|
GENERATOR PULSE DCRR 1283
|
Facility
|
OP
|
$23,031.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,994.13 |
| Max. Negotiated Rate |
$22,110.48 |
| Rate for Payer: Aetna Commercial |
$17,734.45
|
| Rate for Payer: Anthem Medicaid |
$7,920.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,964.76
|
| Rate for Payer: Cash Price |
$11,515.88
|
| Rate for Payer: Cigna Commercial |
$19,116.35
|
| Rate for Payer: First Health Commercial |
$21,880.16
|
| Rate for Payer: Humana Commercial |
$19,576.99
|
| Rate for Payer: Humana KY Medicaid |
$7,920.62
|
| Rate for Payer: Kentucky WC Medicaid |
$8,001.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,079.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,267.94
|
| Rate for Payer: Ohio Health Group HMO |
$17,273.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,139.84
|
| Rate for Payer: PHCS Commercial |
$22,110.48
|
| Rate for Payer: United Healthcare All Payer |
$20,267.94
|
|
|
GENERATOR PULSE DCRR 1283
|
Facility
|
IP
|
$23,031.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,994.13 |
| Max. Negotiated Rate |
$22,110.48 |
| Rate for Payer: Aetna Commercial |
$17,734.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,964.76
|
| Rate for Payer: Cash Price |
$11,515.88
|
| Rate for Payer: Cigna Commercial |
$19,116.35
|
| Rate for Payer: First Health Commercial |
$21,880.16
|
| Rate for Payer: Humana Commercial |
$19,576.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,886.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,997.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,909.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,267.94
|
| Rate for Payer: Ohio Health Group HMO |
$17,273.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,606.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,994.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,139.84
|
| Rate for Payer: PHCS Commercial |
$22,110.48
|
| Rate for Payer: United Healthcare All Payer |
$20,267.94
|
|
|
GENERATOR PULSE DCRR 1297
|
Facility
|
OP
|
$26,681.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,468.63 |
| Max. Negotiated Rate |
$25,614.48 |
| Rate for Payer: Aetna Commercial |
$20,544.95
|
| Rate for Payer: Anthem Medicaid |
$9,175.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,811.76
|
| Rate for Payer: Cash Price |
$13,340.88
|
| Rate for Payer: Cigna Commercial |
$22,145.85
|
| Rate for Payer: First Health Commercial |
$25,347.66
|
| Rate for Payer: Humana Commercial |
$22,679.49
|
| Rate for Payer: Humana KY Medicaid |
$9,175.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,879.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,691.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,004.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,359.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,479.94
|
| Rate for Payer: Ohio Health Group HMO |
$20,011.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,271.34
|
| Rate for Payer: PHCS Commercial |
$25,614.48
|
| Rate for Payer: United Healthcare All Payer |
$23,479.94
|
|
|
GENERATOR PULSE DCRR 1297
|
Facility
|
IP
|
$26,681.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,468.63 |
| Max. Negotiated Rate |
$25,614.48 |
| Rate for Payer: Aetna Commercial |
$20,544.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,811.76
|
| Rate for Payer: Cash Price |
$13,340.88
|
| Rate for Payer: Cigna Commercial |
$22,145.85
|
| Rate for Payer: First Health Commercial |
$25,347.66
|
| Rate for Payer: Humana Commercial |
$22,679.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,879.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,691.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,004.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,479.94
|
| Rate for Payer: Ohio Health Group HMO |
$20,011.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,468.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,271.34
|
| Rate for Payer: PHCS Commercial |
$25,614.48
|
| Rate for Payer: United Healthcare All Payer |
$23,479.94
|
|
|
GENERATOR PULSE DCRR 331 443
|
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 331 443
|
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 341 826
|
Facility
|
IP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
GENERATOR PULSE DCRR 341 826
|
Facility
|
OP
|
$16,620.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,160.60 |
| Max. Negotiated Rate |
$15,955.20 |
| Rate for Payer: Aetna Commercial |
$12,797.40
|
| Rate for Payer: Anthem Medicaid |
$5,715.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,963.60
|
| Rate for Payer: Cash Price |
$8,310.00
|
| Rate for Payer: Cigna Commercial |
$13,794.60
|
| Rate for Payer: First Health Commercial |
$15,789.00
|
| Rate for Payer: Humana Commercial |
$14,127.00
|
| Rate for Payer: Humana KY Medicaid |
$5,715.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,773.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,628.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,265.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,986.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,830.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,625.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,160.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.20
|
| Rate for Payer: PHCS Commercial |
$15,955.20
|
| Rate for Payer: United Healthcare All Payer |
$14,625.60
|
|
|
GENERATOR PULSE DCRR 343 175
|
Facility
|
OP
|
$26,700.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,471.00 |
| Max. Negotiated Rate |
$25,632.00 |
| Rate for Payer: Aetna Commercial |
$20,559.00
|
| Rate for Payer: Anthem Medicaid |
$9,182.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,826.00
|
| Rate for Payer: Cash Price |
$13,350.00
|
| Rate for Payer: Cigna Commercial |
$22,161.00
|
| Rate for Payer: First Health Commercial |
$25,365.00
|
| Rate for Payer: Humana Commercial |
$22,695.00
|
| Rate for Payer: Humana KY Medicaid |
$9,182.13
|
| Rate for Payer: Kentucky WC Medicaid |
$9,275.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,894.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,704.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,366.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.00
|
| Rate for Payer: PHCS Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Payer |
