|
LEGION HF ART INSERT SZ 7-8 11
|
Facility
|
IP
|
$12,250.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,675.11 |
| Max. Negotiated Rate |
$11,760.36 |
| Rate for Payer: Aetna Commercial |
$9,432.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,555.30
|
| Rate for Payer: Cash Price |
$6,125.19
|
| Rate for Payer: Cigna Commercial |
$10,167.82
|
| Rate for Payer: First Health Commercial |
$11,637.86
|
| Rate for Payer: Humana Commercial |
$10,412.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,045.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,040.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,675.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,780.33
|
| Rate for Payer: Ohio Health Group HMO |
$9,187.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,800.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,657.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.76
|
| Rate for Payer: PHCS Commercial |
$11,760.36
|
| Rate for Payer: United Healthcare All Payer |
$10,780.33
|
|
|
LEGION HF ART INSERT SZ 7-8 11
|
Facility
|
OP
|
$12,250.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,675.11 |
| Max. Negotiated Rate |
$11,760.36 |
| Rate for Payer: Aetna Commercial |
$9,432.79
|
| Rate for Payer: Anthem Medicaid |
$4,212.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,555.30
|
| Rate for Payer: Cash Price |
$6,125.19
|
| Rate for Payer: Cigna Commercial |
$10,167.82
|
| Rate for Payer: First Health Commercial |
$11,637.86
|
| Rate for Payer: Humana Commercial |
$10,412.82
|
| Rate for Payer: Humana KY Medicaid |
$4,212.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,255.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,045.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,040.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,675.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,297.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,780.33
|
| Rate for Payer: Ohio Health Group HMO |
$9,187.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,800.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,657.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.76
|
| Rate for Payer: PHCS Commercial |
$11,760.36
|
| Rate for Payer: United Healthcare All Payer |
$10,780.33
|
|
|
LEGION HF ART INSRT SZ3-4*15MM
|
Facility
|
OP
|
$9,639.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.77 |
| Max. Negotiated Rate |
$9,253.67 |
| Rate for Payer: Aetna Commercial |
$7,422.21
|
| Rate for Payer: Anthem Medicaid |
$3,314.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,518.61
|
| Rate for Payer: Cash Price |
$4,819.62
|
| Rate for Payer: Cigna Commercial |
$8,000.57
|
| Rate for Payer: First Health Commercial |
$9,157.28
|
| Rate for Payer: Humana Commercial |
$8,193.35
|
| Rate for Payer: Humana KY Medicaid |
$3,314.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,348.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,904.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,113.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,891.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,381.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,482.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,229.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,711.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,386.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,651.08
|
| Rate for Payer: PHCS Commercial |
$9,253.67
|
| Rate for Payer: United Healthcare All Payer |
$8,482.53
|
|
|
LEGION HF ART INSRT SZ3-4*15MM
|
Facility
|
IP
|
$9,639.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,891.77 |
| Max. Negotiated Rate |
$9,253.67 |
| Rate for Payer: Aetna Commercial |
$7,422.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,518.61
|
| Rate for Payer: Cash Price |
$4,819.62
|
| Rate for Payer: Cigna Commercial |
$8,000.57
|
| Rate for Payer: First Health Commercial |
$9,157.28
|
| Rate for Payer: Humana Commercial |
$8,193.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,904.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,113.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,891.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,482.53
|
| Rate for Payer: Ohio Health Group HMO |
$7,229.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,711.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,386.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,651.08
|
| Rate for Payer: PHCS Commercial |
$9,253.67
|
| Rate for Payer: United Healthcare All Payer |
$8,482.53
|
|
|
LEGION HF ART INSRT SZ5-6 11MM
|
Facility
|
IP
|
$7,913.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.94 |
| Max. Negotiated Rate |
$7,596.60 |
| Rate for Payer: Aetna Commercial |
$6,093.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,172.23
|
| Rate for Payer: Cash Price |
$3,956.56
|
| Rate for Payer: Cigna Commercial |
$6,567.89
|
| Rate for Payer: First Health Commercial |
$7,517.46
|
| Rate for Payer: Humana Commercial |
$6,726.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,330.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,884.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,460.05
|
| Rate for Payer: PHCS Commercial |
$7,596.60
|
| Rate for Payer: United Healthcare All Payer |
$6,963.55
|
|
|
LEGION HF ART INSRT SZ5-6 11MM
|
Facility
|
OP
|
$7,913.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,373.94 |
| Max. Negotiated Rate |
$7,596.60 |
| Rate for Payer: Aetna Commercial |
$6,093.10
|
| Rate for Payer: Anthem Medicaid |
$2,721.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,172.23
|
| Rate for Payer: Cash Price |
$3,956.56
|
| Rate for Payer: Cigna Commercial |
$6,567.89
|
| Rate for Payer: First Health Commercial |
$7,517.46
|
| Rate for Payer: Humana Commercial |
$6,726.15
|
| Rate for Payer: Humana KY Medicaid |
$2,721.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,749.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,330.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,884.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,460.05
|
| Rate for Payer: PHCS Commercial |
$7,596.60
|
| Rate for Payer: United Healthcare All Payer |
$6,963.55
|
|
|
LEGION HF ART INSRT SZ 5-6 9MM
|
Facility
|
OP
|
$8,404.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,521.32 |
