|
LEGION OFFSET COUPLER 4MM
|
Facility
|
IP
|
$7,886.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.93 |
| Max. Negotiated Rate |
$7,570.98 |
| Rate for Payer: Aetna Commercial |
$6,072.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,151.42
|
| Rate for Payer: Cash Price |
$3,943.22
|
| Rate for Payer: Cigna Commercial |
$6,545.75
|
| Rate for Payer: First Health Commercial |
$7,492.12
|
| Rate for Payer: Humana Commercial |
$6,703.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,820.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,940.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,914.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,309.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,861.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,441.64
|
| Rate for Payer: PHCS Commercial |
$7,570.98
|
| Rate for Payer: United Healthcare All Payer |
$6,940.07
|
|
|
LEGION OFFSET COUPLER 6MM
|
Facility
|
OP
|
$7,886.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.93 |
| Max. Negotiated Rate |
$7,570.98 |
| Rate for Payer: Aetna Commercial |
$6,072.56
|
| Rate for Payer: Anthem Medicaid |
$2,712.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,151.42
|
| Rate for Payer: Cash Price |
$3,943.22
|
| Rate for Payer: Cigna Commercial |
$6,545.75
|
| Rate for Payer: First Health Commercial |
$7,492.12
|
| Rate for Payer: Humana Commercial |
$6,703.47
|
| Rate for Payer: Humana KY Medicaid |
$2,712.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,739.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,820.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,766.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,940.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,914.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,309.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,861.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,441.64
|
| Rate for Payer: PHCS Commercial |
$7,570.98
|
| Rate for Payer: United Healthcare All Payer |
$6,940.07
|
|
|
LEGION OFFSET COUPLER 6MM
|
Facility
|
IP
|
$7,886.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.93 |
| Max. Negotiated Rate |
$7,570.98 |
| Rate for Payer: Aetna Commercial |
$6,072.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,151.42
|
| Rate for Payer: Cash Price |
$3,943.22
|
| Rate for Payer: Cigna Commercial |
$6,545.75
|
| Rate for Payer: First Health Commercial |
$7,492.12
|
| Rate for Payer: Humana Commercial |
$6,703.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,820.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,940.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,914.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,309.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,861.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,441.64
|
| Rate for Payer: PHCS Commercial |
$7,570.98
|
| Rate for Payer: United Healthcare All Payer |
$6,940.07
|
|
|
LEGION OFFSET COUPLER ANGLED
|
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 OFFSET COUPLER ANGLED
|
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 OX CONS FEM 2 LT
|
Facility
|
OP
|
$27,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,102.46 |
| Max. Negotiated Rate |
$25,927.86 |
| Rate for Payer: Aetna Commercial |
$20,796.31
|
| Rate for Payer: Anthem Medicaid |
$9,288.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,066.39
|
| Rate for Payer: Cash Price |
$13,504.09
|
| Rate for Payer: Cigna Commercial |
$22,416.80
|
| Rate for Payer: First Health Commercial |
$25,657.78
|
| Rate for Payer: Humana Commercial |
$22,956.96
|
| Rate for Payer: Humana KY Medicaid |
$9,288.12
|
| Rate for Payer: Kentucky WC Medicaid |
$9,382.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,932.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,102.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,474.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,767.21
|
| Rate for Payer: Ohio Health Group HMO |
$20,256.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,606.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,497.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,635.65
|
| Rate for Payer: PHCS Commercial |
$25,927.86
|
| Rate for Payer: United Healthcare All Payer |
$23,767.21
|
|
|
LEGION OX CONS FEM 2 LT
|
Facility
|
IP
|
$27,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,102.46 |
| Max. Negotiated Rate |
$25,927.86 |
| Rate for Payer: Aetna Commercial |
$20,796.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,066.39
|
| Rate for Payer: Cash Price |
$13,504.09
|
| Rate for Payer: Cigna Commercial |
$22,416.80
|
| Rate for Payer: First Health Commercial |
$25,657.78
|
| Rate for Payer: Humana Commercial |
$22,956.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,932.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,102.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,767.21
|
| Rate for Payer: Ohio Health Group HMO |
$20,256.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,606.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,497.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,635.65
|
| Rate for Payer: PHCS Commercial |
$25,927.86
|
| Rate for Payer: United Healthcare All Payer |
