|
GENERATOR CONSULTA C4TR01
|
Facility
|
IP
|
$33,612.50
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,083.75 |
| Max. Negotiated Rate |
$32,268.00 |
| Rate for Payer: Aetna Commercial |
$25,881.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,217.75
|
| Rate for Payer: Cash Price |
$16,806.25
|
| Rate for Payer: Cigna Commercial |
$27,898.38
|
| Rate for Payer: First Health Commercial |
$31,931.88
|
| Rate for Payer: Humana Commercial |
$28,570.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,562.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,806.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,083.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,579.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,890.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,242.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,192.62
|
| Rate for Payer: PHCS Commercial |
$32,268.00
|
| Rate for Payer: United Healthcare All Payer |
$29,579.00
|
|
|
GENERATOR DCRR 5386
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
GENERATOR DCRR 5386
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
GENERATOR GALLANT CDDRA500Q
|
Facility
|
OP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem Medicaid |
$11,391.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Humana KY Medicaid |
$11,391.69
|
| Rate for Payer: Kentucky WC Medicaid |
$11,507.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GENERATOR GALLANT CDDRA500Q
|
Facility
|
IP
|
$33,125.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,937.50 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$25,506.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,837.50
|
| Rate for Payer: Cash Price |
$16,562.50
|
| Rate for Payer: Cigna Commercial |
$27,493.75
|
| Rate for Payer: First Health Commercial |
$31,468.75
|
| Rate for Payer: Humana Commercial |
$28,156.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,162.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,446.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,150.00
|
| Rate for Payer: Ohio Health Group HMO |
$24,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,818.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,856.25
|
| Rate for Payer: PHCS Commercial |
$31,800.00
|
| Rate for Payer: United Healthcare All Payer |
$29,150.00
|
|
|
GENERATOR INSYNC III 8042
|
Facility
|
IP
|
$38,750.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,625.00 |
| Max. Negotiated Rate |
$37,200.00 |
| Rate for Payer: Aetna Commercial |
$29,837.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,225.00
|
| Rate for Payer: Cash Price |
$19,375.00
|
| Rate for Payer: Cigna Commercial |
$32,162.50
|
| Rate for Payer: First Health Commercial |
$36,812.50
|
| Rate for Payer: Humana Commercial |
$32,937.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,775.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,597.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,625.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,712.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,737.50
|
| Rate for Payer: PHCS Commercial |
$37,200.00
|
| Rate for Payer: United Healthcare All Payer |
$34,100.00
|
|
|
GENERATOR INSYNC III 8042
|
Facility
|
OP
|
$38,750.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,625.00 |
| Max. Negotiated Rate |
$37,200.00 |
| Rate for Payer: Aetna Commercial |
$29,837.50
|
| Rate for Payer: Anthem Medicaid |
$13,326.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,225.00
|
| Rate for Payer: Cash Price |
$19,375.00
|
| Rate for Payer: Cigna Commercial |
$32,162.50
|
| Rate for Payer: First Health Commercial |
$36,812.50
|
| Rate for Payer: Humana Commercial |
$32,937.50
|
| Rate for Payer: Humana KY Medicaid |
$13,326.12
|
| Rate for Payer: Kentucky WC Medicaid |
$13,461.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,775.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,597.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,625.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,593.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$29,062.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,712.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,737.50
|
| Rate for Payer: PHCS Commercial |
$37,200.00
|
| Rate for Payer: United Healthcare All Payer |
$34,100.00
|
|
|
GENERATOR INTELLIS IMP MRI KIT
|
Facility
|
IP
|
$97,634.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,290.20 |
| Max. Negotiated Rate |
$93,728.64 |
| Rate for Payer: Aetna Commercial |
$75,178.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,154.52
|
| Rate for Payer: Cash Price |
$48,817.00
|
| Rate for Payer: Cigna Commercial |
$81,036.22
|
| Rate for Payer: First Health Commercial |
$92,752.30
|
| Rate for Payer: Humana Commercial |
