|
LEGION PRESSFIT STEM 24X220
|
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 9X120
|
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 9X120
|
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 9X160
|
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 9X160
|
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 PS ART INSRT SZ3-4*13MM
|
Facility
|
IP
|
$10,910.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.01 |
| Max. Negotiated Rate |
$10,473.62 |
| Rate for Payer: Aetna Commercial |
$8,400.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,509.82
|
| Rate for Payer: Cash Price |
$5,455.01
|
| Rate for Payer: Cigna Commercial |
$9,055.32
|
| Rate for Payer: First Health Commercial |
$10,364.52
|
| Rate for Payer: Humana Commercial |
$9,273.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,946.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,051.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,600.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,182.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,728.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,491.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.91
|
| Rate for Payer: PHCS Commercial |
$10,473.62
|
| Rate for Payer: United Healthcare All Payer |
$9,600.82
|
|
|
LEGION PS ART INSRT SZ3-4*13MM
|
Facility
|
OP
|
$10,910.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,273.01 |
| Max. Negotiated Rate |
$10,473.62 |
| Rate for Payer: Aetna Commercial |
$8,400.72
|
| Rate for Payer: Anthem Medicaid |
$3,751.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,509.82
|
| Rate for Payer: Cash Price |
$5,455.01
|
| Rate for Payer: Cigna Commercial |
$9,055.32
|
| Rate for Payer: First Health Commercial |
$10,364.52
|
| Rate for Payer: Humana Commercial |
$9,273.52
|
| Rate for Payer: Humana KY Medicaid |
$3,751.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,790.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,946.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,051.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,827.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,600.82
|
| Rate for Payer: Ohio Health Group HMO |
$8,182.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,728.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,491.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,527.91
|
| Rate for Payer: PHCS Commercial |
$10,473.62
|
| Rate for Payer: United Healthcare All Payer |
$9,600.82
|
|
|
LEGION PS HIGH FLX SZ1-2 10MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 10MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 11MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 11MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 12MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 12MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 13MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 13MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 15MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 15MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 18MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ1-2 18MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ 1-2 9MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS HIGH FLX SZ 1-2 9MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
LEGION PS NP FEM SZ 2 LT
|
Facility
|
OP
|
$9,924.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.22 |
| Max. Negotiated Rate |
$9,527.09 |
| Rate for Payer: Aetna Commercial |
$7,641.52
|
| Rate for Payer: Anthem Medicaid |
$3,412.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,740.76
|
| Rate for Payer: Cash Price |
$4,962.02
|
| Rate for Payer: Cigna Commercial |
$8,236.96
|
| Rate for Payer: First Health Commercial |
$9,427.85
|
| Rate for Payer: Humana Commercial |
$8,435.44
|
| Rate for Payer: Humana KY Medicaid |
$3,412.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,447.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,137.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,323.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,481.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,939.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,633.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,847.59
|
| Rate for Payer: PHCS Commercial |
$9,527.09
|
| Rate for Payer: United Healthcare All Payer |
$8,733.16
|
|
|
LEGION PS NP FEM SZ 2 LT
|
Facility
|
IP
|
$9,924.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,977.22 |
| Max. Negotiated Rate |
$9,527.09 |
| Rate for Payer: Aetna Commercial |
$7,641.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,740.76
|
| Rate for Payer: Cash Price |
$4,962.02
|
| Rate for Payer: Cigna Commercial |
$8,236.96
|
| Rate for Payer: First Health Commercial |
$9,427.85
|
| Rate for Payer: Humana Commercial |
$8,435.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,137.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,323.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,977.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,733.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,443.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,939.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,633.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,847.59
|
| Rate for Payer: PHCS Commercial |
$9,527.09
|
| Rate for Payer: United Healthcare All Payer |
$8,733.16
|
|
|
LEGION PS NP FEM SZ 2 RT
|
Facility
|
OP
|
$9,664.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.47 |
| Max. Negotiated Rate |
$9,278.30 |
| Rate for Payer: Aetna Commercial |
$7,441.97
|
| Rate for Payer: Anthem Medicaid |
$3,323.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.62
|
| Rate for Payer: Cash Price |
$4,832.45
|
| Rate for Payer: Cigna Commercial |
$8,021.87
|
| Rate for Payer: First Health Commercial |
$9,181.66
|
| Rate for Payer: Humana Commercial |
$8,215.17
|
| Rate for Payer: Humana KY Medicaid |
$3,323.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,357.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,390.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.78
|
| Rate for Payer: PHCS Commercial |
$9,278.30
|
| Rate for Payer: United Healthcare All Payer |
$8,505.11
|
|
|
LEGION PS NP FEM SZ 2 RT
|
Facility
|
IP
|
$9,664.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.47 |
| Max. Negotiated Rate |
$9,278.30 |
| Rate for Payer: Aetna Commercial |
$7,441.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.62
|
| Rate for Payer: Cash Price |
$4,832.45
|
| Rate for Payer: Cigna Commercial |
$8,021.87
|
| Rate for Payer: First Health Commercial |
$9,181.66
|
| Rate for Payer: Humana Commercial |
$8,215.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.78
|
| Rate for Payer: PHCS Commercial |
$9,278.30
|
| Rate for Payer: United Healthcare All Payer |
$8,505.11
|
|
