|
LEGION TIB WED SZ 3-4 71423042
|
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 71423046
|
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 71423046
|
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 5-6 71421143
|
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 5-6 71421143
|
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 5-6 71421147
|
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 5-6 71421147
|
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 5-6 71423035
|
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 5-6 71423035
|
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 5-6 71423039
|
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 5-6 71423039
|
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 5-6 71423043
|
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 5-6 71423043
|
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 5-6 71423047
|
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 5-6 71423047
|
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 7-8 71421144
|
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 7-8 71421144
|
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 7-8 71421148
|
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 7-8 71421148
|
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 7-8 71423036
|
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 7-8 71423036
|
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 7-8 71423040
|
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 7-8 71423040
|
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 7-8 71423044
|
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 7-8 71423044
|
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
|
|
