|
LEGION REV TIB BASE SZ 7 RT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 8 LT
|
Facility
|
IP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 8 LT
|
Facility
|
OP
|
$18,830.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,649.00 |
| Max. Negotiated Rate |
$18,076.80 |
| Rate for Payer: Aetna Commercial |
$14,499.10
|
| Rate for Payer: Anthem Medicaid |
$6,475.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,687.40
|
| Rate for Payer: Cash Price |
$9,415.00
|
| Rate for Payer: Cigna Commercial |
$15,628.90
|
| Rate for Payer: First Health Commercial |
$17,888.50
|
| Rate for Payer: Humana Commercial |
$16,005.50
|
| Rate for Payer: Humana KY Medicaid |
$6,475.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,541.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,440.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,896.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,649.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,605.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$14,122.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,382.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,992.70
|
| Rate for Payer: PHCS Commercial |
$18,076.80
|
| Rate for Payer: United Healthcare All Payer |
$16,570.40
|
|
|
LEGION REV TIB BASE SZ 8 RT
|
Facility
|
IP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
|
LEGION REV TIB BASE SZ 8 RT
|
Facility
|
OP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem Medicaid |
$4,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Humana KY Medicaid |
$4,502.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,548.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,592.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
|
LEGION SHORT STEM XTEN 10X80
|
Facility
|
OP
|
$5,203.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.03 |
| Max. Negotiated Rate |
$4,995.30 |
| Rate for Payer: Aetna Commercial |
$4,006.65
|
| Rate for Payer: Anthem Medicaid |
$1,789.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,058.68
|
| Rate for Payer: Cash Price |
$2,601.72
|
| Rate for Payer: Cigna Commercial |
$4,318.86
|
| Rate for Payer: First Health Commercial |
$4,943.27
|
| Rate for Payer: Humana Commercial |
$4,422.92
|
| Rate for Payer: Humana KY Medicaid |
$1,789.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,266.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,902.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,162.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,526.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.37
|
| Rate for Payer: PHCS Commercial |
$4,995.30
|
| Rate for Payer: United Healthcare All Payer |
$4,579.03
|
|
|
LEGION SHORT STEM XTEN 10X80
|
Facility
|
IP
|
$5,203.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.03 |
| Max. Negotiated Rate |
$4,995.30 |
| Rate for Payer: Aetna Commercial |
$4,006.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,058.68
|
| Rate for Payer: Cash Price |
$2,601.72
|
| Rate for Payer: Cigna Commercial |
$4,318.86
|
| Rate for Payer: First Health Commercial |
$4,943.27
|
| Rate for Payer: Humana Commercial |
$4,422.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,266.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,902.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,162.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,526.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.37
|
| Rate for Payer: PHCS Commercial |
$4,995.30
|
| Rate for Payer: United Healthcare All Payer |
$4,579.03
|
|
|
LEGION SHORT STEM XTEN 12X80
|
Facility
|
OP
|
$5,203.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.03 |
| Max. Negotiated Rate |
$4,995.30 |
| Rate for Payer: Aetna Commercial |
$4,006.65
|
| Rate for Payer: Anthem Medicaid |
$1,789.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,058.68
|
| Rate for Payer: Cash Price |
$2,601.72
|
| Rate for Payer: Cigna Commercial |
$4,318.86
|
| Rate for Payer: First Health Commercial |
$4,943.27
|
| Rate for Payer: Humana Commercial |
$4,422.92
|
| Rate for Payer: Humana KY Medicaid |
$1,789.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,266.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,902.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,162.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,526.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.37
|
| Rate for Payer: PHCS Commercial |
$4,995.30
|
| Rate for Payer: United Healthcare All Payer |
$4,579.03
|
|
|
LEGION SHORT STEM XTEN 12X80
|
Facility
|
IP
|
$5,203.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.03 |
| Max. Negotiated Rate |
$4,995.30 |
| Rate for Payer: Aetna Commercial |
$4,006.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,058.68
|
| Rate for Payer: Cash Price |
$2,601.72
|
| Rate for Payer: Cigna Commercial |
$4,318.86
|
| Rate for Payer: First Health Commercial |
$4,943.27
|
| Rate for Payer: Humana Commercial |
$4,422.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,266.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,902.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,162.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,526.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.37
|
| Rate for Payer: PHCS Commercial |
$4,995.30
|
| Rate for Payer: United Healthcare All Payer |
$4,579.03
|
|
|
LEGION SHORT STEM XTEN 14X80
|
Facility
|
IP
|
$5,203.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.03 |
| Max. Negotiated Rate |
$4,995.30 |
| Rate for Payer: Aetna Commercial |
$4,006.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,058.68
|
| Rate for Payer: Cash Price |
$2,601.72
|
| Rate for Payer: Cigna Commercial |
$4,318.86
|
| Rate for Payer: First Health Commercial |
$4,943.27
|
| Rate for Payer: Humana Commercial |
$4,422.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,266.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,902.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,162.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,526.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.37
|
| Rate for Payer: PHCS Commercial |
$4,995.30
|
| Rate for Payer: United Healthcare All Payer |
$4,579.03
|
|
|
LEGION SHORT STEM XTEN 14X80
|
Facility
|
OP
|
$5,203.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.03 |
| Max. Negotiated Rate |
$4,995.30 |
| Rate for Payer: Aetna Commercial |
$4,006.65
|
| Rate for Payer: Anthem Medicaid |
$1,789.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,058.68
|
| Rate for Payer: Cash Price |
$2,601.72
|
| Rate for Payer: Cigna Commercial |
$4,318.86
|
| Rate for Payer: First Health Commercial |
$4,943.27
|
| Rate for Payer: Humana Commercial |
$4,422.92
|
| Rate for Payer: Humana KY Medicaid |
$1,789.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,266.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,902.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,162.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,526.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.37
|
| Rate for Payer: PHCS Commercial |
$4,995.30
|
| Rate for Payer: United Healthcare All Payer |
$4,579.03
|
|
|
LEGION STEM 10X120MM
|
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 STEM 10X120MM
|
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 STEM 10X160MM
|
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 STEM 10X160MM
|
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 STEM 12X120MM
|
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 STEM 12X120MM
|
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 STEM 12X160MM
|
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 STEM 12X160MM
|
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 STEM 14X120MM
|
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 STEM 14X120MM
|
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 STEM 14X160MM
|
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 STEM 14X160MM
|
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 STEM 16X120MM
|
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 STEM 16X120MM
|
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
|
|
