|
LEGION HF ART INSRT SZ3-4*15MM
|
Facility
|
IP
|
$9,439.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.10 |
| Max. Negotiated Rate |
$9,061.67 |
| Rate for Payer: Aetna Commercial |
$7,268.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,362.61
|
| Rate for Payer: Cash Price |
$4,719.62
|
| Rate for Payer: Cigna Commercial |
$7,834.57
|
| Rate for Payer: First Health Commercial |
$8,967.28
|
| Rate for Payer: Humana Commercial |
$8,023.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,740.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,966.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,831.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,306.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,079.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,887.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,926.16
|
| Rate for Payer: PHCS Commercial |
$9,061.67
|
| Rate for Payer: United Healthcare All Payer |
$8,306.53
|
|
|
LEGION HF ART INSRT SZ5-6 11MM
|
Facility
|
OP
|
$7,713.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.71 |
| Max. Negotiated Rate |
$7,404.60 |
| Rate for Payer: Aetna Commercial |
$5,939.10
|
| Rate for Payer: Anthem Medicaid |
$2,652.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.23
|
| Rate for Payer: Cash Price |
$3,856.56
|
| Rate for Payer: Cigna Commercial |
$6,401.89
|
| Rate for Payer: First Health Commercial |
$7,327.46
|
| Rate for Payer: Humana Commercial |
$6,556.15
|
| Rate for Payer: Humana KY Medicaid |
$2,652.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,679.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,787.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,784.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.07
|
| Rate for Payer: PHCS Commercial |
$7,404.60
|
| Rate for Payer: United Healthcare All Payer |
$6,787.55
|
|
|
LEGION HF ART INSRT SZ5-6 11MM
|
Facility
|
IP
|
$7,713.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.71 |
| Max. Negotiated Rate |
$7,404.60 |
| Rate for Payer: Aetna Commercial |
$5,939.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,016.23
|
| Rate for Payer: Cash Price |
$3,856.56
|
| Rate for Payer: Cigna Commercial |
$6,401.89
|
| Rate for Payer: First Health Commercial |
$7,327.46
|
| Rate for Payer: Humana Commercial |
$6,556.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,692.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,787.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,784.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.07
|
| Rate for Payer: PHCS Commercial |
$7,404.60
|
| Rate for Payer: United Healthcare All Payer |
$6,787.55
|
|
|
LEGION HF ART INSRT SZ 5-6 9MM
|
Facility
|
OP
|
$8,204.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.57 |
| Max. Negotiated Rate |
$7,876.23 |
| Rate for Payer: Aetna Commercial |
$6,317.40
|
| Rate for Payer: Anthem Medicaid |
$2,821.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,399.44
|
| Rate for Payer: Cash Price |
$4,102.20
|
| Rate for Payer: Cigna Commercial |
$6,809.66
|
| Rate for Payer: First Health Commercial |
$7,794.19
|
| Rate for Payer: Humana Commercial |
$6,973.75
|
| Rate for Payer: Humana KY Medicaid |
$2,821.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,850.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,727.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,054.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,461.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,878.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,219.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,543.37
|
| Rate for Payer: PHCS Commercial |
$7,876.23
|
| Rate for Payer: United Healthcare All Payer |
$7,219.88
|
|
|
LEGION HF ART INSRT SZ 5-6 9MM
|
Facility
|
IP
|
$8,204.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.57 |
| Max. Negotiated Rate |
$7,876.23 |
| Rate for Payer: Aetna Commercial |
$6,317.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,399.44
|
| Rate for Payer: Cash Price |
$4,102.20
|
| Rate for Payer: Cigna Commercial |
$6,809.66
|
| Rate for Payer: First Health Commercial |
$7,794.19
|
| Rate for Payer: Humana Commercial |
$6,973.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,727.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,054.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,461.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,219.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,543.37
|
| Rate for Payer: PHCS Commercial |
$7,876.23
|
| Rate for Payer: United Healthcare All Payer |
$7,219.88
|
|
|
LEGION HIGH FLEX ART INST
|
Facility
|
OP
|
$10,669.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.05 |
| Max. Negotiated Rate |
$10,242.85 |
| Rate for Payer: Aetna Commercial |
$8,215.62
|
| Rate for Payer: Anthem Medicaid |
$3,669.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,322.32
|
| Rate for Payer: Cash Price |
$5,334.82
|
| Rate for Payer: Cigna Commercial |
$8,855.80
|
| Rate for Payer: First Health Commercial |
$10,136.16
|
| Rate for Payer: Humana Commercial |
$9,069.19
|
| Rate for Payer: Humana KY Medicaid |
$3,669.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,706.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,749.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,742.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,389.28
|
| Rate for Payer: Ohio Health Group HMO |
$8,002.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.59
|
| Rate for Payer: PHCS Commercial |
$10,242.85
|
| Rate for Payer: United Healthcare All Payer |
$9,389.28
|
|
|
LEGION HIGH FLEX ART INST
|
Facility
|
IP
|
$10,669.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.05 |
| Max. Negotiated Rate |
$10,242.85 |
| Rate for Payer: Aetna Commercial |
$8,215.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,322.32
|
| Rate for Payer: Cash Price |
$5,334.82
|
| Rate for Payer: Cigna Commercial |
$8,855.80
|
| Rate for Payer: First Health Commercial |
$10,136.16
|
| Rate for Payer: Humana Commercial |
$9,069.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,749.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,389.28
|
| Rate for Payer: Ohio Health Group HMO |
$8,002.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.59
|
| Rate for Payer: PHCS Commercial |
$10,242.85
|
| Rate for Payer: United Healthcare All Payer |
$9,389.28
|
|
|
LEGION ISRT HK RP SZ 2-3 11MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 11MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 13MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 13MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 15MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 15MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 18MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 18MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 21MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 2-3 21MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 11MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 11MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 13MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 13MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 15MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 15MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 18MM
|
Facility
|
IP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
|
LEGION ISRT HK RP SZ 4-5 18MM
|
Facility
|
OP
|
$12,089.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,571.60 |
| Max. Negotiated Rate |
$11,605.63 |
| Rate for Payer: Aetna Commercial |
$9,308.68
|
| Rate for Payer: Anthem Medicaid |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,429.58
|
| Rate for Payer: Cash Price |
$6,044.60
|
| Rate for Payer: Cigna Commercial |
$10,034.04
|
| Rate for Payer: First Health Commercial |
$11,484.74
|
| Rate for Payer: Humana Commercial |
$10,275.82
|
| Rate for Payer: Humana KY Medicaid |
$4,157.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,199.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,913.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,921.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,626.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,240.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,638.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,066.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,747.65
|
| Rate for Payer: PHCS Commercial |
$11,605.63
|
| Rate for Payer: United Healthcare All Payer |
$10,638.50
|
|
