|
GENERATOR PULSE DCRR 341 826
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
GENERATOR PULSE DCRR 341 826
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
GENERATOR PULSE DCRR 343 175
|
Facility
|
IP
|
$27,500.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,250.00 |
| Max. Negotiated Rate |
$26,400.00 |
| Rate for Payer: Aetna Commercial |
$21,175.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,450.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna Commercial |
$22,825.00
|
| Rate for Payer: First Health Commercial |
$26,125.00
|
| Rate for Payer: Humana Commercial |
$23,375.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,550.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,295.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,925.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,975.00
|
| Rate for Payer: PHCS Commercial |
$26,400.00
|
| Rate for Payer: United Healthcare All Payer |
$24,200.00
|
|
|
GENERATOR PULSE DCRR 343 175
|
Facility
|
OP
|
$27,500.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,250.00 |
| Max. Negotiated Rate |
$26,400.00 |
| Rate for Payer: Aetna Commercial |
$21,175.00
|
| Rate for Payer: Anthem Medicaid |
$9,457.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,450.00
|
| Rate for Payer: Cash Price |
$13,750.00
|
| Rate for Payer: Cigna Commercial |
$22,825.00
|
| Rate for Payer: First Health Commercial |
$26,125.00
|
| Rate for Payer: Humana Commercial |
$23,375.00
|
| Rate for Payer: Humana KY Medicaid |
$9,457.25
|
| Rate for Payer: Kentucky WC Medicaid |
$9,553.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,550.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,295.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,250.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,647.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,925.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,975.00
|
| Rate for Payer: PHCS Commercial |
$26,400.00
|
| Rate for Payer: United Healthcare All Payer |
$24,200.00
|
|
|
GENERATOR PULSE DCRR 349 799
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GENERATOR PULSE DCRR 349 799
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GENERATOR PULSE DCRR 5326
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
GENERATOR PULSE DCRR 5326
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
GENERATOR PULSE DCRR 5330
|
Facility
|
IP
|
$21,481.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,444.38 |
| Max. Negotiated Rate |
$20,622.00 |
| Rate for Payer: Aetna Commercial |
$16,540.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,755.38
|
| Rate for Payer: Cash Price |
$10,740.62
|
| Rate for Payer: Cigna Commercial |
$17,829.44
|
| Rate for Payer: First Health Commercial |
$20,407.19
|
| Rate for Payer: Humana Commercial |
$18,259.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,614.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,853.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,444.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,903.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,110.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,688.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,822.06
|
| Rate for Payer: PHCS Commercial |
$20,622.00
|
| Rate for Payer: United Healthcare All Payer |
$18,903.50
|
|
|
GENERATOR PULSE DCRR 5330
|
Facility
|
OP
|
$21,481.25
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,444.38 |
| Max. Negotiated Rate |
$20,622.00 |
| Rate for Payer: Aetna Commercial |
$16,540.56
|
| Rate for Payer: Anthem Medicaid |
$7,387.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,755.38
|
| Rate for Payer: Cash Price |
$10,740.62
|
| Rate for Payer: Cigna Commercial |
$17,829.44
|
| Rate for Payer: First Health Commercial |
$20,407.19
|
| Rate for Payer: Humana Commercial |
$18,259.06
|
| Rate for Payer: Humana KY Medicaid |
$7,387.40
|
| Rate for Payer: Kentucky WC Medicaid |
$7,462.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,614.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,853.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,444.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,535.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,903.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,110.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,688.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,822.06
|
| Rate for Payer: PHCS Commercial |
$20,622.00
|
| Rate for Payer: United Healthcare All Payer |
$18,903.50
|
|
|
GENERATOR PULSE DCRR 5330L
|
Facility
|
OP
|
$24,282.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,284.75 |
| Max. Negotiated Rate |
$23,311.20 |
| Rate for Payer: Aetna Commercial |
$18,697.53
|
| Rate for Payer: Anthem Medicaid |
$8,350.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,940.35
|
| Rate for Payer: Cash Price |
$12,141.25
|
| Rate for Payer: Cigna Commercial |
$20,154.47
|
| Rate for Payer: First Health Commercial |
$23,068.38
|
| Rate for Payer: Humana Commercial |
$20,640.12
|
| Rate for Payer: Humana KY Medicaid |
$8,350.75
|
| Rate for Payer: Kentucky WC Medicaid |
$8,435.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,911.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,920.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,284.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,518.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,368.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,426.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,125.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,754.92
|
| Rate for Payer: PHCS Commercial |
$23,311.20
|
| Rate for Payer: United Healthcare All Payer |
$21,368.60
|
|
|
GENERATOR PULSE DCRR 5330L
|
Facility
|
IP
|
$24,282.50
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,284.75 |
| Max. Negotiated Rate |
$23,311.20 |
| Rate for Payer: Aetna Commercial |
$18,697.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,940.35
|
| Rate for Payer: Cash Price |
$12,141.25
|
| Rate for Payer: Cigna Commercial |
$20,154.47
|
| Rate for Payer: First Health Commercial |
$23,068.38
|
| Rate for Payer: Humana Commercial |
$20,640.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,911.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,920.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,284.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,368.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,426.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,125.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,754.92
|
| Rate for Payer: PHCS Commercial |
$23,311.20
|
| Rate for Payer: United Healthcare All Payer |
$21,368.60
|
|
|
GENERATOR PULSE DCRR 5336
|
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 PULSE DCRR 5336
|
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 PULSE DCRR 5346
|
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 PULSE DCRR 5346
|
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 PULSE DCRR 5360
|
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 PULSE DCRR 5360
|
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 PULSE DCRR 5366
|
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 PULSE DCRR 5366
|
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 PULSE DCRR 5370
|
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 PULSE DCRR 5370
|
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 PULSE DCRR 5380
|
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 PULSE DCRR 5380
|
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 PULSE DCRR 830
|
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
|
|
