|
LEGION MOT ISRT GD 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 18MM LT
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 18MM LT
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem Medicaid |
$4,473.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Humana KY Medicaid |
$4,473.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,519.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 18MM RT
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 18MM RT
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem Medicaid |
$4,473.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Humana KY Medicaid |
$4,473.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,519.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 21MM LT
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 21MM LT
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem Medicaid |
$4,473.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Humana KY Medicaid |
$4,473.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,519.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 21MM RT
|
Facility
|
IP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION MOT ISRT GD 6-7 21MM RT
|
Facility
|
OP
|
$13,009.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.17 |
| Max. Negotiated Rate |
$12,488.64 |
| Rate for Payer: Aetna Commercial |
$10,016.93
|
| Rate for Payer: Anthem Medicaid |
$4,473.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,147.02
|
| Rate for Payer: Cash Price |
$6,504.50
|
| Rate for Payer: Cigna Commercial |
$10,797.47
|
| Rate for Payer: First Health Commercial |
$12,358.55
|
| Rate for Payer: Humana Commercial |
$11,057.65
|
| Rate for Payer: Humana KY Medicaid |
$4,473.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,519.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,667.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,600.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,447.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,756.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,691.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,032.79
|
| Rate for Payer: PHCS Commercial |
$12,488.64
|
| Rate for Payer: United Healthcare All Payer |
$11,447.92
|
|
|
LEGION NAR OXIN CR SZ 3N L
|
Facility
|
OP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem Medicaid |
$3,708.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Humana KY Medicaid |
$3,708.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,745.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,782.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
LEGION NAR OXIN CR SZ 3N L
|
Facility
|
IP
|
$10,782.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,401.72 |
| Max. Negotiated Rate |
$10,351.20 |
| Rate for Payer: Aetna Commercial |
$8,302.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,410.35
|
| Rate for Payer: Cash Price |
$5,391.25
|
| Rate for Payer: Cigna Commercial |
$8,949.48
|
| Rate for Payer: First Health Commercial |
$10,243.38
|
| Rate for Payer: Humana Commercial |
$9,165.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,841.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,957.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,234.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,488.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,086.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,401.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.58
|
| Rate for Payer: PHCS Commercial |
$10,351.20
|
| Rate for Payer: United Healthcare All Payer |
$9,488.60
|
|
|
LEGION NAR OXIN FEM SZ 4 L
|
Facility
|
OP
|
$13,319.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.50 |
| Max. Negotiated Rate |
$12,786.48 |
| Rate for Payer: Aetna Commercial |
$10,255.82
|
| Rate for Payer: Anthem Medicaid |
$4,580.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,389.02
|
| Rate for Payer: Cash Price |
$6,659.62
|
| Rate for Payer: Cigna Commercial |
$11,054.98
|
| Rate for Payer: First Health Commercial |
$12,653.29
|
| Rate for Payer: Humana Commercial |
$11,321.36
|
| Rate for Payer: Humana KY Medicaid |
$4,580.49
|
| Rate for Payer: Kentucky WC Medicaid |
$4,627.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,921.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,829.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,672.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,720.94
|
| Rate for Payer: Ohio Health Group HMO |
$9,989.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.97
|
| Rate for Payer: PHCS Commercial |
$12,786.48
|
| Rate for Payer: United Healthcare All Payer |
$11,720.94
|
|
|
LEGION NAR OXIN FEM SZ 4 L
|
Facility
|
IP
|
$13,319.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.50 |
| Max. Negotiated Rate |
$12,786.48 |
| Rate for Payer: Aetna Commercial |
$10,255.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,389.02
|
| Rate for Payer: Cash Price |
$6,659.62
|
| Rate for Payer: Cigna Commercial |
$11,054.98
|
| Rate for Payer: First Health Commercial |
$12,653.29
|
| Rate for Payer: Humana Commercial |
$11,321.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,921.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,829.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,720.94
|
| Rate for Payer: Ohio Health Group HMO |
$9,989.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.97
|
| Rate for Payer: PHCS Commercial |
$12,786.48
|
| Rate for Payer: United Healthcare All Payer |
$11,720.94
|
|
|
LEGION OFFSET COUPLER 2MM
|
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 OFFSET COUPLER 2MM
|
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 OFFSET COUPLER 4MM
|
Facility
|
OP
|
$7,686.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.24 |
| Max. Negotiated Rate |
$7,378.98 |
| Rate for Payer: Aetna Commercial |
$5,918.56
|
| Rate for Payer: Anthem Medicaid |
$2,643.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,995.42
|
| Rate for Payer: Cash Price |
$3,843.22
|
| Rate for Payer: Cigna Commercial |
$6,379.75
|
| Rate for Payer: First Health Commercial |
$7,302.12
|
| Rate for Payer: Humana Commercial |
$6,533.47
|
| Rate for Payer: Humana KY Medicaid |
$2,643.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,670.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,302.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,672.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,696.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,764.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,764.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,537.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,382.80
|
| Rate for Payer: PHCS Commercial |
$7,378.98
|
| Rate for Payer: United Healthcare All Payer |
$6,764.07
|
|
|
LEGION OFFSET COUPLER 4MM
|
Facility
|
IP
|
$7,686.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.24 |
| Max. Negotiated Rate |
$7,378.98 |
| Rate for Payer: Aetna Commercial |
$5,918.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,995.42
|
| Rate for Payer: Cash Price |
$3,843.22
|
| Rate for Payer: Cigna Commercial |
$6,379.75
|
| Rate for Payer: First Health Commercial |
$7,302.12
|
| Rate for Payer: Humana Commercial |
$6,533.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,302.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,672.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,764.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,764.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,537.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,382.80
|
| Rate for Payer: PHCS Commercial |
$7,378.98
|
| Rate for Payer: United Healthcare All Payer |
$6,764.07
|
|
|
LEGION OFFSET COUPLER 6MM
|
Facility
|
IP
|
$7,686.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.24 |
| Max. Negotiated Rate |
$7,378.98 |
| Rate for Payer: Aetna Commercial |
$5,918.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,995.42
|
| Rate for Payer: Cash Price |
$3,843.22
|
| Rate for Payer: Cigna Commercial |
$6,379.75
|
| Rate for Payer: First Health Commercial |
$7,302.12
|
| Rate for Payer: Humana Commercial |
$6,533.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,302.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,672.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,764.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,764.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,537.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,382.80
|
| Rate for Payer: PHCS Commercial |
$7,378.98
|
| Rate for Payer: United Healthcare All Payer |
$6,764.07
|
|
|
LEGION OFFSET COUPLER 6MM
|
Facility
|
OP
|
$7,686.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.24 |
| Max. Negotiated Rate |
$7,378.98 |
| Rate for Payer: Aetna Commercial |
$5,918.56
|
| Rate for Payer: Anthem Medicaid |
$2,643.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,995.42
|
| Rate for Payer: Cash Price |
$3,843.22
|
| Rate for Payer: Cigna Commercial |
$6,379.75
|
| Rate for Payer: First Health Commercial |
$7,302.12
|
| Rate for Payer: Humana Commercial |
$6,533.47
|
| Rate for Payer: Humana KY Medicaid |
$2,643.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,670.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,302.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,672.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,305.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,696.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,764.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,764.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,537.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,382.80
|
| Rate for Payer: PHCS Commercial |
$7,378.98
|
| Rate for Payer: United Healthcare All Payer |
$6,764.07
|
|
