|
LEGION STEM 16X160MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 16X160MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 18X120MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 18X120MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 18X160MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 18X160MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 20X120MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 20X120MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 20X160MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION STEM 20X160MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION SZ 8 RT. NONPOROUS FEM
|
Facility
|
IP
|
$9,925.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.76 |
| Max. Negotiated Rate |
$9,528.84 |
| Rate for Payer: Aetna Commercial |
$7,642.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,742.19
|
| Rate for Payer: Cash Price |
$4,962.94
|
| Rate for Payer: Cigna Commercial |
$8,238.48
|
| Rate for Payer: First Health Commercial |
$9,429.59
|
| Rate for Payer: Humana Commercial |
$8,437.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,139.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,325.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,734.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,444.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,635.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,848.86
|
| Rate for Payer: PHCS Commercial |
$9,528.84
|
| Rate for Payer: United Healthcare All Payer |
$8,734.77
|
|
|
LEGION SZ 8 RT. NONPOROUS FEM
|
Facility
|
OP
|
$9,925.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.76 |
| Max. Negotiated Rate |
$9,528.84 |
| Rate for Payer: Aetna Commercial |
$7,642.93
|
| Rate for Payer: Anthem Medicaid |
$3,413.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,742.19
|
| Rate for Payer: Cash Price |
$4,962.94
|
| Rate for Payer: Cigna Commercial |
$8,238.48
|
| Rate for Payer: First Health Commercial |
$9,429.59
|
| Rate for Payer: Humana Commercial |
$8,437.00
|
| Rate for Payer: Humana KY Medicaid |
$3,413.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,448.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,139.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,325.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,734.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,444.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,635.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,848.86
|
| Rate for Payer: PHCS Commercial |
$9,528.84
|
| Rate for Payer: United Healthcare All Payer |
$8,734.77
|
|
|
LEGION TIB WED SZ 1-2 71423041
|
Facility
|
OP
|
$9,903.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.19 |
| Max. Negotiated Rate |
$9,507.82 |
| Rate for Payer: Aetna Commercial |
$7,626.06
|
| Rate for Payer: Anthem Medicaid |
$3,405.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,725.10
|
| Rate for Payer: Cash Price |
$4,951.99
|
| Rate for Payer: Cigna Commercial |
$8,220.30
|
| Rate for Payer: First Health Commercial |
$9,408.78
|
| Rate for Payer: Humana Commercial |
$8,418.38
|
| Rate for Payer: Humana KY Medicaid |
$3,405.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,440.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,121.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,309.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,971.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,474.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,715.50
|
| Rate for Payer: Ohio Health Group HMO |
$7,427.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,923.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,616.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,833.75
|
| Rate for Payer: PHCS Commercial |
$9,507.82
|
| Rate for Payer: United Healthcare All Payer |
$8,715.50
|
|
|
LEGION TIB WED SZ 1-2 71423041
|
Facility
|
IP
|
$9,903.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.19 |
| Max. Negotiated Rate |
$9,507.82 |
| Rate for Payer: Aetna Commercial |
$7,626.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,725.10
|
| Rate for Payer: Cash Price |
$4,951.99
|
| Rate for Payer: Cigna Commercial |
$8,220.30
|
| Rate for Payer: First Health Commercial |
$9,408.78
|
| Rate for Payer: Humana Commercial |
$8,418.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,121.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,309.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,971.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,715.50
|
| Rate for Payer: Ohio Health Group HMO |
$7,427.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,923.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,616.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,833.75
|
| Rate for Payer: PHCS Commercial |
$9,507.82
|
| Rate for Payer: United Healthcare All Payer |
$8,715.50
|
|
|
LEGION TIB WED SZ 1-2 71423045
|
Facility
|
IP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
LEGION TIB WED SZ 1-2 71423045
|
Facility
|
OP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem Medicaid |
$2,685.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Humana KY Medicaid |
$2,685.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
LEGION TIB WED SZ 3-4 71421142
|
Facility
|
IP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
LEGION TIB WED SZ 3-4 71421142
|
Facility
|
OP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem Medicaid |
$3,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Humana KY Medicaid |
$3,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,892.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
LEGION TIB WED SZ 3-4 71421146
|
Facility
|
IP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
LEGION TIB WED SZ 3-4 71421146
|
Facility
|
OP
|
$11,096.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.07 |
| Max. Negotiated Rate |
$10,653.02 |
| Rate for Payer: Aetna Commercial |
$8,544.61
|
| Rate for Payer: Anthem Medicaid |
$3,816.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.58
|
| Rate for Payer: Cash Price |
$5,548.45
|
| Rate for Payer: Cigna Commercial |
$9,210.43
|
| Rate for Payer: First Health Commercial |
$10,542.06
|
| Rate for Payer: Humana Commercial |
$9,432.36
|
| Rate for Payer: Humana KY Medicaid |
$3,816.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,892.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.27
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,656.86
|
| Rate for Payer: PHCS Commercial |
$10,653.02
|
| Rate for Payer: United Healthcare All Payer |
$9,765.27
|
|
|
LEGION TIB WED SZ 3-4 71423034
|
Facility
|
IP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
LEGION TIB WED SZ 3-4 71423034
|
Facility
|
OP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem Medicaid |
$2,685.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Humana KY Medicaid |
$2,685.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
LEGION TIB WED SZ 3-4 71423038
|
Facility
|
IP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
LEGION TIB WED SZ 3-4 71423038
|
Facility
|
OP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem Medicaid |
$2,685.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Humana KY Medicaid |
$2,685.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,739.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
|
LEGION TIB WED SZ 3-4 71423042
|
Facility
|
IP
|
$7,808.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.66 |
| Max. Negotiated Rate |
$7,496.52 |
| Rate for Payer: Aetna Commercial |
$6,012.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,090.93
|
| Rate for Payer: Cash Price |
$3,904.44
|
| Rate for Payer: Cigna Commercial |
$6,481.37
|
| Rate for Payer: First Health Commercial |
$7,418.44
|
| Rate for Payer: Humana Commercial |
$6,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,403.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,762.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,871.81
|
| Rate for Payer: Ohio Health Group HMO |
$5,856.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,247.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,793.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,388.13
|
| Rate for Payer: PHCS Commercial |
$7,496.52
|
| Rate for Payer: United Healthcare All Payer |
$6,871.81
|
|
