|
STEM EXTENSION FLTED ST 14X100
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLUTED ST 12X65
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLUTED ST 12X65
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLUTED ST 14X65
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLUTED ST 14X65
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLUTED ST 16X10
|
Facility
|
IP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION FLUTED ST 16X10
|
Facility
|
OP
|
$9,340.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,802.01 |
| Max. Negotiated Rate |
$8,966.45 |
| Rate for Payer: Aetna Commercial |
$7,191.84
|
| Rate for Payer: Anthem Medicaid |
$3,212.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,285.24
|
| Rate for Payer: Cash Price |
$4,670.02
|
| Rate for Payer: Cigna Commercial |
$7,752.24
|
| Rate for Payer: First Health Commercial |
$8,873.05
|
| Rate for Payer: Humana Commercial |
$7,939.04
|
| Rate for Payer: Humana KY Medicaid |
$3,212.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,244.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,658.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,892.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,276.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,219.24
|
| Rate for Payer: Ohio Health Group HMO |
$7,005.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,472.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,125.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,444.63
|
| Rate for Payer: PHCS Commercial |
$8,966.45
|
| Rate for Payer: United Healthcare All Payer |
$8,219.24
|
|
|
STEM EXTENSION GB BMT 10X40
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 10X40
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 10X80
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 10X80
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 12X120
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 12X120
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 12X160
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM EXTENSION GB BMT 12X160
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM EXTENSION GB BMT 12X200
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM EXTENSION GB BMT 12X200
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM EXTENSION GB BMT 12X40
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 12X40
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 12X80
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 12X80
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 14X120
|
Facility
|
IP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 14X120
|
Facility
|
OP
|
$10,231.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,069.41 |
| Max. Negotiated Rate |
$9,822.12 |
| Rate for Payer: Aetna Commercial |
$7,878.16
|
| Rate for Payer: Anthem Medicaid |
$3,518.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,980.48
|
| Rate for Payer: Cash Price |
$5,115.69
|
| Rate for Payer: Cigna Commercial |
$8,492.05
|
| Rate for Payer: First Health Commercial |
$9,719.81
|
| Rate for Payer: Humana Commercial |
$8,696.67
|
| Rate for Payer: Humana KY Medicaid |
$3,518.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,554.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,389.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,550.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,069.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,589.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,003.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,673.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,185.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,901.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,059.65
|
| Rate for Payer: PHCS Commercial |
$9,822.12
|
| Rate for Payer: United Healthcare All Payer |
$9,003.61
|
|
|
STEM EXTENSION GB BMT 14X160
|
Facility
|
IP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
|
STEM EXTENSION GB BMT 14X160
|
Facility
|
OP
|
$12,056.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,617.09 |
| Max. Negotiated Rate |
$11,574.69 |
| Rate for Payer: Aetna Commercial |
$9,283.87
|
| Rate for Payer: Anthem Medicaid |
$4,146.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,404.44
|
| Rate for Payer: Cash Price |
$6,028.49
|
| Rate for Payer: Cigna Commercial |
$10,007.29
|
| Rate for Payer: First Health Commercial |
$11,454.12
|
| Rate for Payer: Humana Commercial |
$10,248.42
|
| Rate for Payer: Humana KY Medicaid |
$4,146.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,188.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,886.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,898.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,229.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,610.13
|
| Rate for Payer: Ohio Health Group HMO |
$9,042.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,645.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,489.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,319.31
|
| Rate for Payer: PHCS Commercial |
$11,574.69
|
| Rate for Payer: United Healthcare All Payer |
$10,610.13
|
|
