|
LEGION L-WEDGE SZ 7 5X5
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 7 5X5
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 10X10
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 10X10
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 10X5
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 10X5
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 15X10
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 15X10
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 15X5
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 15X5
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 5X10
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 5X10
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 5X5
|
Facility
|
IP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION L-WEDGE SZ 8 5X5
|
Facility
|
OP
|
$6,735.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.62 |
| Max. Negotiated Rate |
$6,465.99 |
| Rate for Payer: Aetna Commercial |
$5,186.27
|
| Rate for Payer: Anthem Medicaid |
$2,316.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,253.62
|
| Rate for Payer: Cash Price |
$3,367.70
|
| Rate for Payer: Cigna Commercial |
$5,590.39
|
| Rate for Payer: First Health Commercial |
$6,398.64
|
| Rate for Payer: Humana Commercial |
$5,725.10
|
| Rate for Payer: Humana KY Medicaid |
$2,316.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,339.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,523.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,970.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,020.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,362.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,927.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,051.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,388.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,859.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,647.43
|
| Rate for Payer: PHCS Commercial |
$6,465.99
|
| Rate for Payer: United Healthcare All Payer |
$5,927.16
|
|
|
LEGION MOT ISRT GD 2-3 11MM RT
|
Facility
|
IP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 11MM RT
|
Facility
|
OP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem Medicaid |
$4,733.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Humana KY Medicaid |
$4,733.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,781.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,828.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 13MM RT
|
Facility
|
IP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 13MM RT
|
Facility
|
OP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem Medicaid |
$4,733.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Humana KY Medicaid |
$4,733.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,781.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,828.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 15MM LT
|
Facility
|
OP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem Medicaid |
$4,733.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Humana KY Medicaid |
$4,733.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,781.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,828.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 15MM LT
|
Facility
|
IP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 15MM RT
|
Facility
|
OP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem Medicaid |
$4,733.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Humana KY Medicaid |
$4,733.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,781.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,828.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 15MM RT
|
Facility
|
IP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 18MM LT
|
Facility
|
IP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 18MM LT
|
Facility
|
OP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem Medicaid |
$4,733.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Humana KY Medicaid |
$4,733.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,781.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,828.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
|
LEGION MOT ISRT GD 2-3 18MM RT
|
Facility
|
OP
|
$13,763.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.95 |
| Max. Negotiated Rate |
$13,212.63 |
| Rate for Payer: Aetna Commercial |
$10,597.63
|
| Rate for Payer: Anthem Medicaid |
$4,733.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,735.26
|
| Rate for Payer: Cash Price |
$6,881.58
|
| Rate for Payer: Cigna Commercial |
$11,423.42
|
| Rate for Payer: First Health Commercial |
$13,075.00
|
| Rate for Payer: Humana Commercial |
$11,698.69
|
| Rate for Payer: Humana KY Medicaid |
$4,733.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,781.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,285.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,157.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,128.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,828.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,111.58
|
| Rate for Payer: Ohio Health Group HMO |
$10,322.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,010.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,973.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,496.58
|
| Rate for Payer: PHCS Commercial |
$13,212.63
|
| Rate for Payer: United Healthcare All Payer |
$12,111.58
|
|
