|
STEM EXTNSN GB BMT 14X160 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 14X200 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 14X200 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 16X160 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 16X160 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 16X200 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 16X200 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 18X160 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 18X160 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 18X200 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 18X200 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 20X160 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 20X160 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 20X200 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 20X200 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 22X160 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 22X160 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 22X200 BW
|
Facility
|
IP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM EXTNSN GB BMT 22X200 BW
|
Facility
|
OP
|
$12,322.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,601.96 |
| Max. Negotiated Rate |
$11,829.89 |
| Rate for Payer: Aetna Commercial |
$9,488.56
|
| Rate for Payer: Anthem Medicaid |
$4,237.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,611.78
|
| Rate for Payer: Cash Price |
$6,161.40
|
| Rate for Payer: Cigna Commercial |
$10,227.92
|
| Rate for Payer: First Health Commercial |
$11,706.66
|
| Rate for Payer: Humana Commercial |
$10,474.38
|
| Rate for Payer: Humana KY Medicaid |
$4,237.81
|
| Rate for Payer: Kentucky WC Medicaid |
$4,280.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,104.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,094.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,696.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,322.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,844.06
|
| Rate for Payer: Ohio Health Group HMO |
$9,242.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,464.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,820.07
|
| Rate for Payer: PHCS Commercial |
$11,829.89
|
| Rate for Payer: United Healthcare All Payer |
$10,844.06
|
|
|
STEM FEM 12/14 135^ STD SZ 10
|
Facility
|
IP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 135^ STD SZ 10
|
Facility
|
OP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem Medicaid |
$26,115.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Humana KY Medicaid |
$26,115.27
|
| Rate for Payer: Kentucky WC Medicaid |
$26,381.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,639.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 135^ STD SZ 11
|
Facility
|
OP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem Medicaid |
$26,115.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Humana KY Medicaid |
$26,115.27
|
| Rate for Payer: Kentucky WC Medicaid |
$26,381.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,639.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 135^ STD SZ 11
|
Facility
|
IP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 135^ STD SZ 12
|
Facility
|
OP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem Medicaid |
$26,115.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Humana KY Medicaid |
$26,115.27
|
| Rate for Payer: Kentucky WC Medicaid |
$26,381.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,639.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
|
STEM FEM 12/14 135^ STD SZ 12
|
Facility
|
IP
|
$75,938.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,872.01 |
| Max. Negotiated Rate |
$72,901.02 |
| Rate for Payer: Aetna Commercial |
$58,472.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,232.08
|
| Rate for Payer: Cash Price |
$37,969.28
|
| Rate for Payer: Cigna Commercial |
$63,029.00
|
| Rate for Payer: First Health Commercial |
$72,141.63
|
| Rate for Payer: Humana Commercial |
$64,547.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,269.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,042.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,781.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,825.93
|
| Rate for Payer: Ohio Health Group HMO |
$56,953.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,187.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,872.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,540.95
|
| Rate for Payer: PHCS Commercial |
$72,901.02
|
| Rate for Payer: United Healthcare All Payer |
$66,825.93
|
|
