|
LEGION OX CONS FEM 7 RT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 8 LT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 8 LT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 8 RT
|
Facility
|
OP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem Medicaid |
$13,895.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Humana KY Medicaid |
$13,895.54
|
| Rate for Payer: Kentucky WC Medicaid |
$14,036.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,174.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX CONS FEM 8 RT
|
Facility
|
IP
|
$40,405.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,252.75 |
| Max. Negotiated Rate |
$38,789.52 |
| Rate for Payer: Aetna Commercial |
$31,112.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,516.48
|
| Rate for Payer: Cash Price |
$20,202.88
|
| Rate for Payer: Cigna Commercial |
$33,536.77
|
| Rate for Payer: First Health Commercial |
$38,385.46
|
| Rate for Payer: Humana Commercial |
$34,344.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,132.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,819.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,121.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,557.06
|
| Rate for Payer: Ohio Health Group HMO |
$30,304.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,081.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,252.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,525.78
|
| Rate for Payer: PHCS Commercial |
$38,789.52
|
| Rate for Payer: United Healthcare All Payer |
$35,557.06
|
|
|
LEGION OX FEM COMP SZ 5 R
|
Facility
|
IP
|
$13,217.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.22 |
| Max. Negotiated Rate |
$12,688.37 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,309.30
|
| Rate for Payer: Cash Price |
$6,608.52
|
| Rate for Payer: Cigna Commercial |
$10,970.15
|
| Rate for Payer: First Health Commercial |
$12,556.20
|
| Rate for Payer: Humana Commercial |
$11,234.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,837.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,754.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,965.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,631.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,643.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,718.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,097.29
|
| Rate for Payer: PHCS Commercial |
$12,688.37
|
| Rate for Payer: United Healthcare All Payer |
$11,631.00
|
|
|
LEGION OX FEM COMP SZ 5 R
|
Facility
|
OP
|
$13,217.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,718.22 |
| Max. Negotiated Rate |
$12,688.37 |
| Rate for Payer: Aetna Commercial |
$10,177.13
|
| Rate for Payer: Anthem Medicaid |
$4,545.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,309.30
|
| Rate for Payer: Cash Price |
$6,608.52
|
| Rate for Payer: Cigna Commercial |
$10,970.15
|
| Rate for Payer: First Health Commercial |
$12,556.20
|
| Rate for Payer: Humana Commercial |
$11,234.49
|
| Rate for Payer: Humana KY Medicaid |
$4,545.34
|
| Rate for Payer: Kentucky WC Medicaid |
$4,591.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,837.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,754.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,965.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,636.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,631.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,912.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,643.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,718.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,097.29
|
| Rate for Payer: PHCS Commercial |
$12,688.37
|
| Rate for Payer: United Healthcare All Payer |
$11,631.00
|
|
|
LEGION PRESSFIT STEM 10X120
|
Facility
|
IP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 10X120
|
Facility
|
OP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem Medicaid |
$2,600.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Humana KY Medicaid |
$2,600.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 10X160
|
Facility
|
IP
|
$9,570.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$9,187.92 |
| Rate for Payer: Aetna Commercial |
$7,369.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,465.18
|
| Rate for Payer: Cash Price |
$4,785.38
|
| Rate for Payer: Cigna Commercial |
$7,943.72
|
| Rate for Payer: First Health Commercial |
$9,092.21
|
| Rate for Payer: Humana Commercial |
$8,135.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,848.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,063.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,422.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,178.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.93
|
| Rate for Payer: PHCS Commercial |
$9,187.92
|
| Rate for Payer: United Healthcare All Payer |
$8,422.26
|
|
|
LEGION PRESSFIT STEM 10X160
|
Facility
|
OP
|
$9,570.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$9,187.92 |
| Rate for Payer: Aetna Commercial |
$7,369.48
|
| Rate for Payer: Anthem Medicaid |
$3,291.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,465.18
|
| Rate for Payer: Cash Price |
$4,785.38
|
| Rate for Payer: Cigna Commercial |
$7,943.72
|
| Rate for Payer: First Health Commercial |
$9,092.21
|
| Rate for Payer: Humana Commercial |
$8,135.14
|
| Rate for Payer: Humana KY Medicaid |
$3,291.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,848.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,063.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,422.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,178.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.93
|
| Rate for Payer: PHCS Commercial |
$9,187.92
|
| Rate for Payer: United Healthcare All Payer |
$8,422.26
|
|
|
LEGION PRESSFIT STEM 10X220
|
Facility
|
OP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem Medicaid |
$2,600.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Humana KY Medicaid |
$2,600.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 10X220
|
Facility
|
IP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 11X120
|
Facility
|
IP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 11X120
|
Facility
|
OP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem Medicaid |
$2,600.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Humana KY Medicaid |
$2,600.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 11X160
|
Facility
|
OP
|
$9,570.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$9,187.92 |
| Rate for Payer: Aetna Commercial |
$7,369.48
|
| Rate for Payer: Anthem Medicaid |
$3,291.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,465.18
