|
LEGION TIB WED SZ 5-6 71421143
|
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 5-6 71421143
|
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 5-6 71421147
|
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 5-6 71421147
|
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 5-6 71423035
|
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 5-6 71423035
|
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 5-6 71423039
|
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 5-6 71423039
|
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 5-6 71423043
|
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 5-6 71423043
|
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 5-6 71423047
|
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 5-6 71423047
|
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 7-8 71421144
|
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 7-8 71421144
|
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 7-8 71421148
|
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 7-8 71421148
|
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 7-8 71423036
|
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 7-8 71423036
|
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 7-8 71423040
|
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 7-8 71423040
|
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 7-8 71423044
|
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 7-8 71423044
|
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 7-8 71423048
|
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 7-8 71423048
|
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 VISIONAIRE CUT BLCK L
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
