|
STEM EXTENSION GB BMT 12X120
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 12X120
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 12X160
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 12X160
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 12X200
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 12X200
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 12X40
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 12X40
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 12X80
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 12X80
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 14X120
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 14X120
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 14X160
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 14X160
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 14X200
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 14X200
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 14X40
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 14X40
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 14X80
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 14X80
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 16X120
|
Facility
|
IP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 16X120
|
Facility
|
OP
|
$10,031.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.08 |
| Max. Negotiated Rate |
$9,630.12 |
| Rate for Payer: Aetna Commercial |
$7,724.16
|
| Rate for Payer: Anthem Medicaid |
$3,449.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,824.48
|
| Rate for Payer: Cash Price |
$5,015.69
|
| Rate for Payer: Cigna Commercial |
$8,326.05
|
| Rate for Payer: First Health Commercial |
$9,529.81
|
| Rate for Payer: Humana Commercial |
$8,526.67
|
| Rate for Payer: Humana KY Medicaid |
$3,449.79
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,225.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,403.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,009.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,519.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,827.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,523.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,006.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,304.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.73
|
| Rate for Payer: PHCS Commercial |
$9,630.12
|
| Rate for Payer: United Healthcare All Payer |
$8,827.61
|
|
|
STEM EXTENSION GB BMT 16X160
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 16X160
|
Facility
|
OP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem Medicaid |
$4,061.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Humana KY Medicaid |
$4,061.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,102.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,143.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
|
STEM EXTENSION GB BMT 16X200
|
Facility
|
IP
|
$11,810.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.34 |
| Max. Negotiated Rate |
$11,337.93 |
| Rate for Payer: Aetna Commercial |
$9,093.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,212.07
|
| Rate for Payer: Cash Price |
$5,905.17
|
| Rate for Payer: Cigna Commercial |
$9,802.58
|
| Rate for Payer: First Health Commercial |
$11,219.82
|
| Rate for Payer: Humana Commercial |
$10,038.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,684.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,716.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,543.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,393.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,857.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,362.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,535.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,661.21
|
| Rate for Payer: PHCS Commercial |
$11,337.93
|
| Rate for Payer: United Healthcare All Payer |
$10,393.10
|
|
