|
LEGION XLPE DISH INST 1-2 15MM
|
Facility
|
OP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem Medicaid |
$2,521.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Humana KY Medicaid |
$2,521.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,546.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,571.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 3-4 11MM
|
Facility
|
OP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem Medicaid |
$2,521.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Humana KY Medicaid |
$2,521.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,546.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,571.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 3-4 11MM
|
Facility
|
IP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 3-4 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 XLPE DISH INST 3-4 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 XLPE DISH INST 3-4 15MM
|
Facility
|
IP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 3-4 15MM
|
Facility
|
OP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem Medicaid |
$2,521.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Humana KY Medicaid |
$2,521.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,546.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,571.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 5-6 11MM
|
Facility
|
IP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 5-6 11MM
|
Facility
|
OP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem Medicaid |
$2,521.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Humana KY Medicaid |
$2,521.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,546.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,571.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 5-6 13MM
|
Facility
|
IP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPE DISH INST 5-6 13MM
|
Facility
|
OP
|
$7,330.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.22 |
| Max. Negotiated Rate |
$7,037.50 |
| Rate for Payer: Aetna Commercial |
$5,644.66
|
| Rate for Payer: Anthem Medicaid |
$2,521.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,717.97
|
| Rate for Payer: Cash Price |
$3,665.36
|
| Rate for Payer: Cigna Commercial |
$6,084.51
|
| Rate for Payer: First Health Commercial |
$6,964.19
|
| Rate for Payer: Humana Commercial |
$6,231.12
|
| Rate for Payer: Humana KY Medicaid |
$2,521.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,546.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,011.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,410.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,199.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,571.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,451.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,498.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,864.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,377.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,058.20
|
| Rate for Payer: PHCS Commercial |
$7,037.50
|
| Rate for Payer: United Healthcare All Payer |
$6,451.04
|
|
|
LEGION XLPEPS INSRT SZ3-4 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 XLPEPS INSRT SZ3-4 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 XLPE PSINSRT SZ3-4 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 XLPE PSINSRT SZ3-4 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
|
|
|
LE INTRCL STR D TAIL ASSM 55MM
|
Facility
|
OP
|
$11,596.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,478.86 |
| Max. Negotiated Rate |
$11,132.35 |
| Rate for Payer: Aetna Commercial |
$8,929.07
|
| Rate for Payer: Anthem Medicaid |
$3,987.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,045.04
|
| Rate for Payer: Cash Price |
$5,798.10
|
| Rate for Payer: Cigna Commercial |
$9,624.85
|
| Rate for Payer: First Health Commercial |
$11,016.39
|
| Rate for Payer: Humana Commercial |
$9,856.77
|
| Rate for Payer: Humana KY Medicaid |
$3,987.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,028.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,508.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,558.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,478.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,067.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,204.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,697.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,276.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,088.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,001.38
|
| Rate for Payer: PHCS Commercial |
$11,132.35
|
| Rate for Payer: United Healthcare All Payer |
$10,204.66
|
|
|
LE INTRCL STR D TAIL ASSM 55MM
|
Facility
|
IP
|
$11,596.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,478.86 |
| Max. Negotiated Rate |
$11,132.35 |
| Rate for Payer: Aetna Commercial |
$8,929.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,045.04
|
| Rate for Payer: Cash Price |
$5,798.10
|
| Rate for Payer: Cigna Commercial |
$9,624.85
|
| Rate for Payer: First Health Commercial |
$11,016.39
|
| Rate for Payer: Humana Commercial |
$9,856.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,508.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,558.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,478.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,204.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,697.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,276.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,088.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,001.38
|
| Rate for Payer: PHCS Commercial |
$11,132.35
|
| Rate for Payer: United Healthcare All Payer |
$10,204.66
|
|
|
LEISHMANIASIS (VISCERAL) AB S
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 86717
|
| Hospital Charge Code |
30001193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.67
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
LEISHMANIASIS (VISCERAL) AB S
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 86717
|
| Hospital Charge Code |
30001193
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem Medicaid |
$12.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Humana KY Medicaid |
$12.25
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Kentucky WC Medicaid |
$12.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$98.67
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
LENEVA�� 3CC
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
27000280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
LENEVA�� 3CC
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
27000280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem Medicaid |
$2,638.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Humana KY Medicaid |
$2,638.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,691.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
LENGTHENING OF HAND TENDON
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26478
|
| Hospital Charge Code |
76100707
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
LENGTHENING OF HAND TENDON
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26478
|
| Hospital Charge Code |
76100707
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.53 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Humana KY Medicaid |
$364.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$368.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
LENGTHENING OF HAND TENDON
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26478
|
| Hospital Charge Code |
76100707
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.74 |
| Max. Negotiated Rate |
$1,081.98 |
| Rate for Payer: Aetna Commercial |
$877.62
|
| Rate for Payer: Ambetter Exchange |
$610.59
|
| Rate for Payer: Anthem Medicaid |
$297.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.71
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$1,081.98
|
| Rate for Payer: Healthspan PPO |
$794.93
|
| Rate for Payer: Humana Medicaid |
$297.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$752.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.69
|
| Rate for Payer: Molina Healthcare Passport |
$297.74
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.77
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.59
|
|
|
LENGTHENING OF HAND TENDON(P
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 26478
|
| Hospital Charge Code |
761P0707
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.74 |
| Max. Negotiated Rate |
$1,081.98 |
| Rate for Payer: Aetna Commercial |
$877.62
|
| Rate for Payer: Ambetter Exchange |
$610.59
|
| Rate for Payer: Anthem Medicaid |
$297.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.71
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$1,081.98
|
| Rate for Payer: Healthspan PPO |
$794.93
|
| Rate for Payer: Humana Medicaid |
$297.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$752.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.69
|
| Rate for Payer: Molina Healthcare Passport |
$297.74
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.77
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.59
|
|
