|
LEGION MOT ISRT GD 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 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 6-7 18MM LT
|
Facility
|
IP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 18MM LT
|
Facility
|
OP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem Medicaid |
$4,560.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Humana KY Medicaid |
$4,560.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,607.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,652.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 18MM RT
|
Facility
|
OP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem Medicaid |
$4,560.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Humana KY Medicaid |
$4,560.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,607.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,652.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 18MM RT
|
Facility
|
IP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 21MM LT
|
Facility
|
OP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem Medicaid |
$4,560.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Humana KY Medicaid |
$4,560.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,607.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,652.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 21MM LT
|
Facility
|
IP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 21MM RT
|
Facility
|
OP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem Medicaid |
$4,560.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Humana KY Medicaid |
$4,560.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,607.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,652.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION MOT ISRT GD 6-7 21MM RT
|
Facility
|
IP
|
$13,262.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,978.66 |
| Max. Negotiated Rate |
$12,731.71 |
| Rate for Payer: Aetna Commercial |
$10,211.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,344.52
|
| Rate for Payer: Cash Price |
$6,631.10
|
| Rate for Payer: Cigna Commercial |
$11,007.63
|
| Rate for Payer: First Health Commercial |
$12,599.09
|
| Rate for Payer: Humana Commercial |
$11,272.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,875.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,787.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,978.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,670.74
|
| Rate for Payer: Ohio Health Group HMO |
$9,946.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,609.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,538.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,150.92
|
| Rate for Payer: PHCS Commercial |
$12,731.71
|
| Rate for Payer: United Healthcare All Payer |
$11,670.74
|
|
|
LEGION NAR OXIN CR SZ 3N L
|
Facility
|
OP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem Medicaid |
$3,790.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Humana KY Medicaid |
$3,790.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,829.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,867.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
LEGION NAR OXIN CR SZ 3N L
|
Facility
|
IP
|
$11,023.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,307.05 |
| Max. Negotiated Rate |
$10,582.56 |
| Rate for Payer: Aetna Commercial |
$8,488.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,598.33
|
| Rate for Payer: Cash Price |
$5,511.75
|
| Rate for Payer: Cigna Commercial |
$9,149.50
|
| Rate for Payer: First Health Commercial |
$10,472.33
|
| Rate for Payer: Humana Commercial |
$9,369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,039.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,135.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,700.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,267.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,818.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,590.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,606.22
|
| Rate for Payer: PHCS Commercial |
$10,582.56
|
| Rate for Payer: United Healthcare All Payer |
$9,700.68
|
|
|
LEGION NAR OXIN FEM SZ 4 L
|
Facility
|
IP
|
$13,574.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,072.24 |
| Max. Negotiated Rate |
$13,031.18 |
| Rate for Payer: Aetna Commercial |
$10,452.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,587.84
|
| Rate for Payer: Cash Price |
$6,787.08
|
| Rate for Payer: Cigna Commercial |
$11,266.54
|
| Rate for Payer: First Health Commercial |
$12,895.44
|
| Rate for Payer: Humana Commercial |
$11,538.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,130.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,017.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,072.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,945.25
|
| Rate for Payer: Ohio Health Group HMO |
$10,180.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,859.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,809.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,366.16
|
| Rate for Payer: PHCS Commercial |
$13,031.18
|
| Rate for Payer: United Healthcare All Payer |
$11,945.25
|
|
|
LEGION NAR OXIN FEM SZ 4 L
|
Facility
|
OP
|
$13,574.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,072.24 |
| Max. Negotiated Rate |
$13,031.18 |
| Rate for Payer: Aetna Commercial |
$10,452.10
|
| Rate for Payer: Anthem Medicaid |
$4,668.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,587.84
|
| Rate for Payer: Cash Price |
$6,787.08
|
| Rate for Payer: Cigna Commercial |
$11,266.54
|
| Rate for Payer: First Health Commercial |
$12,895.44
|
| Rate for Payer: Humana Commercial |
$11,538.03
|
| Rate for Payer: Humana KY Medicaid |
$4,668.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,130.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,017.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,072.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,945.25
|
| Rate for Payer: Ohio Health Group HMO |
$10,180.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,859.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,809.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,366.16
|
| Rate for Payer: PHCS Commercial |
$13,031.18
|
| Rate for Payer: United Healthcare All Payer |
$11,945.25
|
|
|
LEGION OFFSET COUPLER 2MM
|
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 OFFSET COUPLER 2MM
|
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 OFFSET COUPLER 4MM
|
Facility
|
OP
|
$7,886.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.93 |
| Max. Negotiated Rate |
$7,570.98 |
| Rate for Payer: Aetna Commercial |
$6,072.56
|
| Rate for Payer: Anthem Medicaid |
$2,712.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,151.42
|
| Rate for Payer: Cash Price |
$3,943.22
|
| Rate for Payer: Cigna Commercial |
$6,545.75
|
| Rate for Payer: First Health Commercial |
$7,492.12
|
| Rate for Payer: Humana Commercial |
$6,703.47
|
| Rate for Payer: Humana KY Medicaid |
$2,712.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,739.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,466.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,820.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,766.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,940.07
|
| Rate for Payer: Ohio Health Group HMO |
$5,914.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,309.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,861.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,441.64
|
| Rate for Payer: PHCS Commercial |
$7,570.98
|
| Rate for Payer: United Healthcare All Payer |
$6,940.07
|
|
