|
GENERATOR ALTRUA DCRR S208
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem Medicaid |
$6,671.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Humana KY Medicaid |
$6,671.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,739.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
GENERATOR ALTRUA DCRR S606
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
GENERATOR ALTRUA DCRR S606
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
GENERATOR ATLAS DCRR V-242
|
Facility
|
IP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
GENERATOR ATLAS DCRR V-242
|
Facility
|
OP
|
$76,300.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,919.00 |
| Max. Negotiated Rate |
$73,248.00 |
| Rate for Payer: Aetna Commercial |
$58,751.00
|
| Rate for Payer: Anthem Medicaid |
$26,239.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,514.00
|
| Rate for Payer: Cash Price |
$38,150.00
|
| Rate for Payer: Cigna Commercial |
$63,329.00
|
| Rate for Payer: First Health Commercial |
$72,485.00
|
| Rate for Payer: Humana Commercial |
$64,855.00
|
| Rate for Payer: Humana KY Medicaid |
$26,239.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26,506.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,566.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,309.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,890.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,766.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$57,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,919.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,653.00
|
| Rate for Payer: PHCS Commercial |
$73,248.00
|
| Rate for Payer: United Healthcare All Payer |
$67,144.00
|
|
|
GENERATOR CONSULTA C4TR01
|
Facility
|
OP
|
$32,649.50
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,244.44 |
| Max. Negotiated Rate |
$31,343.52 |
| Rate for Payer: Aetna Commercial |
$25,140.12
|
| Rate for Payer: Anthem Medicaid |
$11,228.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,466.61
|
| Rate for Payer: Cash Price |
$16,324.75
|
| Rate for Payer: Cigna Commercial |
$27,099.08
|
| Rate for Payer: First Health Commercial |
$31,017.02
|
| Rate for Payer: Humana Commercial |
$27,752.08
|
| Rate for Payer: Humana KY Medicaid |
$11,228.16
|
| Rate for Payer: Kentucky WC Medicaid |
$11,342.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,772.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,095.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,794.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,453.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,731.56
|
| Rate for Payer: Ohio Health Group HMO |
$24,487.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,529.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,244.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,121.34
|
| Rate for Payer: PHCS Commercial |
$31,343.52
|
| Rate for Payer: United Healthcare All Payer |
$28,731.56
|
|
|
GENERATOR CONSULTA C4TR01
|
Facility
|
IP
|
$32,649.50
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,244.44 |
| Max. Negotiated Rate |
$31,343.52 |
| Rate for Payer: Aetna Commercial |
$25,140.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,466.61
|
| Rate for Payer: Cash Price |
$16,324.75
|
| Rate for Payer: Cigna Commercial |
$27,099.08
|
| Rate for Payer: First Health Commercial |
$31,017.02
|
| Rate for Payer: Humana Commercial |
$27,752.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,772.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,095.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,794.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,731.56
|
| Rate for Payer: Ohio Health Group HMO |
$24,487.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,529.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,244.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,121.34
|
| Rate for Payer: PHCS Commercial |
$31,343.52
|
| Rate for Payer: United Healthcare All Payer |
$28,731.56
|
|
|
GENERATOR DCRR 5386
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENERATOR DCRR 5386
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENERATOR GALLANT CDDRA500Q
|
Facility
|
IP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GENERATOR GALLANT CDDRA500Q
|
Facility
|
OP
|
$32,175.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,182.75 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$24,774.75
|
| Rate for Payer: Anthem Medicaid |
$11,064.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,096.50
|
| Rate for Payer: Cash Price |
$16,087.50
|
| Rate for Payer: Cigna Commercial |
$26,705.25
|
| Rate for Payer: First Health Commercial |
$30,566.25
|
| Rate for Payer: Humana Commercial |
$27,348.75
|
| Rate for Payer: Humana KY Medicaid |
$11,064.98
|
| Rate for Payer: Kentucky WC Medicaid |
$11,177.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,383.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,745.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,314.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,435.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,974.25
|
| Rate for Payer: PHCS Commercial |
$30,888.00
|
| Rate for Payer: United Healthcare All Payer |
$28,314.00
|
|
|
GENERATOR INSYNC III 8042
|
Facility
|
OP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem Medicaid |
$12,947.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
| Rate for Payer: Cash Price |
$18,825.00
|
| Rate for Payer: Cigna Commercial |
$31,249.50
|
| Rate for Payer: First Health Commercial |
$35,767.50
|
| Rate for Payer: Humana Commercial |
$32,002.50
|
| Rate for Payer: Humana KY Medicaid |
$12,947.84
|
| Rate for Payer: Kentucky WC Medicaid |
$13,079.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,873.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,785.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,295.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,207.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,132.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,894.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,671.50
