|
LEGION OX CONS FEM 7 LT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 7 LT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 7 RT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 7 RT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 8 LT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 8 LT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 8 RT
|
Facility
|
OP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem Medicaid |
$14,299.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Humana KY Medicaid |
$14,299.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14,445.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,586.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX CONS FEM 8 RT
|
Facility
|
IP
|
$41,581.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,474.38 |
| Max. Negotiated Rate |
$39,918.00 |
| Rate for Payer: Aetna Commercial |
$32,017.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,433.38
|
| Rate for Payer: Cash Price |
$20,790.62
|
| Rate for Payer: Cigna Commercial |
$34,512.44
|
| Rate for Payer: First Health Commercial |
$39,502.19
|
| Rate for Payer: Humana Commercial |
$35,344.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,096.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,474.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,591.50
|
| Rate for Payer: Ohio Health Group HMO |
$31,185.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,175.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,691.06
|
| Rate for Payer: PHCS Commercial |
$39,918.00
|
| Rate for Payer: United Healthcare All Payer |
$36,591.50
|
|
|
LEGION OX FEM COMP SZ 5 R
|
Facility
|
IP
|
$13,471.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,041.42 |
| Max. Negotiated Rate |
$12,932.53 |
| Rate for Payer: Aetna Commercial |
$10,372.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,507.68
|
| Rate for Payer: Cash Price |
$6,735.70
|
| Rate for Payer: Cigna Commercial |
$11,181.25
|
| Rate for Payer: First Health Commercial |
$12,797.82
|
| Rate for Payer: Humana Commercial |
$11,450.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,046.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,941.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,041.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,854.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,103.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,777.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,720.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,295.26
|
| Rate for Payer: PHCS Commercial |
$12,932.53
|
| Rate for Payer: United Healthcare All Payer |
$11,854.82
|
|
|
LEGION OX FEM COMP SZ 5 R
|
Facility
|
OP
|
$13,471.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,041.42 |
| Max. Negotiated Rate |
$12,932.53 |
| Rate for Payer: Aetna Commercial |
$10,372.97
|
| Rate for Payer: Anthem Medicaid |
$4,632.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,507.68
|
| Rate for Payer: Cash Price |
$6,735.70
|
| Rate for Payer: Cigna Commercial |
$11,181.25
|
| Rate for Payer: First Health Commercial |
$12,797.82
|
| Rate for Payer: Humana Commercial |
$11,450.68
|
| Rate for Payer: Humana KY Medicaid |
$4,632.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,679.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,046.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,941.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,041.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,725.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,854.82
|
| Rate for Payer: Ohio Health Group HMO |
$10,103.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,777.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,720.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,295.26
|
| Rate for Payer: PHCS Commercial |
$12,932.53
|
| Rate for Payer: United Healthcare All Payer |
$11,854.82
|
|
|
LEGION PRESSFIT STEM 10X120
|
Facility
|
IP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 10X120
|
Facility
|
OP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem Medicaid |
$2,669.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Humana KY Medicaid |
$2,669.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,696.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 10X160
|
Facility
|
IP
|
$9,770.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.22 |
| Max. Negotiated Rate |
$9,379.92 |
| Rate for Payer: Aetna Commercial |
$7,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.19
|
| Rate for Payer: Cash Price |
$4,885.38
|
| Rate for Payer: Cigna Commercial |
$8,109.72
|
| Rate for Payer: First Health Commercial |
$9,282.21
|
| Rate for Payer: Humana Commercial |
$8,305.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,210.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,816.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,500.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,741.82
|
| Rate for Payer: PHCS Commercial |
$9,379.92
|
| Rate for Payer: United Healthcare All Payer |
$8,598.26
|
|
|
LEGION PRESSFIT STEM 10X160
|
Facility
|
OP
|
$9,770.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.22 |
| Max. Negotiated Rate |
$9,379.92 |
| Rate for Payer: Aetna Commercial |
$7,523.48
|
| Rate for Payer: Anthem Medicaid |
$3,360.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.19
|
| Rate for Payer: Cash Price |
$4,885.38
|
| Rate for Payer: Cigna Commercial |
$8,109.72
|
| Rate for Payer: First Health Commercial |
$9,282.21
|
| Rate for Payer: Humana Commercial |
$8,305.14
|
| Rate for Payer: Humana KY Medicaid |
$3,360.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,394.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,210.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,427.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,816.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,500.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,741.82
|
| Rate for Payer: PHCS Commercial |
$9,379.92
|
| Rate for Payer: United Healthcare All Payer |
$8,598.26
|
|
|
LEGION PRESSFIT STEM 10X220
|
Facility
|
OP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem Medicaid |
$2,669.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Humana KY Medicaid |
$2,669.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,696.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 10X220
|
Facility
|
IP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 11X120