$23,767.21
|
|
|
LEGION OX CONS FEM 2 RT
|
Facility
|
IP
|
$27,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,102.46 |
| Max. Negotiated Rate |
$25,927.86 |
| Rate for Payer: Aetna Commercial |
$20,796.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,066.39
|
| Rate for Payer: Cash Price |
$13,504.09
|
| Rate for Payer: Cigna Commercial |
$22,416.80
|
| Rate for Payer: First Health Commercial |
$25,657.78
|
| Rate for Payer: Humana Commercial |
$22,956.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,932.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,102.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,767.21
|
| Rate for Payer: Ohio Health Group HMO |
$20,256.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,606.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,497.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,635.65
|
| Rate for Payer: PHCS Commercial |
$25,927.86
|
| Rate for Payer: United Healthcare All Payer |
$23,767.21
|
|
|
LEGION OX CONS FEM 2 RT
|
Facility
|
OP
|
$27,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,102.46 |
| Max. Negotiated Rate |
$25,927.86 |
| Rate for Payer: Aetna Commercial |
$20,796.31
|
| Rate for Payer: Anthem Medicaid |
$9,288.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,066.39
|
| Rate for Payer: Cash Price |
$13,504.09
|
| Rate for Payer: Cigna Commercial |
$22,416.80
|
| Rate for Payer: First Health Commercial |
$25,657.78
|
| Rate for Payer: Humana Commercial |
$22,956.96
|
| Rate for Payer: Humana KY Medicaid |
$9,288.12
|
| Rate for Payer: Kentucky WC Medicaid |
$9,382.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,932.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,102.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,474.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,767.21
|
| Rate for Payer: Ohio Health Group HMO |
$20,256.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,606.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,497.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,635.65
|
| Rate for Payer: PHCS Commercial |
$25,927.86
|
| Rate for Payer: United Healthcare All Payer |
$23,767.21
|
|
|
LEGION OX CONS FEM 3 LT
|
Facility
|
IP
|
$27,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,102.46 |
| Max. Negotiated Rate |
$25,927.86 |
| Rate for Payer: Aetna Commercial |
$20,796.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,066.39
|
| Rate for Payer: Cash Price |
$13,504.09
|
| Rate for Payer: Cigna Commercial |
$22,416.80
|
| Rate for Payer: First Health Commercial |
$25,657.78
|
| Rate for Payer: Humana Commercial |
$22,956.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,932.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,102.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,767.21
|
| Rate for Payer: Ohio Health Group HMO |
$20,256.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,606.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,497.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,635.65
|
| Rate for Payer: PHCS Commercial |
$25,927.86
|
| Rate for Payer: United Healthcare All Payer |
$23,767.21
|
|
|
LEGION OX CONS FEM 3 LT
|
Facility
|
OP
|
$27,008.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,102.46 |
| Max. Negotiated Rate |
$25,927.86 |
| Rate for Payer: Aetna Commercial |
$20,796.31
|
| Rate for Payer: Anthem Medicaid |
$9,288.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,066.39
|
| Rate for Payer: Cash Price |
$13,504.09
|
| Rate for Payer: Cigna Commercial |
$22,416.80
|
| Rate for Payer: First Health Commercial |
$25,657.78
|
| Rate for Payer: Humana Commercial |
$22,956.96
|
| Rate for Payer: Humana KY Medicaid |
$9,288.12
|
| Rate for Payer: Kentucky WC Medicaid |
$9,382.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,146.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,932.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,102.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,474.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,767.21
|
| Rate for Payer: Ohio Health Group HMO |
$20,256.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,606.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,497.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,635.65
|
| Rate for Payer: PHCS Commercial |
$25,927.86
|
| Rate for Payer: United Healthcare All Payer |
$23,767.21
|
|
|
LEGION OX CONS FEM 3 RT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 3 RT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 4 LT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 4 LT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 4 RT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 4 RT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 5 LT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 5 LT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 5 RT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 5 RT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 6 LT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 6 LT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 6 RT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 6 RT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
