|
LEGION PS OXIN FEM SZ 3 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 PS OXIN FEM SZ 3 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 PS OXIN FEM SZ 3RT
|
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 PS OXIN FEM SZ 3RT
|
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 PS OXIN FEM SZ 4LT
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
LEGION PS OXIN FEM SZ 4LT
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
LEGION PS OXIN FEM SZ 4 RT
|
Facility
|
OP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem Medicaid |
$6,248.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Humana KY Medicaid |
$6,248.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,311.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,373.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION PS OXIN FEM SZ 4 RT
|
Facility
|
IP
|
$18,168.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,361.93 |
| Max. Negotiated Rate |
$17,441.93 |
| Rate for Payer: Aetna Commercial |
$13,989.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,171.57
|
| Rate for Payer: Cash Price |
$9,084.34
|
| Rate for Payer: Cigna Commercial |
$15,080.00
|
| Rate for Payer: First Health Commercial |
$17,260.25
|
| Rate for Payer: Humana Commercial |
$15,443.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,898.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,408.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,988.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,626.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,361.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,632.29
|
| Rate for Payer: PHCS Commercial |
$17,441.93
|
| Rate for Payer: United Healthcare All Payer |
$15,988.44
|
|
|
LEGION PS OXIN FEM SZ 6 LT
|
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 PS OXIN FEM SZ 6 LT
|
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 PS OXIN FEM SZ 6 RT
|
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 PS OXIN FEM SZ 6 RT
|
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 PS OXIN FEM SZ 7 LT
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
LEGION PS OXIN FEM SZ 7 LT
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
LEGION PS OXIN FEM SZ 7RT.
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
LEGION PS OXIN FEM SZ 7RT.
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
LEGION PS OXIN FEM SZ 8 LT
|
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 PS OXIN FEM SZ 8 LT
|
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 PS OXIN FEM SZ 8RT
|
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 PS OXIN FEM SZ 8RT
|
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 REV TIB BASE SZ 1 LT
|
Facility
|
OP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem Medicaid |
$4,415.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Humana KY Medicaid |
$4,415.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,504.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
LEGION REV TIB BASE SZ 1 LT
|
Facility
|
IP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
LEGION REV TIB BASE SZ 1 RT
|
Facility
|
OP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem Medicaid |
$4,415.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Humana KY Medicaid |
$4,415.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,504.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
LEGION REV TIB BASE SZ 1 RT
|
Facility
|
IP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
LEGION REV TIB BASE SZ 2 LT
|
Facility
|
IP
|
$18,240.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,371.20 |
| Max. Negotiated Rate |
$17,510.40 |
| Rate for Payer: Aetna Commercial |
$14,044.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,227.20
|
| Rate for Payer: Cash Price |
$9,120.00
|
| Rate for Payer: Cigna Commercial |
$15,139.20
|
| Rate for Payer: First Health Commercial |
$17,328.00
|
| Rate for Payer: Humana Commercial |
$15,504.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,956.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,461.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,472.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,051.20
|
| Rate for Payer: Ohio Health Group HMO |
$13,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,371.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,654.40
|
| Rate for Payer: PHCS Commercial |
$17,510.40
|
| Rate for Payer: United Healthcare All Payer |
$16,051.20
|
|
