|
GENERATOR PULSE SCRR 5172
|
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 530
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem Medicaid |
$7,552.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Humana KY Medicaid |
$7,552.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,629.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,704.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 530
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 540
|
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 540
|
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 560
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 560
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem Medicaid |
$7,552.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Humana KY Medicaid |
$7,552.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,629.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,704.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 562
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem Medicaid |
$7,552.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Humana KY Medicaid |
$7,552.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,629.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,704.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 562
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 565
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem Medicaid |
$7,552.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Humana KY Medicaid |
$7,552.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,629.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,704.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 565
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 840
|
Facility
|
OP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem Medicaid |
$7,552.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Humana KY Medicaid |
$7,552.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,629.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,704.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR 840
|
Facility
|
IP
|
$21,962.30
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.10 |
| Max. Negotiated Rate |
$21,083.81 |
| Rate for Payer: Aetna Commercial |
$16,910.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,130.59
|
| Rate for Payer: Cash Price |
$10,981.15
|
| Rate for Payer: Cigna Commercial |
$18,228.71
|
| Rate for Payer: First Health Commercial |
$20,864.18
|
| Rate for Payer: Humana Commercial |
$18,667.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,009.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,208.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,588.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,326.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,471.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,392.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,855.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,808.31
|
| Rate for Payer: PHCS Commercial |
$21,083.81
|
| Rate for Payer: United Healthcare All Payer |
$19,326.82
|
|
|
GENERATOR PULSE SCRR SESR01
|
Facility
|
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$12,979.20 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
GENERATOR PULSE SCRR SESR01
|
Facility
|
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,757.60 |
| Max. Negotiated Rate |
$12,979.20 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
GENERATOR PULSE SCRR SSR303
|
Facility
|
OP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem Medicaid |
$5,406.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Humana KY Medicaid |
$5,406.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,461.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
GENERATOR PULSE SCRR SSR303
|
Facility
|
IP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
GENERATOR PULSE SSIR 5180
|
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 SSIR 5180
|
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 SCRR 338 851/130 050
|
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 SCRR 338 851/130 050
|
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 VERSA DCRR VEDR01
|
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 VERSA DCRR VEDR01
|
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 VICTORY DCRR 5810
|
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 VICTORY DCRR 5810
|
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
|
|
