|
GENERATOR PULSE SCRR 1176
|
Facility
|
OP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem Medicaid |
$6,142.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Humana KY Medicaid |
$6,142.74
|
| Rate for Payer: Kentucky WC Medicaid |
$6,205.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,265.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
GENERATOR PULSE SCRR 1176
|
Facility
|
IP
|
$17,862.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,322.06 |
| Max. Negotiated Rate |
$17,147.52 |
| Rate for Payer: Aetna Commercial |
$13,753.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,932.36
|
| Rate for Payer: Cash Price |
$8,931.00
|
| Rate for Payer: Cigna Commercial |
$14,825.46
|
| Rate for Payer: First Health Commercial |
$16,968.90
|
| Rate for Payer: Humana Commercial |
$15,182.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,646.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,182.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,358.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,718.56
|
| Rate for Payer: Ohio Health Group HMO |
$13,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,572.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,322.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.22
|
| Rate for Payer: PHCS Commercial |
$17,147.52
|
| Rate for Payer: United Healthcare All Payer |
$15,718.56
|
|
|
GENERATOR PULSE SCRR 2525T
|
Facility
|
IP
|
$18,582.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.66 |
| Max. Negotiated Rate |
$17,838.72 |
| Rate for Payer: Aetna Commercial |
$14,308.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,493.96
|
| Rate for Payer: Cash Price |
$9,291.00
|
| Rate for Payer: Cigna Commercial |
$15,423.06
|
| Rate for Payer: First Health Commercial |
$17,652.90
|
| Rate for Payer: Humana Commercial |
$15,794.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,713.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,936.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.42
|
| Rate for Payer: PHCS Commercial |
$17,838.72
|
| Rate for Payer: United Healthcare All Payer |
$16,352.16
|
|
|
GENERATOR PULSE SCRR 2525T
|
Facility
|
OP
|
$18,582.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,415.66 |
| Max. Negotiated Rate |
$17,838.72 |
| Rate for Payer: Aetna Commercial |
$14,308.14
|
| Rate for Payer: Anthem Medicaid |
$6,390.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,493.96
|
| Rate for Payer: Cash Price |
$9,291.00
|
| Rate for Payer: Cigna Commercial |
$15,423.06
|
| Rate for Payer: First Health Commercial |
$17,652.90
|
| Rate for Payer: Humana Commercial |
$15,794.70
|
| Rate for Payer: Humana KY Medicaid |
$6,390.35
|
| Rate for Payer: Kentucky WC Medicaid |
$6,455.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,237.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,713.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,574.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,518.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,352.16
|
| Rate for Payer: Ohio Health Group HMO |
$13,936.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,716.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,415.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,760.42
|
| Rate for Payer: PHCS Commercial |
$17,838.72
|
| Rate for Payer: United Healthcare All Payer |
$16,352.16
|
|
|
GENERATOR PULSE SCRR 331 446
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 331 446
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 331 599
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 331 599
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 341 824
|
Facility
|
IP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 341 824
|
Facility
|
OP
|
$24,875.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5130L
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
GENERATOR PULSE SCRR 5130L
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
GENERATOR PULSE SCRR 5130R
|
Facility
|
OP
|
$18,078.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.14 |
| Max. Negotiated Rate |
$17,354.88 |
| Rate for Payer: Aetna Commercial |
$13,920.06
|
| Rate for Payer: Anthem Medicaid |
$6,217.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,100.84
|
| Rate for Payer: Cash Price |
$9,039.00
|
| Rate for Payer: Cigna Commercial |
$15,004.74
|
| Rate for Payer: First Health Commercial |
$17,174.10
|
| Rate for Payer: Humana Commercial |
$15,366.30
|
| Rate for Payer: Humana KY Medicaid |
$6,217.02
|
| Rate for Payer: Kentucky WC Medicaid |
$6,280.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,823.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,341.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,423.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,341.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,908.64
|
| Rate for Payer: Ohio Health Group HMO |
$13,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,615.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,350.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,604.18
|
| Rate for Payer: PHCS Commercial |
$17,354.88
|
| Rate for Payer: United Healthcare All Payer |
$15,908.64
|
|
|