$82,988.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,059.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,053.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,290.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$85,917.92
|
| Rate for Payer: Ohio Health Group HMO |
$73,225.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,107.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84,941.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,367.46
|
| Rate for Payer: PHCS Commercial |
$93,728.64
|
| Rate for Payer: United Healthcare All Payer |
$85,917.92
|
|
|
GENERATOR INTELLIS IMP MRI KIT
|
Facility
|
OP
|
$97,634.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,290.20 |
| Max. Negotiated Rate |
$93,728.64 |
| Rate for Payer: Aetna Commercial |
$75,178.18
|
| Rate for Payer: Anthem Medicaid |
$33,576.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,154.52
|
| Rate for Payer: Cash Price |
$48,817.00
|
| Rate for Payer: Cigna Commercial |
$81,036.22
|
| Rate for Payer: First Health Commercial |
$92,752.30
|
| Rate for Payer: Humana Commercial |
$82,988.90
|
| Rate for Payer: Humana KY Medicaid |
$33,576.33
|
| Rate for Payer: Kentucky WC Medicaid |
$33,918.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,059.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,053.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,290.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,250.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$85,917.92
|
| Rate for Payer: Ohio Health Group HMO |
$73,225.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,107.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84,941.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,367.46
|
| Rate for Payer: PHCS Commercial |
$93,728.64
|
| Rate for Payer: United Healthcare All Payer |
$85,917.92
|
|
|
GENERATOR PLUSE DCRR KDR701
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem Medicaid |
$7,522.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Humana KY Medicaid |
$7,522.81
|
| Rate for Payer: Kentucky WC Medicaid |
$7,599.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,673.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
GENERATOR PLUSE DCRR KDR701
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$21,000.00 |
| Rate for Payer: Aetna Commercial |
$16,843.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,062.50
|
| Rate for Payer: Cash Price |
$10,937.50
|
| Rate for Payer: Cigna Commercial |
$18,156.25
|
| Rate for Payer: First Health Commercial |
$20,781.25
|
| Rate for Payer: Humana Commercial |
$18,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,937.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,143.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,250.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,031.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,093.75
|
| Rate for Payer: PHCS Commercial |
$21,000.00
|
| Rate for Payer: United Healthcare All Payer |
$19,250.00
|
|
|
GENERATOR PM3562
|
Facility
|
IP
|
$19,015.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$18,254.40 |
| Rate for Payer: Aetna Commercial |
$14,641.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,831.70
|
| Rate for Payer: Cash Price |
$9,507.50
|
| Rate for Payer: Cigna Commercial |
$15,782.45
|
| Rate for Payer: First Health Commercial |
$18,064.25
|
| Rate for Payer: Humana Commercial |
$16,162.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,592.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,033.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,704.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,733.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,543.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,120.35
|
| Rate for Payer: PHCS Commercial |
$18,254.40
|
| Rate for Payer: United Healthcare All Payer |
$16,733.20
|
|
|
GENERATOR PM3562
|
Facility
|
OP
|
$19,015.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,704.50 |
| Max. Negotiated Rate |
$18,254.40 |
| Rate for Payer: Aetna Commercial |
$14,641.55
|
| Rate for Payer: Anthem Medicaid |
$6,539.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,831.70
|
| Rate for Payer: Cash Price |
$9,507.50
|
| Rate for Payer: Cigna Commercial |
$15,782.45
|
| Rate for Payer: First Health Commercial |
$18,064.25
|
| Rate for Payer: Humana Commercial |
$16,162.75
|
| Rate for Payer: Humana KY Medicaid |
$6,539.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,605.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,592.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,033.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,704.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,670.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,733.20
|
| Rate for Payer: Ohio Health Group HMO |
$14,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,543.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,120.35
|
| Rate for Payer: PHCS Commercial |
$18,254.40
|
