|
LEGION PRESSFIT STEM 9X160
|
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 9X160
|
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 PS ART INSRT SZ3-4*13MM
|
Facility
|
OP
|
$10,669.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.05 |
| Max. Negotiated Rate |
$10,242.85 |
| Rate for Payer: Aetna Commercial |
$8,215.62
|
| Rate for Payer: Anthem Medicaid |
$3,669.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,322.32
|
| Rate for Payer: Cash Price |
$5,334.82
|
| Rate for Payer: Cigna Commercial |
$8,855.80
|
| Rate for Payer: First Health Commercial |
$10,136.16
|
| Rate for Payer: Humana Commercial |
$9,069.19
|
| Rate for Payer: Humana KY Medicaid |
$3,669.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,706.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,749.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,742.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,389.28
|
| Rate for Payer: Ohio Health Group HMO |
$8,002.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.59
|
| Rate for Payer: PHCS Commercial |
$10,242.85
|
| Rate for Payer: United Healthcare All Payer |
$9,389.28
|
|
|
LEGION PS ART INSRT SZ3-4*13MM
|
Facility
|
IP
|
$10,669.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.05 |
| Max. Negotiated Rate |
$10,242.85 |
| Rate for Payer: Aetna Commercial |
$8,215.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,322.32
|
| Rate for Payer: Cash Price |
$5,334.82
|
| Rate for Payer: Cigna Commercial |
$8,855.80
|
| Rate for Payer: First Health Commercial |
$10,136.16
|
| Rate for Payer: Humana Commercial |
$9,069.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,749.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,200.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,389.28
|
| Rate for Payer: Ohio Health Group HMO |
$8,002.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,133.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,387.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.59
|
| Rate for Payer: PHCS Commercial |
$10,242.85
|
| Rate for Payer: United Healthcare All Payer |
$9,389.28
|
|
|
LEGION PS HIGH FLX SZ1-2 10MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 10MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 11MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 11MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 12MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 12MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 13MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 13MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 15MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 15MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 18MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ1-2 18MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ 1-2 9MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS HIGH FLX SZ 1-2 9MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
LEGION PS NP FEM SZ 2 LT
|
Facility
|
OP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem Medicaid |
$3,344.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Humana KY Medicaid |
$3,344.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,378.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,411.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION PS NP FEM SZ 2 LT
|
Facility
|
IP
|
$9,724.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.13 |
| Max. Negotiated Rate |
$9,335.09 |
| Rate for Payer: Aetna Commercial |
$7,487.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,584.76
|
| Rate for Payer: Cash Price |
$4,862.02
|
| Rate for Payer: Cigna Commercial |
$8,070.96
|
| Rate for Payer: First Health Commercial |
$9,237.85
|
| Rate for Payer: Humana Commercial |
$8,265.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,973.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,176.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,917.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,557.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,293.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,944.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.46
|
| Rate for Payer: PHCS Commercial |
$9,335.09
|
| Rate for Payer: United Healthcare All Payer |
$8,557.16
|
|
|
LEGION PS NP FEM SZ 2 RT
|
Facility
|
OP
|
$9,464.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.44 |
| Max. Negotiated Rate |
$9,086.30 |
| Rate for Payer: Aetna Commercial |
$7,287.97
|
| Rate for Payer: Anthem Medicaid |
$3,254.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.62
|
| Rate for Payer: Cash Price |
$4,732.45
|
| Rate for Payer: Cigna Commercial |
$7,855.87
|
| Rate for Payer: First Health Commercial |
$8,991.66
|
| Rate for Payer: Humana Commercial |
$8,045.16
|
| Rate for Payer: Humana KY Medicaid |
$3,254.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,288.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,985.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,320.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,329.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.12
|
| Rate for Payer: PHCS Commercial |
$9,086.30
|
| Rate for Payer: United Healthcare All Payer |
$8,329.11
|
|
|
LEGION PS NP FEM SZ 2 RT
|
Facility
|
IP
|
$9,464.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.44 |
| Max. Negotiated Rate |
$9,086.30 |
| Rate for Payer: Aetna Commercial |
$7,287.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.62
|
| Rate for Payer: Cash Price |
$4,732.45
|
| Rate for Payer: Cigna Commercial |
$7,855.87
|
| Rate for Payer: First Health Commercial |
$8,991.66
|
| Rate for Payer: Humana Commercial |
$8,045.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,985.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,329.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.12
|
| Rate for Payer: PHCS Commercial |
$9,086.30
|
| Rate for Payer: United Healthcare All Payer |
$8,329.11
|
|
|
LEGION PS NP FEM SZ 3 LT
|
Facility
|
OP
|
$10,623.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.08 |
| Max. Negotiated Rate |
$10,198.78 |
| Rate for Payer: Aetna Commercial |
$8,180.27
|
| Rate for Payer: Anthem Medicaid |
$3,653.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,286.51
|
| Rate for Payer: Cash Price |
$5,311.86
|
| Rate for Payer: Cigna Commercial |
$8,817.70
|
| Rate for Payer: First Health Commercial |
$10,092.54
|
| Rate for Payer: Humana Commercial |
$9,030.17
|
| Rate for Payer: Humana KY Medicaid |
$3,653.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,690.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,711.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,840.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,726.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,348.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,967.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,381.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,293.36
|
| Rate for Payer: PHCS Commercial |
$10,198.78
|
| Rate for Payer: United Healthcare All Payer |
$9,348.88
|
|
|
LEGION PS NP FEM SZ 3 LT
|
Facility
|
IP
|
$10,623.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.08 |
| Max. Negotiated Rate |
$10,198.78 |
| Rate for Payer: Aetna Commercial |
$8,180.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,286.51
|
| Rate for Payer: Cash Price |
$5,311.86
|
| Rate for Payer: Cigna Commercial |
$8,817.70
|
| Rate for Payer: First Health Commercial |
$10,092.54
|
| Rate for Payer: Humana Commercial |
$9,030.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,711.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,840.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,348.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,967.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,381.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,293.36
|
| Rate for Payer: PHCS Commercial |
$10,198.78
|
| Rate for Payer: United Healthcare All Payer |
$9,348.88
|
|
|
LEGION PS NP FEM SZ 3 RT
|
Facility
|
OP
|
$10,623.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.08 |
| Max. Negotiated Rate |
$10,198.78 |
| Rate for Payer: Aetna Commercial |
$8,180.27
|
| Rate for Payer: Anthem Medicaid |
$3,653.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,286.51
|
| Rate for Payer: Cash Price |
$5,311.86
|
| Rate for Payer: Cigna Commercial |
$8,817.70
|
| Rate for Payer: First Health Commercial |
$10,092.54
|
| Rate for Payer: Humana Commercial |
$9,030.17
|
| Rate for Payer: Humana KY Medicaid |
$3,653.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,690.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,711.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,840.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,187.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,726.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,348.88
|
| Rate for Payer: Ohio Health Group HMO |
$7,967.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,381.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,293.36
|
| Rate for Payer: PHCS Commercial |
$10,198.78
|
| Rate for Payer: United Healthcare All Payer |
$9,348.88
|
|
