|
LEGION REV TIB BASE SZ 8 RT
|
Facility
|
OP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem Medicaid |
$4,415.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Humana KY Medicaid |
$4,415.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,504.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
LEGION REV TIB BASE SZ 8 RT
|
Facility
|
IP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
LEGION SHORT STEM XTEN 10X80
|
Facility
|
IP
|
$5,189.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$4,982.28 |
| Rate for Payer: Aetna Commercial |
$3,996.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.11
|
| Rate for Payer: Cash Price |
$2,594.94
|
| Rate for Payer: Cigna Commercial |
$4,307.60
|
| Rate for Payer: First Health Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial |
$4,411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.86
|
| Rate for Payer: PHCS Commercial |
$4,982.28
|
| Rate for Payer: United Healthcare All Payer |
$4,567.09
|
|
|
LEGION SHORT STEM XTEN 10X80
|
Facility
|
OP
|
$5,189.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$4,982.28 |
| Rate for Payer: Aetna Commercial |
$3,996.21
|
| Rate for Payer: Anthem Medicaid |
$1,784.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.11
|
| Rate for Payer: Cash Price |
$2,594.94
|
| Rate for Payer: Cigna Commercial |
$4,307.60
|
| Rate for Payer: First Health Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial |
$4,411.40
|
| Rate for Payer: Humana KY Medicaid |
$1,784.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.86
|
| Rate for Payer: PHCS Commercial |
$4,982.28
|
| Rate for Payer: United Healthcare All Payer |
$4,567.09
|
|
|
LEGION SHORT STEM XTEN 12X80
|
Facility
|
IP
|
$5,189.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$4,982.28 |
| Rate for Payer: Aetna Commercial |
$3,996.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.11
|
| Rate for Payer: Cash Price |
$2,594.94
|
| Rate for Payer: Cigna Commercial |
$4,307.60
|
| Rate for Payer: First Health Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial |
$4,411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.86
|
| Rate for Payer: PHCS Commercial |
$4,982.28
|
| Rate for Payer: United Healthcare All Payer |
$4,567.09
|
|
|
LEGION SHORT STEM XTEN 12X80
|
Facility
|
OP
|
$5,189.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$4,982.28 |
| Rate for Payer: Aetna Commercial |
$3,996.21
|
| Rate for Payer: Anthem Medicaid |
$1,784.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.11
|
| Rate for Payer: Cash Price |
$2,594.94
|
| Rate for Payer: Cigna Commercial |
$4,307.60
|
| Rate for Payer: First Health Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial |
$4,411.40
|
| Rate for Payer: Humana KY Medicaid |
$1,784.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.86
|
| Rate for Payer: PHCS Commercial |
$4,982.28
|
| Rate for Payer: United Healthcare All Payer |
$4,567.09
|
|
|
LEGION SHORT STEM XTEN 14X80
|
Facility
|
OP
|
$5,189.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$4,982.28 |
| Rate for Payer: Aetna Commercial |
$3,996.21
|
| Rate for Payer: Anthem Medicaid |
$1,784.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.11
|
| Rate for Payer: Cash Price |
$2,594.94
|
| Rate for Payer: Cigna Commercial |
$4,307.60
|
| Rate for Payer: First Health Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial |
$4,411.40
|
| Rate for Payer: Humana KY Medicaid |
$1,784.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.86
|
| Rate for Payer: PHCS Commercial |
$4,982.28
|
| Rate for Payer: United Healthcare All Payer |
$4,567.09
|
|
|
LEGION SHORT STEM XTEN 14X80
|
Facility
|
IP
|
$5,189.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$4,982.28 |
| Rate for Payer: Aetna Commercial |
$3,996.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.11
|
| Rate for Payer: Cash Price |
$2,594.94
|
| Rate for Payer: Cigna Commercial |
$4,307.60
|
| Rate for Payer: First Health Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial |
$4,411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,255.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,608.86
|
| Rate for Payer: PHCS Commercial |
$4,982.28
|
| Rate for Payer: United Healthcare All Payer |
$4,567.09
|
|
|
LEGION STEM 10X120MM
|
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 STEM 10X120MM
|
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 STEM 10X160MM
|
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 STEM 10X160MM
|
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 STEM 12X120MM
|
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 STEM 12X120MM
|
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 STEM 12X160MM
|
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 STEM 12X160MM
|
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 STEM 14X120MM
|
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 STEM 14X120MM
|
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 STEM 14X160MM
|
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 STEM 14X160MM
|
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 STEM 16X120MM
|
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 STEM 16X120MM
|
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 STEM 16X160MM
|
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 STEM 16X160MM
|
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 STEM 18X120MM
|
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
|
|
