|
LEGION REV TIB BASE SZ 1 RT
|
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
|
|
|
LEGION REV TIB BASE SZ 1 RT
|
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 2 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 2 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 2 RT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 2 RT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 3 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 3 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 3 RT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 3 RT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 4 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 4 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 4 RT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 4 RT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 5 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 5 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 5 RT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 5 RT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 6 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 6 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 6 RT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 6 RT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 7 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 7 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 7 RT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
