|
LEGION PS OXIN FEM SZ 2 LT
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
LEGION PS OXIN FEM SZ 2 RT
|
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
|
|
|
LEGION PS OXIN FEM SZ 2 RT
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
LEGION PS OXIN FEM SZ 3 LT
|
Facility
|
OP
|
$13,471.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,041.42 |
| Max. Negotiated Rate |
$12,932.53 |
| Rate for Payer: Aetna Commercial |
$10,372.97
|
| Rate for Payer: Anthem Medicaid |
$4,632.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,507.68
|
| Rate for Payer: Cash Price |
$6,735.70
|
| Rate for Payer: Cigna Commercial |
$11,181.25
|
| Rate for Payer: First Health Commercial |
$12,797.82
|
| Rate for Payer: Humana Commercial |
$11,450.68
|
| Rate for Payer: Humana KY Medicaid |
$4,632.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,679.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,046.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,941.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,041.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,725.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,854.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,103.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,777.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,720.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,295.26
|
| Rate for Payer: PHCS Commercial |
$12,932.53
|
| Rate for Payer: United Healthcare All Payer |
$11,854.82
|
|
|
LEGION PS OXIN FEM SZ 3 LT
|
Facility
|
IP
|
$13,471.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,041.42 |
| Max. Negotiated Rate |
$12,932.53 |
| Rate for Payer: Aetna Commercial |
$10,372.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,507.68
|
| Rate for Payer: Cash Price |
$6,735.70
|
| Rate for Payer: Cigna Commercial |
$11,181.25
|
| Rate for Payer: First Health Commercial |
$12,797.82
|
| Rate for Payer: Humana Commercial |
$11,450.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,046.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,941.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,041.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,854.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,103.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,777.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,720.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,295.26
|
| Rate for Payer: PHCS Commercial |
$12,932.53
|
| Rate for Payer: United Healthcare All Payer |
$11,854.82
|
|
|
LEGION PS OXIN FEM SZ 3RT
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 3RT
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 4LT
|
Facility
|
OP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem Medicaid |
$6,227.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Humana KY Medicaid |
$6,227.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,290.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,352.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
LEGION PS OXIN FEM SZ 4LT
|
Facility
|
IP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
LEGION PS OXIN FEM SZ 4 RT
|
Facility
|
OP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem Medicaid |
$6,450.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Humana KY Medicaid |
$6,450.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,516.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,579.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION PS OXIN FEM SZ 4 RT
|
Facility
|
IP
|
$18,756.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,627.01 |
| Max. Negotiated Rate |
$18,006.43 |
| Rate for Payer: Aetna Commercial |
$14,442.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,630.23
|
| Rate for Payer: Cash Price |
$9,378.35
|
| Rate for Payer: Cigna Commercial |
$15,568.06
|
| Rate for Payer: First Health Commercial |
$17,818.87
|
| Rate for Payer: Humana Commercial |
$15,943.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,380.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,842.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,627.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,505.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,067.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,005.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,318.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,942.12
|
| Rate for Payer: PHCS Commercial |
$18,006.43
|
| Rate for Payer: United Healthcare All Payer |
$16,505.90
|
|
|
LEGION PS OXIN FEM SZ 6 LT
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 6 LT
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 6 RT
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 6 RT
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 7 LT
|
Facility
|
OP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem Medicaid |
$6,227.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Humana KY Medicaid |
$6,227.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,290.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,352.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
LEGION PS OXIN FEM SZ 7 LT
|
Facility
|
IP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
LEGION PS OXIN FEM SZ 7RT.
|
Facility
|
OP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem Medicaid |
$6,227.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Humana KY Medicaid |
$6,227.51
|
| Rate for Payer: Kentucky WC Medicaid |
$6,290.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,352.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
LEGION PS OXIN FEM SZ 7RT.
|
Facility
|
IP
|
$18,108.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,432.55 |
| Max. Negotiated Rate |
$17,384.16 |
| Rate for Payer: Aetna Commercial |
$13,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,124.63
|
| Rate for Payer: Cash Price |
$9,054.25
|
| Rate for Payer: Cigna Commercial |
$15,030.06
|
| Rate for Payer: First Health Commercial |
$17,203.08
|
| Rate for Payer: Humana Commercial |
$15,392.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,848.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,432.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,935.48
|
| Rate for Payer: Ohio Health Group HMO |
$13,581.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,486.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,754.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,494.86
|
| Rate for Payer: PHCS Commercial |
$17,384.16
|
| Rate for Payer: United Healthcare All Payer |
$15,935.48
|
|
|
LEGION PS OXIN FEM SZ 8 LT
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 8 LT
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 8RT
|
Facility
|
IP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION PS OXIN FEM SZ 8RT
|
Facility
|
OP
|
$12,564.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,769.47 |
| Max. Negotiated Rate |
$12,062.30 |
| Rate for Payer: Aetna Commercial |
$9,674.97
|
| Rate for Payer: Anthem Medicaid |
$4,321.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,800.62
|
| Rate for Payer: Cash Price |
$6,282.45
|
| Rate for Payer: Cigna Commercial |
$10,428.87
|
| Rate for Payer: First Health Commercial |
$11,936.66
|
| Rate for Payer: Humana Commercial |
$10,680.17
|
| Rate for Payer: Humana KY Medicaid |
$4,321.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,365.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,303.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,272.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,769.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,407.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,057.11
|
| Rate for Payer: Ohio Health Group HMO |
$9,423.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,051.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,931.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,669.78
|
| Rate for Payer: PHCS Commercial |
$12,062.30
|
| Rate for Payer: United Healthcare All Payer |
$11,057.11
|
|
|
LEGION REV TIB BASE SZ 1 LT
|
Facility
|
OP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem Medicaid |
$4,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Humana KY Medicaid |
$4,502.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,548.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,592.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
|
LEGION REV TIB BASE SZ 1 LT
|
Facility
|
IP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