| Max. Negotiated Rate |
$8,068.23 |
| Rate for Payer: Aetna Commercial |
$6,471.40
|
| Rate for Payer: Anthem Medicaid |
$2,890.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,555.44
|
| Rate for Payer: Cash Price |
$4,202.20
|
| Rate for Payer: Cigna Commercial |
$6,975.66
|
| Rate for Payer: First Health Commercial |
$7,984.19
|
| Rate for Payer: Humana Commercial |
$7,143.75
|
| Rate for Payer: Humana KY Medicaid |
$2,890.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,919.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,891.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,202.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,521.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,948.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,395.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,303.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,723.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,311.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,799.04
|
| Rate for Payer: PHCS Commercial |
$8,068.23
|
| Rate for Payer: United Healthcare All Payer |
$7,395.88
|
|
|
LEGION HF ART INSRT SZ 5-6 9MM
|
Facility
|
IP
|
$8,404.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,521.32 |
| Max. Negotiated Rate |
$8,068.23 |
| Rate for Payer: Aetna Commercial |
$6,471.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,555.44
|
| Rate for Payer: Cash Price |
$4,202.20
|
| Rate for Payer: Cigna Commercial |
$6,975.66
|
| Rate for Payer: First Health Commercial |
$7,984.19
|
| Rate for Payer: Humana Commercial |
$7,143.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,891.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,202.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,521.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,395.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,303.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,723.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,311.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,799.04
|
| Rate for Payer: PHCS Commercial |
$8,068.23
|
| Rate for Payer: United Healthcare All Payer |
$7,395.88
|
|
|
LEGION HIGH FLEX ART INST
|
Facility
|
OP
|
$10,910.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.01 |
| Max. Negotiated Rate |
$10,473.62 |
| Rate for Payer: Aetna Commercial |
$8,400.72
|
| Rate for Payer: Anthem Medicaid |
$3,751.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,509.82
|
| Rate for Payer: Cash Price |
$5,455.01
|
| Rate for Payer: Cigna Commercial |
$9,055.32
|
| Rate for Payer: First Health Commercial |
$10,364.52
|
| Rate for Payer: Humana Commercial |
$9,273.52
|
| Rate for Payer: Humana KY Medicaid |
$3,751.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,946.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,051.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,600.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,182.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,728.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,491.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.91
|
| Rate for Payer: PHCS Commercial |
$10,473.62
|
| Rate for Payer: United Healthcare All Payer |
$9,600.82
|
|
|
LEGION HIGH FLEX ART INST
|
Facility
|
IP
|
$10,910.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.01 |
| Max. Negotiated Rate |
$10,473.62 |
| Rate for Payer: Aetna Commercial |
$8,400.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,509.82
|
| Rate for Payer: Cash Price |
$5,455.01
|
| Rate for Payer: Cigna Commercial |
$9,055.32
|
| Rate for Payer: First Health Commercial |
$10,364.52
|
| Rate for Payer: Humana Commercial |
$9,273.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,946.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,051.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,600.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,182.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,728.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,491.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.91
|
| Rate for Payer: PHCS Commercial |
$10,473.62
|
| Rate for Payer: United Healthcare All Payer |
$9,600.82
|
|
|
LEGION ISRT HK RP SZ 2-3 11MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 11MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 13MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 13MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 15MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 15MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 18MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 18MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 21MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 2-3 21MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 4-5 11MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 4-5 11MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 4-5 13MM
|
Facility
|
IP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 4-5 13MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
|
LEGION ISRT HK RP SZ 4-5 15MM
|
Facility
|
OP
|
$12,337.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,701.21 |
| Max. Negotiated Rate |
$11,843.87 |
| Rate for Payer: Aetna Commercial |
$9,499.77
|
| Rate for Payer: Anthem Medicaid |
$4,242.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,623.14
|
| Rate for Payer: Cash Price |
$6,168.68
|
| Rate for Payer: Cigna Commercial |
$10,240.01
|
| Rate for Payer: First Health Commercial |
$11,720.49
|
| Rate for Payer: Humana Commercial |
$10,486.76
|
| Rate for Payer: Humana KY Medicaid |
$4,242.82
|
| Rate for Payer: Kentucky WC Medicaid |
$4,286.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,116.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,104.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,701.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,327.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,856.88
|
| Rate for Payer: Ohio Health Group HMO |
$9,253.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,869.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,733.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,512.78
|
| Rate for Payer: PHCS Commercial |
$11,843.87
|
| Rate for Payer: United Healthcare All Payer |
$10,856.88
|
|
