|
LEGION MOT ISRT GD 2-3 21MM 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 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 4-5 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 4-5 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 4-5 13MM 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 4-5 13MM 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 4-5 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 4-5 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 4-5 15MM LT
|
Facility
|
OP
|
$15,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.38 |
| Max. Negotiated Rate |
$14,520.96 |
| Rate for Payer: Aetna Commercial |
$11,647.02
|
| Rate for Payer: Anthem Medicaid |
$5,201.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,798.28
|
| Rate for Payer: Cash Price |
$7,563.00
|
| Rate for Payer: Cigna Commercial |
$12,554.58
|
| Rate for Payer: First Health Commercial |
$14,369.70
|
| Rate for Payer: Humana Commercial |
$12,857.10
|
| Rate for Payer: Humana KY Medicaid |
$5,201.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,254.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,403.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,162.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,537.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,306.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,310.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,344.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.06
|
| Rate for Payer: PHCS Commercial |
$14,520.96
|
| Rate for Payer: United Healthcare All Payer |
$13,310.88
|
|
|
LEGION MOT ISRT GD 4-5 15MM LT
|
Facility
|
IP
|
$15,126.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,966.38 |
| Max. Negotiated Rate |
$14,520.96 |
| Rate for Payer: Aetna Commercial |
$11,647.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,798.28
|
| Rate for Payer: Cash Price |
$7,563.00
|
| Rate for Payer: Cigna Commercial |
$12,554.58
|
| Rate for Payer: First Health Commercial |
$14,369.70
|
| Rate for Payer: Humana Commercial |
$12,857.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,403.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,162.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,537.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,310.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,344.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,966.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,689.06
|
| Rate for Payer: PHCS Commercial |
$14,520.96
|
| Rate for Payer: United Healthcare All Payer |
$13,310.88
|
|
|
LEGION MOT ISRT GD 4-5 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 4-5 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 4-5 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: Medical Mutual Of Ohio HMO |
$11,075.93
|
| 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 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 4-5 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 4-5 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 4-5 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 4-5 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
|
|
|
LEGION MOT ISRT GD 4-5 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 4-5 21MM 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 4-5 21MM 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 6-7 11MM 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: Medical Mutual Of Ohio HMO |
$11,075.93
|
| 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 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 6-7 11MM 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 6-7 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 6-7 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 6-7 13MM 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
|
|
