|
LEGION STEM 18X120MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION STEM 18X160MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION STEM 18X160MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION STEM 20X120MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION STEM 20X120MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION STEM 20X160MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION STEM 20X160MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION SZ 8 RT. NONPOROUS FEM
|
Facility
|
OP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem Medicaid |
$3,344.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Humana KY Medicaid |
$3,344.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION SZ 8 RT. NONPOROUS FEM
|
Facility
|
IP
|
$9,725.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.36 |
| Max. Negotiated Rate |
$9,336.84 |
| Rate for Payer: Aetna Commercial |
$7,488.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,586.19
|
| Rate for Payer: Cash Price |
$4,862.94
|
| Rate for Payer: Cigna Commercial |
$8,072.48
|
| Rate for Payer: First Health Commercial |
$9,239.59
|
| Rate for Payer: Humana Commercial |
$8,267.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,975.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,177.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,294.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,015.02
|
| Rate for Payer: PHCS Commercial |
$9,336.84
|
| Rate for Payer: United Healthcare All Payer |
$8,558.77
|
|
|
LEGION TIB WED SZ 1-2 71423041
|
Facility
|
OP
|
$9,703.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.52 |
| Max. Negotiated Rate |
$9,315.82 |
| Rate for Payer: Aetna Commercial |
$7,472.06
|
| Rate for Payer: Anthem Medicaid |
$3,337.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,569.10
|
| Rate for Payer: Cash Price |
$4,851.99
|
| Rate for Payer: Cigna Commercial |
$8,054.30
|
| Rate for Payer: First Health Commercial |
$9,218.78
|
| Rate for Payer: Humana Commercial |
$8,248.38
|
| Rate for Payer: Humana KY Medicaid |
$3,337.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,371.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,957.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,161.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,911.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,404.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,539.50
|
| Rate for Payer: Ohio Health Group HMO |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,940.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,008.23
|
| Rate for Payer: PHCS Commercial |
$9,315.82
|
| Rate for Payer: United Healthcare All Payer |
$8,539.50
|
|
|
LEGION TIB WED SZ 1-2 71423041
|
Facility
|
IP
|
$9,703.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.52 |
| Max. Negotiated Rate |
$9,315.82 |
| Rate for Payer: Aetna Commercial |
$7,472.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,569.10
|
| Rate for Payer: Cash Price |
$4,851.99
|
| Rate for Payer: Cigna Commercial |
$8,054.30
|
| Rate for Payer: First Health Commercial |
$9,218.78
|
| Rate for Payer: Humana Commercial |
$8,248.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,957.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,161.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,911.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,539.50
|
| Rate for Payer: Ohio Health Group HMO |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,940.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,008.23
|
| Rate for Payer: PHCS Commercial |
$9,315.82
|
| Rate for Payer: United Healthcare All Payer |
$8,539.50
|
|
|
LEGION TIB WED SZ 1-2 71423045
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 1-2 71423045
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71421142
|
Facility
|
OP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem Medicaid |
$3,733.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Humana KY Medicaid |
$3,733.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,771.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,808.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
LEGION TIB WED SZ 3-4 71421142
|
Facility
|
IP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
LEGION TIB WED SZ 3-4 71421146
|
Facility
|
OP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem Medicaid |
$3,733.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Humana KY Medicaid |
$3,733.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,771.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,808.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
LEGION TIB WED SZ 3-4 71421146
|
Facility
|
IP
|
$10,855.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.22 |
| Max. Negotiated Rate |
$10,421.28 |
| Rate for Payer: Aetna Commercial |
$8,358.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.29
|
| Rate for Payer: Cash Price |
$5,427.75
|
| Rate for Payer: Cigna Commercial |
$9,010.06
|
| Rate for Payer: First Health Commercial |
$10,312.72
|
| Rate for Payer: Humana Commercial |
$9,227.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,552.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.20
|
| Rate for Payer: PHCS Commercial |
$10,421.28
|
| Rate for Payer: United Healthcare All Payer |
$9,552.84
|
|
|
LEGION TIB WED SZ 3-4 71423034
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423034
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423038
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423038
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423042
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423042
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423046
|
Facility
|
OP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem Medicaid |
$2,616.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Humana KY Medicaid |
$2,616.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
|
LEGION TIB WED SZ 3-4 71423046
|
Facility
|
IP
|
$7,608.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.15 |
| Max. Negotiated Rate |
$7,304.52 |
| Rate for Payer: Aetna Commercial |
$5,858.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,934.93
|
| Rate for Payer: Cash Price |
$3,804.44
|
| Rate for Payer: Cigna Commercial |
$6,315.37
|
| Rate for Payer: First Health Commercial |
$7,228.44
|
| Rate for Payer: Humana Commercial |
$6,467.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,239.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,615.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,282.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,695.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,706.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,521.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,358.75
|
| Rate for Payer: PHCS Commercial |
$7,304.52
|
| Rate for Payer: United Healthcare All Payer |
$6,695.81
|
|
