|
LEGION PRESSFIT STEM 16X220
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 16X220
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 18X120
|
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 18X120
|
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 18X160
|
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 18X160
|
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 18X220
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 18X220
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 20X120
|
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 20X120
|
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 20X160
|
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 20X160
|
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 20X220
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 20X220
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 22X120
|
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 22X120
|
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 22X160
|
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 22X160
|
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 22X220
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 22X220
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
LEGION PRESSFIT STEM 24X120
|
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 24X120
|
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 24X160
|
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 24X160
|
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 24X220
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