| Rate for Payer: United Healthcare All Payer |
$16,733.20
|
|
|
GENERATOR PROTEGE IPG 3789
|
Facility
|
IP
|
$88,457.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$26,537.10 |
| Max. Negotiated Rate |
$84,918.72 |
| Rate for Payer: Aetna Commercial |
$68,111.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,996.46
|
| Rate for Payer: Cash Price |
$44,228.50
|
| Rate for Payer: Cigna Commercial |
$73,419.31
|
| Rate for Payer: First Health Commercial |
$84,034.15
|
| Rate for Payer: Humana Commercial |
$75,188.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,534.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,281.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,537.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,842.16
|
| Rate for Payer: Ohio Health Group HMO |
$66,342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76,957.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61,035.33
|
| Rate for Payer: PHCS Commercial |
$84,918.72
|
| Rate for Payer: United Healthcare All Payer |
$77,842.16
|
|
|
GENERATOR PROTEGE IPG 3789
|
Facility
|
OP
|
$88,457.00
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$26,537.10 |
| Max. Negotiated Rate |
$84,918.72 |
| Rate for Payer: Aetna Commercial |
$68,111.89
|
| Rate for Payer: Anthem Medicaid |
$30,420.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,996.46
|
| Rate for Payer: Cash Price |
$44,228.50
|
| Rate for Payer: Cigna Commercial |
$73,419.31
|
| Rate for Payer: First Health Commercial |
$84,034.15
|
| Rate for Payer: Humana Commercial |
$75,188.45
|
| Rate for Payer: Humana KY Medicaid |
$30,420.36
|
| Rate for Payer: Kentucky WC Medicaid |
$30,729.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,534.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,281.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,537.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,030.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,842.16
|
| Rate for Payer: Ohio Health Group HMO |
$66,342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76,957.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61,035.33
|
| Rate for Payer: PHCS Commercial |
$84,918.72
|
| Rate for Payer: United Healthcare All Payer |
$77,842.16
|
|
|
GENERATOR PULSE DCRR 122 130
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GENERATOR PULSE DCRR 122 130
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GENERATOR PULSE DCRR 1280
|
Facility
|
OP
|
$25,606.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,681.88 |
| Max. Negotiated Rate |
$24,582.00 |
| Rate for Payer: Aetna Commercial |
$19,716.81
|
| Rate for Payer: Anthem Medicaid |
$8,805.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,972.88
|
| Rate for Payer: Cash Price |
$12,803.12
|
| Rate for Payer: Cigna Commercial |
$21,253.19
|
| Rate for Payer: First Health Commercial |
$24,325.94
|
| Rate for Payer: Humana Commercial |
$21,765.31
|
| Rate for Payer: Humana KY Medicaid |
$8,805.99
|
| Rate for Payer: Kentucky WC Medicaid |
$8,895.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,997.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,897.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,681.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,982.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,533.50
|
| Rate for Payer: Ohio Health Group HMO |
$19,204.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,277.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,668.31
|
| Rate for Payer: PHCS Commercial |
$24,582.00
|
| Rate for Payer: United Healthcare All Payer |
$22,533.50
|
|
|
GENERATOR PULSE DCRR 1280
|
Facility
|
IP
|
$25,606.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,681.88 |
| Max. Negotiated Rate |
$24,582.00 |
| Rate for Payer: Aetna Commercial |
$19,716.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,972.88
|
| Rate for Payer: Cash Price |
$12,803.12
|
| Rate for Payer: Cigna Commercial |
$21,253.19
|
| Rate for Payer: First Health Commercial |
$24,325.94
|
| Rate for Payer: Humana Commercial |
$21,765.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,997.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,897.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,681.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,533.50
|
| Rate for Payer: Ohio Health Group HMO |
$19,204.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,277.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,668.31
|
| Rate for Payer: PHCS Commercial |
$24,582.00
|
| Rate for Payer: United Healthcare All Payer |
$22,533.50
|
|
|
GENERATOR PULSE DCRR 1283
|
Facility
|
IP
|
$23,731.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,119.38 |
| Max. Negotiated Rate |
$22,782.00 |
| Rate for Payer: Aetna Commercial |
$18,273.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.38
|
| Rate for Payer: Cash Price |
$11,865.62
|
| Rate for Payer: Cigna Commercial |
