|
LEGION CR OXIN FEM SZ 4 LT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 4 LT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 4 RT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 4 RT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 5 LT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 5 LT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 5 RT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 5 RT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 6 LT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 6 LT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 6 RT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 6 RT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 7 LT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 7 LT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 7 RT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 7 RT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION CR OXIN FEM SZ 8 LT
|
Facility
|
IP
|
$12,084.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.24 |
| Max. Negotiated Rate |
$11,600.76 |
| Rate for Payer: Aetna Commercial |
$9,304.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,425.62
|
| Rate for Payer: Cash Price |
$6,042.06
|
| Rate for Payer: Cigna Commercial |
$10,029.83
|
| Rate for Payer: First Health Commercial |
$11,479.92
|
| Rate for Payer: Humana Commercial |
$10,271.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,908.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,918.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,625.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,634.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,063.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,667.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,513.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,338.05
|
| Rate for Payer: PHCS Commercial |
$11,600.76
|
| Rate for Payer: United Healthcare All Payer |
$10,634.03
|
|
|
LEGION CR OXIN FEM SZ 8 LT
|
Facility
|
OP
|
$12,084.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.24 |
| Max. Negotiated Rate |
$11,600.76 |
| Rate for Payer: Aetna Commercial |
$9,304.78
|
| Rate for Payer: Anthem Medicaid |
$4,155.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,425.62
|
| Rate for Payer: Cash Price |
$6,042.06
|
| Rate for Payer: Cigna Commercial |
$10,029.83
|
| Rate for Payer: First Health Commercial |
$11,479.92
|
| Rate for Payer: Humana Commercial |
$10,271.51
|
| Rate for Payer: Humana KY Medicaid |
$4,155.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,198.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,908.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,918.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,625.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,239.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,634.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,063.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,667.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,513.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,338.05
|
| Rate for Payer: PHCS Commercial |
$11,600.76
|
| Rate for Payer: United Healthcare All Payer |
$10,634.03
|
|
|
LEGION CR OXIN FEM SZ 8 RT
|
Facility
|
IP
|
$12,084.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.24 |
| Max. Negotiated Rate |
$11,600.76 |
| Rate for Payer: Aetna Commercial |
$9,304.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,425.62
|
| Rate for Payer: Cash Price |
$6,042.06
|
| Rate for Payer: Cigna Commercial |
$10,029.83
|
| Rate for Payer: First Health Commercial |
$11,479.92
|
| Rate for Payer: Humana Commercial |
$10,271.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,908.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,918.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,625.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,634.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,063.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,667.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,513.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,338.05
|
| Rate for Payer: PHCS Commercial |
$11,600.76
|
| Rate for Payer: United Healthcare All Payer |
$10,634.03
|
|
|
LEGION CR OXIN FEM SZ 8 RT
|
Facility
|
OP
|
$12,084.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.24 |
| Max. Negotiated Rate |
$11,600.76 |
| Rate for Payer: Aetna Commercial |
$9,304.78
|
| Rate for Payer: Anthem Medicaid |
$4,155.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,425.62
|
| Rate for Payer: Cash Price |
$6,042.06
|
| Rate for Payer: Cigna Commercial |
$10,029.83
|
| Rate for Payer: First Health Commercial |
$11,479.92
|
| Rate for Payer: Humana Commercial |
$10,271.51
|
| Rate for Payer: Humana KY Medicaid |
$4,155.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,198.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,908.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,918.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,625.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,239.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,634.03
|
| Rate for Payer: Ohio Health Group HMO |
$9,063.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,667.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,513.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,338.05
|
| Rate for Payer: PHCS Commercial |
$11,600.76
|
| Rate for Payer: United Healthcare All Payer |
$10,634.03
|
|
|
LEGION CR XLPE SZ 7-8 13MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION CR XLPE SZ 7-8 13MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION CR XLPE SZ 7-8 15MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION CR XLPE SZ 7-8 15MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION CR XLPE SZ 7-8 18MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