|
| Rate for Payer: Cash Price |
$4,785.38
|
| Rate for Payer: Cigna Commercial |
$7,943.72
|
| Rate for Payer: First Health Commercial |
$9,092.21
|
| Rate for Payer: Humana Commercial |
$8,135.14
|
| Rate for Payer: Humana KY Medicaid |
$3,291.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,848.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,063.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,422.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,178.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.93
|
| Rate for Payer: PHCS Commercial |
$9,187.92
|
| Rate for Payer: United Healthcare All Payer |
$8,422.26
|
|
|
LEGION PRESSFIT STEM 11X160
|
Facility
|
IP
|
$9,570.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$9,187.92 |
| Rate for Payer: Aetna Commercial |
$7,369.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,465.18
|
| Rate for Payer: Cash Price |
$4,785.38
|
| Rate for Payer: Cigna Commercial |
$7,943.72
|
| Rate for Payer: First Health Commercial |
$9,092.21
|
| Rate for Payer: Humana Commercial |
$8,135.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,848.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,063.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,422.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,178.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.93
|
| Rate for Payer: PHCS Commercial |
$9,187.92
|
| Rate for Payer: United Healthcare All Payer |
$8,422.26
|
|
|
LEGION PRESSFIT STEM 11X220
|
Facility
|
OP
|
$9,810.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.40 |
| Max. Negotiated Rate |
$9,418.31 |
| Rate for Payer: Aetna Commercial |
$7,554.27
|
| Rate for Payer: Anthem Medicaid |
$3,373.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,652.38
|
| Rate for Payer: Cash Price |
$4,905.37
|
| Rate for Payer: Cigna Commercial |
$8,142.91
|
| Rate for Payer: First Health Commercial |
$9,320.20
|
| Rate for Payer: Humana Commercial |
$8,339.13
|
| Rate for Payer: Humana KY Medicaid |
$3,373.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,408.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,044.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,240.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,943.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,441.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,633.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,358.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,962.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,041.33
|
| Rate for Payer: PHCS Commercial |
$9,418.31
|
| Rate for Payer: United Healthcare All Payer |
$8,633.45
|
|
|
LEGION PRESSFIT STEM 11X220
|
Facility
|
IP
|
$9,810.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.40 |
| Max. Negotiated Rate |
$9,418.31 |
| Rate for Payer: Aetna Commercial |
$7,554.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,652.38
|
| Rate for Payer: Cash Price |
$4,905.37
|
| Rate for Payer: Cigna Commercial |
$8,142.91
|
| Rate for Payer: First Health Commercial |
$9,320.20
|
| Rate for Payer: Humana Commercial |
$8,339.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,044.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,240.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,943.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,633.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,358.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,962.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,275.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,041.33
|
| Rate for Payer: PHCS Commercial |
$9,418.31
|
| Rate for Payer: United Healthcare All Payer |
$8,633.45
|
|
|
LEGION PRESSFIT STEM 12X120
|
Facility
|
OP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem Medicaid |
$2,600.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Humana KY Medicaid |
$2,600.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 12X120
|
Facility
|
IP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 12X160
|
Facility
|
OP
|
$9,570.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$9,187.92 |
| Rate for Payer: Aetna Commercial |
$7,369.48
|
| Rate for Payer: Anthem Medicaid |
$3,291.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,465.18
|
| Rate for Payer: Cash Price |
$4,785.38
|
| Rate for Payer: Cigna Commercial |
$7,943.72
|
| Rate for Payer: First Health Commercial |
$9,092.21
|
| Rate for Payer: Humana Commercial |
$8,135.14
|
| Rate for Payer: Humana KY Medicaid |
$3,291.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,848.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,063.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,422.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,178.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.93
|
| Rate for Payer: PHCS Commercial |
$9,187.92
|
| Rate for Payer: United Healthcare All Payer |
$8,422.26
|
|
|
LEGION PRESSFIT STEM 12X160
|
Facility
|
IP
|
$9,570.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,244.20 |
| Max. Negotiated Rate |
$9,187.92 |
| Rate for Payer: Aetna Commercial |
$7,369.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,465.18
|
| Rate for Payer: Cash Price |
$4,785.38
|
| Rate for Payer: Cigna Commercial |
$7,943.72
|
| Rate for Payer: First Health Commercial |
$9,092.21
|
| Rate for Payer: Humana Commercial |
$8,135.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,848.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,063.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,422.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,178.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.93
|
| Rate for Payer: PHCS Commercial |
$9,187.92
|
| Rate for Payer: United Healthcare All Payer |
$8,422.26
|
|
|
LEGION PRESSFIT STEM 12X220
|
Facility
|
IP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
|
LEGION PRESSFIT STEM 12X220
|
Facility
|
OP
|
$7,562.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$983.10 |
| Max. Negotiated Rate |
$7,259.85 |
| Rate for Payer: Aetna Commercial |
$5,823.00
|
| Rate for Payer: Anthem Medicaid |
$2,600.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.63
|
| Rate for Payer: Cash Price |
$3,781.17
|
| Rate for Payer: Cigna Commercial |
$6,276.74
|
| Rate for Payer: First Health Commercial |
$7,184.22
|
| Rate for Payer: Humana Commercial |
$6,427.99
|
| Rate for Payer: Humana KY Medicaid |
$2,600.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,654.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,344.33
|
| Rate for Payer: PHCS Commercial |
$7,259.85
|
| Rate for Payer: United Healthcare All Payer |
$6,654.86
|
|
