|
LEGION CR XLPE SZ 7-8 18MM
|
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
|
|
|
LEGIONELLA PNEUMOPHILA
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
30001382
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.12
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
LEGIONELLA PNEUMOPHILA
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 87541
|
| Hospital Charge Code |
30001382
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.12
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
LEGION FEM COMP OX SZ 3 R
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION FEM COMP OX SZ 3 R
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION FEM COMP SZ 5LT
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION FEM COMP SZ 5LT
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION FEM PSTRIOR STAB SZ6 LT
|
Facility
|
IP
|
$13,471.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,041.42 |
| Max. Negotiated Rate |
$12,932.53 |
| Rate for Payer: Aetna Commercial |
$10,372.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,507.68
|
| Rate for Payer: Cash Price |
$6,735.70
|
| Rate for Payer: Cigna Commercial |
$11,181.25
|
| Rate for Payer: First Health Commercial |
$12,797.82
|
| Rate for Payer: Humana Commercial |
$11,450.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,046.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,941.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,041.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,854.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,103.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,777.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,720.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,295.26
|
| Rate for Payer: PHCS Commercial |
$12,932.53
|
| Rate for Payer: United Healthcare All Payer |
$11,854.82
|
|
|
LEGION FEM PSTRIOR STAB SZ6 LT
|
Facility
|
OP
|
$13,471.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,041.42 |
| Max. Negotiated Rate |
$12,932.53 |
| Rate for Payer: Aetna Commercial |
$10,372.97
|
| Rate for Payer: Anthem Medicaid |
$4,632.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,507.68
|
| Rate for Payer: Cash Price |
$6,735.70
|
| Rate for Payer: Cigna Commercial |
$11,181.25
|
| Rate for Payer: First Health Commercial |
$12,797.82
|
| Rate for Payer: Humana Commercial |
$11,450.68
|
| Rate for Payer: Humana KY Medicaid |
$4,632.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,679.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,046.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,941.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,041.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,725.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,854.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,103.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,777.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,720.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,295.26
|
| Rate for Payer: PHCS Commercial |
$12,932.53
|
| Rate for Payer: United Healthcare All Payer |
$11,854.82
|
|
|
LEGION FEM WED SZ 1-2 LNG 10MM
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 1-2 LNG 10MM
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 1-2 LONG 5MM
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 1-2 LONG 5MM
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 3-4 LNG 10MM
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 3-4 LNG 10MM
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 3-4 LONG 5MM
|
Facility
|
OP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem Medicaid |
$3,159.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Humana KY Medicaid |
$3,159.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
LEGION FEM WED SZ 3-4 LONG 5MM
|
Facility
|
IP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
LEGION FEM WED SZ 5-6 LNG 10MM
|
Facility
|
OP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem Medicaid |
$3,159.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Humana KY Medicaid |
$3,159.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
LEGION FEM WED SZ 5-6 LNG 10MM
|
Facility
|
IP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
LEGION FEM WED SZ 5-6 LONG 5MM
|
Facility
|
IP
|
$9,092.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,727.77 |
| Max. Negotiated Rate |
$8,728.88 |
| Rate for Payer: Aetna Commercial |
$7,001.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.21
|
| Rate for Payer: Cash Price |
$4,546.29
|
| Rate for Payer: Cigna Commercial |
$7,546.84
|
| Rate for Payer: First Health Commercial |
$8,637.95
|
| Rate for Payer: Humana Commercial |
$7,728.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,274.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,910.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,273.88
|
| Rate for Payer: PHCS Commercial |
$8,728.88
|
| Rate for Payer: United Healthcare All Payer |
$8,001.47
|
|
|
LEGION FEM WED SZ 5-6 LONG 5MM
|
Facility
|
OP
|
$9,092.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,727.77 |
| Max. Negotiated Rate |
$8,728.88 |
| Rate for Payer: Aetna Commercial |
$7,001.29
|
| Rate for Payer: Anthem Medicaid |
$3,126.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.21
|
| Rate for Payer: Cash Price |
$4,546.29
|
| Rate for Payer: Cigna Commercial |
$7,546.84
|
| Rate for Payer: First Health Commercial |
$8,637.95
|
| Rate for Payer: Humana Commercial |
$7,728.69
|
| Rate for Payer: Humana KY Medicaid |
$3,126.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,274.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,910.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,273.88
|
| Rate for Payer: PHCS Commercial |
$8,728.88
|
| Rate for Payer: United Healthcare All Payer |
$8,001.47
|
|
|
LEGION FEM WED SZ 7-8 LNG 10MM
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 7-8 LNG 10MM
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION FEM WED SZ 7-8 LONG 5MM
|
Facility
|
IP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
|
LEGION FEM WED SZ 7-8 LONG 5MM
|
Facility
|
OP
|
$8,694.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,608.20 |
| Max. Negotiated Rate |
$8,346.24 |
| Rate for Payer: Aetna Commercial |
$6,694.38
|
| Rate for Payer: Anthem Medicaid |
$2,989.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,781.32
|
| Rate for Payer: Cash Price |
$4,347.00
|
| Rate for Payer: Cigna Commercial |
$7,216.02
|
| Rate for Payer: First Health Commercial |
$8,259.30
|
| Rate for Payer: Humana Commercial |
$7,389.90
|
| Rate for Payer: Humana KY Medicaid |
$2,989.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,020.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,129.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,416.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,608.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,049.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,650.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,563.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,998.86
|
| Rate for Payer: PHCS Commercial |
$8,346.24
|
| Rate for Payer: United Healthcare All Payer |
$7,650.72
|
|
