|
LEGION MOT ISRT GD 2-3 18MM 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 21MM 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 21MM 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 21MM 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 21MM 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 4-5 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 4-5 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 4-5 13MM 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 4-5 13MM 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 4-5 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 4-5 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 4-5 15MM LT
|
Facility
|
OP
|
$15,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,688.85 |
| Max. Negotiated Rate |
$15,004.32 |
| Rate for Payer: Aetna Commercial |
$12,034.72
|
| Rate for Payer: Anthem Medicaid |
$5,374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.01
|
| Rate for Payer: Cash Price |
$7,814.75
|
| Rate for Payer: Cigna Commercial |
$12,972.49
|
| Rate for Payer: First Health Commercial |
$14,848.02
|
| Rate for Payer: Humana Commercial |
$13,285.08
|
| Rate for Payer: Humana KY Medicaid |
$5,374.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,429.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,688.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,482.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,753.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,597.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,784.35
|
| Rate for Payer: PHCS Commercial |
$15,004.32
|
| Rate for Payer: United Healthcare All Payer |
$13,753.96
|
|
|
LEGION MOT ISRT GD 4-5 15MM LT
|
Facility
|
IP
|
$15,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,688.85 |
| Max. Negotiated Rate |
$15,004.32 |
| Rate for Payer: Aetna Commercial |
$12,034.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,191.01
|
| Rate for Payer: Cash Price |
$7,814.75
|
| Rate for Payer: Cigna Commercial |
$12,972.49
|
| Rate for Payer: First Health Commercial |
$14,848.02
|
| Rate for Payer: Humana Commercial |
$13,285.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,816.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,534.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,688.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,753.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,722.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,503.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,597.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,784.35
|
| Rate for Payer: PHCS Commercial |
$15,004.32
|
| Rate for Payer: United Healthcare All Payer |
$13,753.96
|
|
|
LEGION MOT ISRT GD 4-5 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 4-5 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 4-5 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 4-5 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 4-5 18MM 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 4-5 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
|
|
|
LEGION MOT ISRT GD 4-5 21MM 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 4-5 21MM 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 4-5 21MM 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 4-5 21MM 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 6-7 11MM 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 6-7 11MM 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
|
|
