|
STEM EXTENSION GB BMT 18X80
|
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 20X120
|
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 20X120
|
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 20X160
|
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 20X160
|
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 20X200
|
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 20X200
|
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 20X40
|
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 20X40
|
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 20X80
|
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 20X80
|
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 22X120
|
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 22X120
|
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 22X160
|
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 22X160
|
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 22X200
|
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 22X200
|
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 22X40
|
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 22X40
|
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 22X80
|
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 22X80
|
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 24X40
|
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 24X40
|
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 24X80
|
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 24X80
|
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
|
|
