|
LEGION PRESSFIT STEM 13X120
|
Facility
|
IP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 13X120
|
Facility
|
OP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem Medicaid |
$3,051.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Humana KY Medicaid |
$3,051.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,082.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,112.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 13X160
|
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 13X160
|
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 13X220
|
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 13X220
|
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 14X120
|
Facility
|
IP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 14X120
|
Facility
|
OP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem Medicaid |
$3,051.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Humana KY Medicaid |
$3,051.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,082.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,112.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 14X160
|
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 14X160
|
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 14X220
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION PRESSFIT STEM 14X220
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION PRESSFIT STEM 15X120
|
Facility
|
OP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem Medicaid |
$3,051.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Humana KY Medicaid |
$3,051.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,082.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,112.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 15X120
|
Facility
|
IP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 15X160
|
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 15X160
|
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 15X220
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION PRESSFIT STEM 15X220
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION PRESSFIT STEM 16X120
|
Facility
|
IP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 16X120
|
Facility
|
OP
|
$8,873.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.57 |
| Max. Negotiated Rate |
$8,518.66 |
| Rate for Payer: Aetna Commercial |
$6,832.67
|
| Rate for Payer: Anthem Medicaid |
$3,051.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,921.41
|
| Rate for Payer: Cash Price |
$4,436.80
|
| Rate for Payer: Cigna Commercial |
$7,365.09
|
| Rate for Payer: First Health Commercial |
$8,429.92
|
| Rate for Payer: Humana Commercial |
$7,542.56
|
| Rate for Payer: Humana KY Medicaid |
$3,051.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,082.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,276.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,548.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,662.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,112.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,808.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,655.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,774.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,153.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,750.82
|
| Rate for Payer: PHCS Commercial |
$8,518.66
|
| Rate for Payer: United Healthcare All Payer |
$7,808.77
|
|
|
LEGION PRESSFIT STEM 16X160
|
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 16X160
|
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 16X220
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION PRESSFIT STEM 16X220
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
LEGION PRESSFIT STEM 18X120
|
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
|
|