|
Facility
|
IP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 11X120
|
Facility
|
OP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem Medicaid |
$2,669.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Humana KY Medicaid |
$2,669.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,696.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 11X160
|
Facility
|
IP
|
$9,770.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.22 |
| Max. Negotiated Rate |
$9,379.92 |
| Rate for Payer: Aetna Commercial |
$7,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.19
|
| Rate for Payer: Cash Price |
$4,885.38
|
| Rate for Payer: Cigna Commercial |
$8,109.72
|
| Rate for Payer: First Health Commercial |
$9,282.21
|
| Rate for Payer: Humana Commercial |
$8,305.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,210.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,816.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,500.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,741.82
|
| Rate for Payer: PHCS Commercial |
$9,379.92
|
| Rate for Payer: United Healthcare All Payer |
$8,598.26
|
|
|
LEGION PRESSFIT STEM 11X160
|
Facility
|
OP
|
$9,770.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.22 |
| Max. Negotiated Rate |
$9,379.92 |
| Rate for Payer: Aetna Commercial |
$7,523.48
|
| Rate for Payer: Anthem Medicaid |
$3,360.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.19
|
| Rate for Payer: Cash Price |
$4,885.38
|
| Rate for Payer: Cigna Commercial |
$8,109.72
|
| Rate for Payer: First Health Commercial |
$9,282.21
|
| Rate for Payer: Humana Commercial |
$8,305.14
|
| Rate for Payer: Humana KY Medicaid |
$3,360.16
|
| Rate for Payer: Kentucky WC Medicaid |
$3,394.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,210.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,427.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,816.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,500.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,741.82
|
| Rate for Payer: PHCS Commercial |
$9,379.92
|
| Rate for Payer: United Healthcare All Payer |
$8,598.26
|
|
|
LEGION PRESSFIT STEM 11X220
|
Facility
|
IP
|
$10,010.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,003.22 |
| Max. Negotiated Rate |
$9,610.31 |
| Rate for Payer: Aetna Commercial |
$7,708.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,808.38
|
| Rate for Payer: Cash Price |
$5,005.37
|
| Rate for Payer: Cigna Commercial |
$8,308.91
|
| Rate for Payer: First Health Commercial |
$9,510.20
|
| Rate for Payer: Humana Commercial |
$8,509.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,208.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,387.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,003.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,809.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,508.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,008.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,709.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,907.41
|
| Rate for Payer: PHCS Commercial |
$9,610.31
|
| Rate for Payer: United Healthcare All Payer |
$8,809.45
|
|
|
LEGION PRESSFIT STEM 11X220
|
Facility
|
OP
|
$10,010.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,003.22 |
| Max. Negotiated Rate |
$9,610.31 |
| Rate for Payer: Aetna Commercial |
$7,708.27
|
| Rate for Payer: Anthem Medicaid |
$3,442.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,808.38
|
| Rate for Payer: Cash Price |
$5,005.37
|
| Rate for Payer: Cigna Commercial |
$8,308.91
|
| Rate for Payer: First Health Commercial |
$9,510.20
|
| Rate for Payer: Humana Commercial |
$8,509.13
|
| Rate for Payer: Humana KY Medicaid |
$3,442.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,477.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,208.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,387.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,003.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,511.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,809.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,508.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,008.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,709.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,907.41
|
| Rate for Payer: PHCS Commercial |
$9,610.31
|
| Rate for Payer: United Healthcare All Payer |
$8,809.45
|
|
|
LEGION PRESSFIT STEM 12X120
|
Facility
|
IP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 12X120
|
Facility
|
OP
|
$7,762.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,328.70 |
| Max. Negotiated Rate |
$7,451.85 |
| Rate for Payer: Aetna Commercial |
$5,977.00
|
| Rate for Payer: Anthem Medicaid |
$2,669.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,054.63
|
| Rate for Payer: Cash Price |
$3,881.17
|
| Rate for Payer: Cigna Commercial |
$6,442.74
|
| Rate for Payer: First Health Commercial |
$7,374.22
|
| Rate for Payer: Humana Commercial |
$6,597.99
|
| Rate for Payer: Humana KY Medicaid |
$2,669.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,696.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,365.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,728.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,328.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,830.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,821.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,209.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,753.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,356.01
|
| Rate for Payer: PHCS Commercial |
$7,451.85
|
| Rate for Payer: United Healthcare All Payer |
$6,830.86
|
|
|
LEGION PRESSFIT STEM 12X160
|
Facility
|
IP
|
$9,770.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.22 |
| Max. Negotiated Rate |
$9,379.92 |
| Rate for Payer: Aetna Commercial |
$7,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.19
|
| Rate for Payer: Cash Price |
$4,885.38
|
| Rate for Payer: Cigna Commercial |
$8,109.72
|
| Rate for Payer: First Health Commercial |
$9,282.21
|
| Rate for Payer: Humana Commercial |
$8,305.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,210.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,816.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,500.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,741.82
|
| Rate for Payer: PHCS Commercial |
$9,379.92
|
| Rate for Payer: United Healthcare All Payer |
$8,598.26
|
|
