|
LEGION PS NP FEM SZ 3 LT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 3 LT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 3 RT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 3 RT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 4 LT
|
Facility
|
IP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 4 LT
|
Facility
|
OP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem Medicaid |
$3,476.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Humana KY Medicaid |
$3,476.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,512.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,546.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 4 RT
|
Facility
|
IP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 4 RT
|
Facility
|
OP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem Medicaid |
$3,476.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Humana KY Medicaid |
$3,476.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,512.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,546.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 5 LT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 5 LT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 5 RT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 5 RT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 6 LT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 6 LT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 6 RT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 6 RT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 7 LT
|
Facility
|
OP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem Medicaid |
$3,476.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Humana KY Medicaid |
$3,476.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,512.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,546.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 7 LT
|
Facility
|
IP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 7RT
|
Facility
|
OP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem Medicaid |
$3,476.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Humana KY Medicaid |
$3,476.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,512.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,546.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 7RT
|
Facility
|
IP
|
$10,110.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,033.06 |
| Max. Negotiated Rate |
$9,705.79 |
| Rate for Payer: Aetna Commercial |
$7,784.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,885.96
|
| Rate for Payer: Cash Price |
$5,055.10
|
| Rate for Payer: Cigna Commercial |
$8,391.47
|
| Rate for Payer: First Health Commercial |
$9,604.69
|
| Rate for Payer: Humana Commercial |
$8,593.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,290.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,461.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,033.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,896.98
|
| Rate for Payer: Ohio Health Group HMO |
$7,582.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,088.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,795.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.04
|
| Rate for Payer: PHCS Commercial |
$9,705.79
|
| Rate for Payer: United Healthcare All Payer |
$8,896.98
|
|
|
LEGION PS NP FEM SZ 8 LT
|
Facility
|
OP
|
$9,664.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.47 |
| Max. Negotiated Rate |
$9,278.30 |
| Rate for Payer: Aetna Commercial |
$7,441.97
|
| Rate for Payer: Anthem Medicaid |
$3,323.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.62
|
| Rate for Payer: Cash Price |
$4,832.45
|
| Rate for Payer: Cigna Commercial |
$8,021.87
|
| Rate for Payer: First Health Commercial |
$9,181.66
|
| Rate for Payer: Humana Commercial |
$8,215.17
|
| Rate for Payer: Humana KY Medicaid |
$3,323.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,357.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,390.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.78
|
| Rate for Payer: PHCS Commercial |
$9,278.30
|
| Rate for Payer: United Healthcare All Payer |
$8,505.11
|
|
|
LEGION PS NP FEM SZ 8 LT
|
Facility
|
IP
|
$9,664.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.47 |
| Max. Negotiated Rate |
$9,278.30 |
| Rate for Payer: Aetna Commercial |
$7,441.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.62
|
| Rate for Payer: Cash Price |
$4,832.45
|
| Rate for Payer: Cigna Commercial |
$8,021.87
|
| Rate for Payer: First Health Commercial |
$9,181.66
|
| Rate for Payer: Humana Commercial |
$8,215.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.78
|
| Rate for Payer: PHCS Commercial |
$9,278.30
|
| Rate for Payer: United Healthcare All Payer |
$8,505.11
|
|
|
LEGION PS NP FEM SZ 8 RT
|
Facility
|
IP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS NP FEM SZ 8 RT
|
Facility
|
OP
|
$10,863.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,259.16 |
| Max. Negotiated Rate |
$10,429.30 |
| Rate for Payer: Aetna Commercial |
$8,365.16
|
| Rate for Payer: Anthem Medicaid |
$3,736.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,473.80
|
| Rate for Payer: Cash Price |
$5,431.93
|
| Rate for Payer: Cigna Commercial |
$9,017.00
|
| Rate for Payer: First Health Commercial |
$10,320.66
|
| Rate for Payer: Humana Commercial |
$9,234.27
|
| Rate for Payer: Humana KY Medicaid |
$3,736.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,774.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,017.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,259.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,811.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,560.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,147.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,691.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,451.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,496.06
|
| Rate for Payer: PHCS Commercial |
$10,429.30
|
| Rate for Payer: United Healthcare All Payer |
$9,560.19
|
|
|
LEGION PS OXIN FEM SZ 2 LT
|
Facility
|
OP
|
$11,968.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,590.56 |
| Max. Negotiated Rate |
$11,489.78 |
| Rate for Payer: Aetna Commercial |
$9,215.76
|
| Rate for Payer: Anthem Medicaid |
$4,115.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,335.45
|
| Rate for Payer: Cash Price |
$5,984.26
|
| Rate for Payer: Cigna Commercial |
$9,933.87
|
| Rate for Payer: First Health Commercial |
$11,370.09
|
| Rate for Payer: Humana Commercial |
$10,173.24
|
| Rate for Payer: Humana KY Medicaid |
$4,115.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,157.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,814.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,198.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,532.30
|
| Rate for Payer: Ohio Health Group HMO |
$8,976.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,574.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,412.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,258.28
|
| Rate for Payer: PHCS Commercial |
$11,489.78
|
| Rate for Payer: United Healthcare All Payer |
$10,532.30
|
|