|
| Rate for Payer: PHCS Commercial |
$36,144.00
|
| Rate for Payer: United Healthcare All Payer |
$33,132.00
|
|
|
GENERATOR INSYNC III 8042
|
Facility
|
IP
|
$37,650.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,894.50 |
| Max. Negotiated Rate |
$36,144.00 |
| Rate for Payer: Aetna Commercial |
$28,990.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,367.00
|
| Rate for Payer: Cash Price |
$18,825.00
|
| Rate for Payer: Cigna Commercial |
$31,249.50
|
| Rate for Payer: First Health Commercial |
$35,767.50
|
| Rate for Payer: Humana Commercial |
$32,002.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,873.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,785.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,295.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,132.00
|
| Rate for Payer: Ohio Health Group HMO |
$28,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,894.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,671.50
|
| Rate for Payer: PHCS Commercial |
$36,144.00
|
| Rate for Payer: United Healthcare All Payer |
$33,132.00
|
|
|
GENERATOR INTELLIS IMP MRI KIT
|
Facility
|
OP
|
$94,048.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,226.24 |
| Max. Negotiated Rate |
$90,286.08 |
| Rate for Payer: Aetna Commercial |
$72,416.96
|
| Rate for Payer: Anthem Medicaid |
$32,343.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,357.44
|
| Rate for Payer: Cash Price |
$47,024.00
|
| Rate for Payer: Cigna Commercial |
$78,059.84
|
| Rate for Payer: First Health Commercial |
$89,345.60
|
| Rate for Payer: Humana Commercial |
$79,940.80
|
| Rate for Payer: Humana KY Medicaid |
$32,343.11
|
| Rate for Payer: Kentucky WC Medicaid |
$32,672.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,119.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,407.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,214.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,992.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,762.24
|
| Rate for Payer: Ohio Health Group HMO |
$70,536.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,226.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,154.88
|
| Rate for Payer: PHCS Commercial |
$90,286.08
|
| Rate for Payer: United Healthcare All Payer |
$82,762.24
|
|
|
GENERATOR INTELLIS IMP MRI KIT
|
Facility
|
IP
|
$94,048.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,226.24 |
| Max. Negotiated Rate |
$90,286.08 |
| Rate for Payer: Aetna Commercial |
$72,416.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,357.44
|
| Rate for Payer: Cash Price |
$47,024.00
|
| Rate for Payer: Cigna Commercial |
$78,059.84
|
| Rate for Payer: First Health Commercial |
$89,345.60
|
| Rate for Payer: Humana Commercial |
$79,940.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,119.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,407.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,214.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,762.24
|
| Rate for Payer: Ohio Health Group HMO |
$70,536.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,226.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,154.88
|
| Rate for Payer: PHCS Commercial |
$90,286.08
|
| Rate for Payer: United Healthcare All Payer |
$82,762.24
|
|
|
GENERATOR PLUSE DCRR KDR701
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENERATOR PLUSE DCRR KDR701
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENERATOR PM3562
|
Facility
|
IP
|
$18,420.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,394.60 |
| Max. Negotiated Rate |
$17,683.20 |
| Rate for Payer: Aetna Commercial |
$14,183.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,367.60
|
| Rate for Payer: Cash Price |
$9,210.00
|
| Rate for Payer: Cigna Commercial |
$15,288.60
|
| Rate for Payer: First Health Commercial |
$17,499.00
|
| Rate for Payer: Humana Commercial |
$15,657.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,104.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,593.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,526.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,209.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,815.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,394.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,710.20
|
| Rate for Payer: PHCS Commercial |
$17,683.20
|
| Rate for Payer: United Healthcare All Payer |
$16,209.60
|
|
|
GENERATOR PM3562
|
Facility
|
OP
|
$18,420.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,394.60 |
| Max. Negotiated Rate |
$17,683.20 |
| Rate for Payer: Aetna Commercial |
$14,183.40
|
| Rate for Payer: Anthem Medicaid |
$6,334.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,367.60
|
| Rate for Payer: Cash Price |
$9,210.00
|
| Rate for Payer: Cigna Commercial |
$15,288.60
|
| Rate for Payer: First Health Commercial |
$17,499.00
|
| Rate for Payer: Humana Commercial |
$15,657.00
|
| Rate for Payer: Humana KY Medicaid |
$6,334.64
|
| Rate for Payer: Kentucky WC Medicaid |
$6,399.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,104.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,593.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,526.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,461.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,209.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,815.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,394.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,710.20
|
| Rate for Payer: PHCS Commercial |
$17,683.20
|
| Rate for Payer: United Healthcare All Payer |
$16,209.60
|
|
|
GENERATOR PROTEGE IPG 3789
|
Facility
|
IP
|
$85,354.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,096.02 |
| Max. Negotiated Rate |
$81,939.84 |
| Rate for Payer: Aetna Commercial |
$65,722.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,576.12
|
| Rate for Payer: Cash Price |
$42,677.00
|
| Rate for Payer: Cigna Commercial |
$70,843.82
|
| Rate for Payer: First Health Commercial |
$81,086.30