$23,496.00
|
|
|
GENERATOR PULSE DCRR 343 175
|
Facility
|
IP
|
$26,700.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,471.00 |
| Max. Negotiated Rate |
$25,632.00 |
| Rate for Payer: Aetna Commercial |
$20,559.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,826.00
|
| Rate for Payer: Cash Price |
$13,350.00
|
| Rate for Payer: Cigna Commercial |
$22,161.00
|
| Rate for Payer: First Health Commercial |
$25,365.00
|
| Rate for Payer: Humana Commercial |
$22,695.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,894.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,704.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.00
|
| Rate for Payer: PHCS Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Payer |
$23,496.00
|
|
|
GENERATOR PULSE DCRR 349 799
|
Facility
|
IP
|
$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 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: 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: 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 PULSE DCRR 349 799
|
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 PULSE DCRR 5326
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
GENERATOR PULSE DCRR 5326
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
GENERATOR PULSE DCRR 5330
|
Facility
|
OP
|
$20,841.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,709.43 |
| Max. Negotiated Rate |
$20,008.08 |
| Rate for Payer: Aetna Commercial |
$16,048.15
|
| Rate for Payer: Anthem Medicaid |
$7,167.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,256.56
|
| Rate for Payer: Cash Price |
$10,420.88
|
| Rate for Payer: Cigna Commercial |
$17,298.65
|
| Rate for Payer: First Health Commercial |
$19,799.66
|
| Rate for Payer: Humana Commercial |
$17,715.49
|
| Rate for Payer: Humana KY Medicaid |
$7,167.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,240.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,090.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,381.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,252.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,311.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,340.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,631.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,168.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,709.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,460.94
|
| Rate for Payer: PHCS Commercial |
$20,008.08
|
| Rate for Payer: United Healthcare All Payer |
$18,340.74
|
|
|
GENERATOR PULSE DCRR 5330
|
Facility
|
IP
|
$20,841.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,709.43 |
| Max. Negotiated Rate |
$20,008.08 |
| Rate for Payer: Aetna Commercial |
$16,048.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,256.56
|
| Rate for Payer: Cash Price |
$10,420.88
|
| Rate for Payer: Cigna Commercial |
$17,298.65
|
| Rate for Payer: First Health Commercial |
$19,799.66
|
| Rate for Payer: Humana Commercial |
$17,715.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,090.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,381.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,252.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,340.74
|
| Rate for Payer: Ohio Health Group HMO |
$15,631.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,168.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,709.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,460.94
|
| Rate for Payer: PHCS Commercial |
$20,008.08
|
| Rate for Payer: United Healthcare All Payer |
$18,340.74
|
|
|
GENERATOR PULSE DCRR 5330L
|
Facility
|
OP
|
$23,568.30
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,063.88 |
| Max. Negotiated Rate |
$22,625.57 |
| Rate for Payer: Aetna Commercial |
$18,147.59
|
| Rate for Payer: Anthem Medicaid |
$8,105.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,383.27
|
| Rate for Payer: Cash Price |
$11,784.15
|
| Rate for Payer: Cigna Commercial |
$19,561.69
|
| Rate for Payer: First Health Commercial |
$22,389.88
|
| Rate for Payer: Humana Commercial |
$20,033.06
|
| Rate for Payer: Humana KY Medicaid |
$8,105.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,187.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,326.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,393.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,070.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,267.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,740.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,676.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,713.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,063.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,306.17
|
| Rate for Payer: PHCS Commercial |
$22,625.57
|
| Rate for Payer: United Healthcare All Payer |
$20,740.10
|
|
|
GENERATOR PULSE DCRR 5330L
|
Facility
|
IP
|
$23,568.30
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,063.88 |
| Max. Negotiated Rate |
$22,625.57 |
| Rate for Payer: Aetna Commercial |
$18,147.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,383.27
|
| Rate for Payer: Cash Price |
$11,784.15
|
| Rate for Payer: Cigna Commercial |
$19,561.69
|
| Rate for Payer: First Health Commercial |
$22,389.88
|
| Rate for Payer: Humana Commercial |
$20,033.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,326.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,393.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,070.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,740.10
|
| Rate for Payer: Ohio Health Group HMO |
$17,676.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,713.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,063.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,306.17
|
| Rate for Payer: PHCS Commercial |
$22,625.57
|
| Rate for Payer: United Healthcare All Payer |
$20,740.10
|
|
|
GENERATOR PULSE DCRR 5336
|
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 PULSE DCRR 5336
|
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 PULSE DCRR 5346
|
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 PULSE DCRR 5346
|
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 PULSE DCRR 5360
|
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 PULSE DCRR 5360
|
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 PULSE DCRR 5366
|
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
|
|