GENERATOR PULSE SCRR 5130R
|
Facility
|
IP
|
$18,078.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.14 |
| Max. Negotiated Rate |
$17,354.88 |
| Rate for Payer: Aetna Commercial |
$13,920.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,100.84
|
| Rate for Payer: Cash Price |
$9,039.00
|
| Rate for Payer: Cigna Commercial |
$15,004.74
|
| Rate for Payer: First Health Commercial |
$17,174.10
|
| Rate for Payer: Humana Commercial |
$15,366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,823.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,341.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,423.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,908.64
|
| Rate for Payer: Ohio Health Group HMO |
$13,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,615.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,350.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,604.18
|
| Rate for Payer: PHCS Commercial |
$17,354.88
|
| Rate for Payer: United Healthcare All Payer |
$15,908.64
|
|
|
GENERATOR PULSE SCRR 5131 M/S
|
Facility
|
IP
|
$16,062.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,088.06 |
| Max. Negotiated Rate |
$15,419.52 |
| Rate for Payer: Aetna Commercial |
$12,367.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.36
|
| Rate for Payer: Cash Price |
$8,031.00
|
| Rate for Payer: Cigna Commercial |
$13,331.46
|
| Rate for Payer: First Health Commercial |
$15,258.90
|
| Rate for Payer: Humana Commercial |
$13,652.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,979.22
|
| Rate for Payer: PHCS Commercial |
$15,419.52
|
| Rate for Payer: United Healthcare All Payer |
$14,134.56
|
|
|
GENERATOR PULSE SCRR 5131 M/S
|
Facility
|
OP
|
$16,062.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,088.06 |
| Max. Negotiated Rate |
$15,419.52 |
| Rate for Payer: Aetna Commercial |
$12,367.74
|
| Rate for Payer: Anthem Medicaid |
$5,523.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.36
|
| Rate for Payer: Cash Price |
$8,031.00
|
| Rate for Payer: Cigna Commercial |
$13,331.46
|
| Rate for Payer: First Health Commercial |
$15,258.90
|
| Rate for Payer: Humana Commercial |
$13,652.70
|
| Rate for Payer: Humana KY Medicaid |
$5,523.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,634.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.56
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,979.22
|
| Rate for Payer: PHCS Commercial |
$15,419.52
|
| Rate for Payer: United Healthcare All Payer |
$14,134.56
|
|
|
GENERATOR PULSE SCRR 5136
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR PULSE SCRR 5136
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR PULSE SCRR 5142
|
Facility
|
OP
|
$22,287.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.33 |
| Max. Negotiated Rate |
$21,395.66 |
| Rate for Payer: Aetna Commercial |
$17,161.11
|
| Rate for Payer: Anthem Medicaid |
$7,664.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,383.98
|
| Rate for Payer: Cash Price |
$11,143.58
|
| Rate for Payer: Cigna Commercial |
$18,498.33
|
| Rate for Payer: First Health Commercial |
$21,172.79
|
| Rate for Payer: Humana Commercial |
$18,944.08
|
| Rate for Payer: Humana KY Medicaid |
$7,664.55
|
| Rate for Payer: Kentucky WC Medicaid |
$7,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,275.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,447.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,686.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,818.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,612.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,715.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,457.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,909.02
|
| Rate for Payer: PHCS Commercial |
$21,395.66
|
| Rate for Payer: United Healthcare All Payer |
$19,612.69
|
|
|
GENERATOR PULSE SCRR 5142
|
Facility
|
IP
|
$22,287.15
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,897.33 |
| Max. Negotiated Rate |
$21,395.66 |
| Rate for Payer: Aetna Commercial |
$17,161.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,383.98
|
| Rate for Payer: Cash Price |
$11,143.58
|
| Rate for Payer: Cigna Commercial |
$18,498.33
|
| Rate for Payer: First Health Commercial |
$21,172.79
|
| Rate for Payer: Humana Commercial |
$18,944.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,275.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,447.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,686.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,612.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,715.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,457.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,909.02
|
| Rate for Payer: PHCS Commercial |
$21,395.66
|
| Rate for Payer: United Healthcare All Payer |
$19,612.69
|
|
|
GENERATOR PULSE SCRR 5157 M/S
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR PULSE SCRR 5157 M/S
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR PULSE SCRR 5160
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR PULSE SCRR 5160
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR PULSE SCRR 5172
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