|
| Rate for Payer: Humana Commercial |
$72,550.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,990.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,991.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,606.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,111.52
|
| Rate for Payer: Ohio Health Group HMO |
$64,015.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,070.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,096.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,459.74
|
| Rate for Payer: PHCS Commercial |
$81,939.84
|
| Rate for Payer: United Healthcare All Payer |
$75,111.52
|
|
|
GENERATOR PROTEGE IPG 3789
|
Facility
|
OP
|
$85,354.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,096.02 |
| Max. Negotiated Rate |
$81,939.84 |
| Rate for Payer: Aetna Commercial |
$65,722.58
|
| Rate for Payer: Anthem Medicaid |
$29,353.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66,576.12
|
| Rate for Payer: Cash Price |
$42,677.00
|
| Rate for Payer: Cigna Commercial |
$70,843.82
|
| Rate for Payer: First Health Commercial |
$81,086.30
|
| Rate for Payer: Humana Commercial |
$72,550.90
|
| Rate for Payer: Humana KY Medicaid |
$29,353.24
|
| Rate for Payer: Kentucky WC Medicaid |
$29,651.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69,990.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62,991.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,606.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,942.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$75,111.52
|
| Rate for Payer: Ohio Health Group HMO |
$64,015.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,070.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,096.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,459.74
|
| Rate for Payer: PHCS Commercial |
$81,939.84
|
| Rate for Payer: United Healthcare All Payer |
$75,111.52
|
|
|
GENERATOR PULSE DCRR 122 130
|
Facility
|
OP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,233.75 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$19,153.75
|
| Rate for Payer: Anthem Medicaid |
$8,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,402.50
|
| Rate for Payer: Cash Price |
$12,437.50
|
| Rate for Payer: Cigna Commercial |
$20,646.25
|
| Rate for Payer: First Health Commercial |
$23,631.25
|
| Rate for Payer: Humana Commercial |
$21,143.75
|
| Rate for Payer: Humana KY Medicaid |
$8,554.51
|
| Rate for Payer: Kentucky WC Medicaid |
$8,641.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,397.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,357.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,726.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,711.25
|
| Rate for Payer: PHCS Commercial |
$23,880.00
|
| Rate for Payer: United Healthcare All Payer |
$21,890.00
|
|
|
GENERATOR PULSE DCRR 122 130
|
Facility
|
IP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,233.75 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$19,153.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,402.50
|
| Rate for Payer: Cash Price |
$12,437.50
|
| Rate for Payer: Cigna Commercial |
$20,646.25
|
| Rate for Payer: First Health Commercial |
$23,631.25
|
| Rate for Payer: Humana Commercial |
$21,143.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,397.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,357.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,462.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$18,656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,975.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,233.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,711.25
|
| Rate for Payer: PHCS Commercial |
$23,880.00
|
| Rate for Payer: United Healthcare All Payer |
$21,890.00
|
|
|
GENERATOR PULSE DCRR 1280
|
Facility
|
IP
|
$24,856.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,231.38 |
| Max. Negotiated Rate |
$23,862.48 |
| Rate for Payer: Aetna Commercial |
$19,139.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,388.26
|
| Rate for Payer: Cash Price |
$12,428.38
|
| Rate for Payer: Cigna Commercial |
$20,631.10
|
| Rate for Payer: First Health Commercial |
$23,613.91
|
| Rate for Payer: Humana Commercial |
$21,128.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,382.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,344.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,457.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,873.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,642.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,971.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,231.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,705.59
|
| Rate for Payer: PHCS Commercial |
$23,862.48
|
| Rate for Payer: United Healthcare All Payer |
$21,873.94
|
|
|
GENERATOR PULSE DCRR 1280
|
Facility
|
OP
|
$24,856.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,231.38 |
| Max. Negotiated Rate |
$23,862.48 |
| Rate for Payer: Aetna Commercial |
$19,139.70
|
| Rate for Payer: Anthem Medicaid |
$8,548.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,388.26
|
| Rate for Payer: Cash Price |
$12,428.38
|
| Rate for Payer: Cigna Commercial |
$20,631.10
|
| Rate for Payer: First Health Commercial |
$23,613.91
|
| Rate for Payer: Humana Commercial |
$21,128.24
|
| Rate for Payer: Humana KY Medicaid |
$8,548.24
|
| Rate for Payer: Kentucky WC Medicaid |
$8,635.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,382.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,344.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,457.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,719.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,873.94
|
| Rate for Payer: Ohio Health Group HMO |
$18,642.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,971.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,231.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,705.59
|
| Rate for Payer: PHCS Commercial |
$23,862.48
|
| Rate for Payer: United Healthcare All Payer |
$21,873.94
|
|
