|
GENERATOR PULSE DCRR 830
|
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 860
|
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 860
|
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 862
|
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 862
|
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 865
|
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 865
|
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 902
|
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 902
|
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 KDR721
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GENERATOR PULSE DCRR KDR721
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GENERATOR PULSE DCRR KDR901
|
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 KDR901
|
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 KDR903
|
Facility
|
OP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem Medicaid |
$9,715.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Humana KY Medicaid |
$9,715.17
|
| Rate for Payer: Kentucky WC Medicaid |
$9,814.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,910.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GENERATOR PULSE DCRR KDR903
|
Facility
|
IP
|
$28,250.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,475.00 |
| Max. Negotiated Rate |
$27,120.00 |
| Rate for Payer: Aetna Commercial |
$21,752.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,035.00
|
| Rate for Payer: Cash Price |
$14,125.00
|
| Rate for Payer: Cigna Commercial |
$23,447.50
|
| Rate for Payer: First Health Commercial |
$26,837.50
|
| Rate for Payer: Humana Commercial |
$24,012.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,165.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,848.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,577.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,492.50
|
| Rate for Payer: PHCS Commercial |
$27,120.00
|
| Rate for Payer: United Healthcare All Payer |
$24,860.00
|
|
|
GENERATOR PULSE DCRR SEDR01
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
GENERATOR PULSE DCRR SEDR01
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
GENERATOR PULSE DCRR V-340
|
Facility
|
IP
|
$107,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,220.00 |
| Max. Negotiated Rate |
$103,104.00 |
| Rate for Payer: Aetna Commercial |
$82,698.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,772.00
|
| Rate for Payer: Cash Price |
$53,700.00
|
| Rate for Payer: Cigna Commercial |
$89,142.00
|
| Rate for Payer: First Health Commercial |
$102,030.00
|
| Rate for Payer: Humana Commercial |
$91,290.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88,068.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79,261.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,220.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,512.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93,438.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74,106.00
|
| Rate for Payer: PHCS Commercial |
$103,104.00
|
| Rate for Payer: United Healthcare All Payer |
$94,512.00
|
|
|
GENERATOR PULSE DCRR V-340
|
Facility
|
OP
|
$107,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$32,220.00 |
| Max. Negotiated Rate |
$103,104.00 |
| Rate for Payer: Aetna Commercial |
$82,698.00
|
| Rate for Payer: Anthem Medicaid |
$36,934.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,772.00
|
| Rate for Payer: Cash Price |
$53,700.00
|
| Rate for Payer: Cigna Commercial |
$89,142.00
|
| Rate for Payer: First Health Commercial |
$102,030.00
|
| Rate for Payer: Humana Commercial |
$91,290.00
|
| Rate for Payer: Humana KY Medicaid |
$36,934.86
|
| Rate for Payer: Kentucky WC Medicaid |
$37,310.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88,068.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79,261.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,220.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,675.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,512.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93,438.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74,106.00
|
| Rate for Payer: PHCS Commercial |
$103,104.00
|
| Rate for Payer: United Healthcare All Payer |
$94,512.00
|
|
|
GENERATOR PULSE SCRR 1176
|
Facility
|
OP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem Medicaid |
$6,342.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Humana KY Medicaid |
$6,342.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,406.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,469.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
GENERATOR PULSE SCRR 1176
|
Facility
|
IP
|
$18,441.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,532.45 |
| Max. Negotiated Rate |
$17,703.84 |
| Rate for Payer: Aetna Commercial |
$14,199.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,384.37
|
| Rate for Payer: Cash Price |
$9,220.75
|
| Rate for Payer: Cigna Commercial |
$15,306.44
|
| Rate for Payer: First Health Commercial |
$17,519.42
|
| Rate for Payer: Humana Commercial |
$15,675.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,122.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,609.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,532.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,228.52
|
| Rate for Payer: Ohio Health Group HMO |
$13,831.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,753.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,044.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,724.64
|
| Rate for Payer: PHCS Commercial |
$17,703.84
|
| Rate for Payer: United Healthcare All Payer |
$16,228.52
|
|
|
GENERATOR PULSE SCRR 2525T
|
Facility
|
OP
|
$19,181.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.45 |
| Max. Negotiated Rate |
$18,414.24 |
| Rate for Payer: Aetna Commercial |
$14,769.75
|
| Rate for Payer: Anthem Medicaid |
$6,596.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,961.57
|
| Rate for Payer: Cash Price |
$9,590.75
|
| Rate for Payer: Cigna Commercial |
$15,920.65
|
| Rate for Payer: First Health Commercial |
$18,222.42
|
| Rate for Payer: Humana Commercial |
$16,304.27
|
| Rate for Payer: Humana KY Medicaid |
$6,596.52
|
| Rate for Payer: Kentucky WC Medicaid |
$6,663.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,728.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,155.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,728.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,879.72
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,687.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.24
|
| Rate for Payer: PHCS Commercial |
$18,414.24
|
| Rate for Payer: United Healthcare All Payer |
$16,879.72
|
|
|
GENERATOR PULSE SCRR 2525T
|
Facility
|
IP
|
$19,181.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,754.45 |
| Max. Negotiated Rate |
$18,414.24 |
| Rate for Payer: Aetna Commercial |
$14,769.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,961.57
|
| Rate for Payer: Cash Price |
$9,590.75
|
| Rate for Payer: Cigna Commercial |
$15,920.65
|
| Rate for Payer: First Health Commercial |
$18,222.42
|
| Rate for Payer: Humana Commercial |
$16,304.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,728.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,155.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,754.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,879.72
|
| Rate for Payer: Ohio Health Group HMO |
$14,386.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,345.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,687.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,235.24
|
| Rate for Payer: PHCS Commercial |
$18,414.24
|
| Rate for Payer: United Healthcare All Payer |
$16,879.72
|
|
|
GENERATOR PULSE SCRR 331 446
|
Facility
|
IP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 331 446
|
Facility
|
OP
|
$21,875.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
