|
LEGION L-WEDGE SZ 8 10X10
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 10X5
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 10X5
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 15X10
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 15X10
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 15X5
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 15X5
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 5X10
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 5X10
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 5X5
|
Facility
|
IP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION L-WEDGE SZ 8 5X5
|
Facility
|
OP
|
$6,535.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$6,273.99 |
| Rate for Payer: Aetna Commercial |
$5,032.27
|
| Rate for Payer: Anthem Medicaid |
$2,247.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,097.62
|
| Rate for Payer: Cash Price |
$3,267.70
|
| Rate for Payer: Cigna Commercial |
$5,424.39
|
| Rate for Payer: First Health Commercial |
$6,208.64
|
| Rate for Payer: Humana Commercial |
$5,555.10
|
| Rate for Payer: Humana KY Medicaid |
$2,247.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,359.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,823.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,751.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,901.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,307.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.98
|
| Rate for Payer: PHCS Commercial |
$6,273.99
|
| Rate for Payer: United Healthcare All Payer |
$5,751.16
|
|
|
LEGION MOT ISRT GD 2-3 11MM RT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 11MM RT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 13MM RT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 13MM RT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 15MM LT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 15MM LT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 15MM RT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 15MM RT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 18MM LT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 18MM LT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 18MM RT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 18MM RT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 21MM LT
|
Facility
|
OP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem Medicaid |
$4,645.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Humana KY Medicaid |
$4,645.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,738.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
|
LEGION MOT ISRT GD 2-3 21MM LT
|
Facility
|
IP
|
$13,507.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,755.94 |
| Max. Negotiated Rate |
$12,966.94 |
| Rate for Payer: Aetna Commercial |
$10,400.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,535.64
|
| Rate for Payer: Cash Price |
$6,753.61
|
| Rate for Payer: Cigna Commercial |
$11,211.00
|
| Rate for Payer: First Health Commercial |
$12,831.87
|
| Rate for Payer: Humana Commercial |
$11,481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,075.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,968.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,052.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,886.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,130.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,701.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.24
|
| Rate for Payer: PHCS Commercial |
$12,966.94
|
| Rate for Payer: United Healthcare All Payer |
$11,886.36
|
|