$19,696.94
|
| Rate for Payer: First Health Commercial |
$22,544.69
|
| Rate for Payer: Humana Commercial |
$20,171.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,459.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,513.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,883.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,798.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,374.56
|
| Rate for Payer: PHCS Commercial |
$22,782.00
|
| Rate for Payer: United Healthcare All Payer |
$20,883.50
|
|
|
GENERATOR PULSE DCRR 1283
|
Facility
|
OP
|
$23,731.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,119.38 |
| Max. Negotiated Rate |
$22,782.00 |
| Rate for Payer: Aetna Commercial |
$18,273.06
|
| Rate for Payer: Anthem Medicaid |
$8,161.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,510.38
|
| Rate for Payer: Cash Price |
$11,865.62
|
| Rate for Payer: Cigna Commercial |
$19,696.94
|
| Rate for Payer: First Health Commercial |
$22,544.69
|
| Rate for Payer: Humana Commercial |
$20,171.56
|
| Rate for Payer: Humana KY Medicaid |
$8,161.18
|
| Rate for Payer: Kentucky WC Medicaid |
$8,244.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,459.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,513.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,119.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,324.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,883.50
|
| Rate for Payer: Ohio Health Group HMO |
$17,798.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,646.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,374.56
|
| Rate for Payer: PHCS Commercial |
$22,782.00
|
| Rate for Payer: United Healthcare All Payer |
$20,883.50
|
|
|
GENERATOR PULSE DCRR 1297
|
Facility
|
OP
|
$27,481.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,244.38 |
| Max. Negotiated Rate |
$26,382.00 |
| Rate for Payer: Aetna Commercial |
$21,160.56
|
| Rate for Payer: Anthem Medicaid |
$9,450.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,435.38
|
| Rate for Payer: Cash Price |
$13,740.62
|
| Rate for Payer: Cigna Commercial |
$22,809.44
|
| Rate for Payer: First Health Commercial |
$26,107.19
|
| Rate for Payer: Humana Commercial |
$23,359.06
|
| Rate for Payer: Humana KY Medicaid |
$9,450.80
|
| Rate for Payer: Kentucky WC Medicaid |
$9,546.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,640.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,183.50
|
| Rate for Payer: Ohio Health Group HMO |
$20,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,908.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,962.06
|
| Rate for Payer: PHCS Commercial |
$26,382.00
|
| Rate for Payer: United Healthcare All Payer |
$24,183.50
|
|
|
GENERATOR PULSE DCRR 1297
|
Facility
|
IP
|
$27,481.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,244.38 |
| Max. Negotiated Rate |
$26,382.00 |
| Rate for Payer: Aetna Commercial |
$21,160.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,435.38
|
| Rate for Payer: Cash Price |
$13,740.62
|
| Rate for Payer: Cigna Commercial |
$22,809.44
|
| Rate for Payer: First Health Commercial |
$26,107.19
|
| Rate for Payer: Humana Commercial |
$23,359.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,244.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,183.50
|
| Rate for Payer: Ohio Health Group HMO |
$20,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,908.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,962.06
|
| Rate for Payer: PHCS Commercial |
$26,382.00
|
| Rate for Payer: United Healthcare All Payer |
$24,183.50
|
|
|
GENERATOR PULSE DCRR 331 443
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem Medicaid |
$8,812.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Humana KY Medicaid |
$8,812.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,902.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,989.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
|
GENERATOR PULSE DCRR 331 443
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,687.50 |
| Max. Negotiated Rate |
$24,600.00 |
| Rate for Payer: Aetna Commercial |
$19,731.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,987.50
|
| Rate for Payer: Cash Price |
$12,812.50
|
| Rate for Payer: Cigna Commercial |
$21,268.75
|
| Rate for Payer: First Health Commercial |
$24,343.75
|
| Rate for Payer: Humana Commercial |
$21,781.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,012.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,911.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,687.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,550.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,218.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,293.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,681.25
|
| Rate for Payer: PHCS Commercial |
$24,600.00
|
| Rate for Payer: United Healthcare All Payer |
$22,550.00
|
|
