
| Rate for Payer: Ohio Health Group HMO |
$12,719.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,567.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,754.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,701.95
|
| Rate for Payer: PHCS Commercial |
$16,280.98
|
| Rate for Payer: United Healthcare All Payer |
$14,924.23
|
|
