|
STEM EXT FLUTED ST 10*100MM
|
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 EXT FLUTED ST 10*100MM
|
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 EXT FLUTED ST 12*65MM
|
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 EXT FLUTED ST 12*65MM
|
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 EXT FLUTED ST 18*100MM
|
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 EXT FLUTED ST 18*100MM
|
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 EXTNSN GB BMT 12X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 12X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 12X200 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 12X200 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 14X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 14X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 14X200 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 14X200 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 16X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 16X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 16X200 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 16X200 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 18X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 18X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 18X200 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 18X200 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 20X160 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 20X160 BW
|
Facility
|
IP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
|
STEM EXTNSN GB BMT 20X200 BW
|
Facility
|
OP
|
$12,572.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,771.67 |
| Max. Negotiated Rate |
$12,069.35 |
| Rate for Payer: Aetna Commercial |
$9,680.62
|
| Rate for Payer: Anthem Medicaid |
$4,323.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,806.35
|
| Rate for Payer: Cash Price |
$6,286.12
|
| Rate for Payer: Cigna Commercial |
$10,434.96
|
| Rate for Payer: First Health Commercial |
$11,943.63
|
| Rate for Payer: Humana Commercial |
$10,686.40
|
| Rate for Payer: Humana KY Medicaid |
$4,323.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,367.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,309.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,278.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,771.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,410.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,063.57
|
| Rate for Payer: Ohio Health Group HMO |
$9,429.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,057.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,937.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,674.85
|
| Rate for Payer: PHCS Commercial |
$12,069.35
|
| Rate for Payer: United Healthcare All Payer |
$11,063.57
|
|
