|
GENERATOR PULSE SCRR 331 599
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 331 599
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 341 824
|
Facility
|
OP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 341 824
|
Facility
|
IP
|
$25,625.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5130L
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
GENERATOR PULSE SCRR 5130L
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
GENERATOR PULSE SCRR 5130R
|
Facility
|
OP
|
$18,663.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,599.05 |
| Max. Negotiated Rate |
$17,916.96 |
| Rate for Payer: Aetna Commercial |
$14,370.90
|
| Rate for Payer: Anthem Medicaid |
$6,418.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,557.53
|
| Rate for Payer: Cash Price |
$9,331.75
|
| Rate for Payer: Cigna Commercial |
$15,490.70
|
| Rate for Payer: First Health Commercial |
$17,730.33
|
| Rate for Payer: Humana Commercial |
$15,863.98
|
| Rate for Payer: Humana KY Medicaid |
$6,418.38
|
| Rate for Payer: Kentucky WC Medicaid |
$6,483.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,304.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,773.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,599.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,547.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,423.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,997.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,930.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,877.82
|
| Rate for Payer: PHCS Commercial |
$17,916.96
|
| Rate for Payer: United Healthcare All Payer |
$16,423.88
|
|
|
GENERATOR PULSE SCRR 5130R
|
Facility
|
IP
|
$18,663.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,599.05 |
| Max. Negotiated Rate |
$17,916.96 |
| Rate for Payer: Aetna Commercial |
$14,370.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,557.53
|
| Rate for Payer: Cash Price |
$9,331.75
|
| Rate for Payer: Cigna Commercial |
$15,490.70
|
| Rate for Payer: First Health Commercial |
$17,730.33
|
| Rate for Payer: Humana Commercial |
$15,863.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,304.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,773.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,599.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,423.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,997.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,930.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,877.82
|
| Rate for Payer: PHCS Commercial |
$17,916.96
|
| Rate for Payer: United Healthcare All Payer |
$16,423.88
|
|
|
GENERATOR PULSE SCRR 5131 M/S
|
Facility
|
OP
|
$16,591.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,977.45 |
| Max. Negotiated Rate |
$15,927.84 |
| Rate for Payer: Aetna Commercial |
$12,775.45
|
| Rate for Payer: Anthem Medicaid |
$5,705.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,941.37
|
| Rate for Payer: Cash Price |
$8,295.75
|
| Rate for Payer: Cigna Commercial |
$13,770.94
|
| Rate for Payer: First Health Commercial |
$15,761.92
|
| Rate for Payer: Humana Commercial |
$14,102.77
|
| Rate for Payer: Humana KY Medicaid |
$5,705.82
|
| Rate for Payer: Kentucky WC Medicaid |
$5,763.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,605.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,244.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,977.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,820.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,600.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,273.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,434.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,448.14
|
| Rate for Payer: PHCS Commercial |
$15,927.84
|
| Rate for Payer: United Healthcare All Payer |
$14,600.52
|
|
|
GENERATOR PULSE SCRR 5131 M/S
|
Facility
|
IP
|
$16,591.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,977.45 |
| Max. Negotiated Rate |
$15,927.84 |
| Rate for Payer: Aetna Commercial |
$12,775.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,941.37
|
| Rate for Payer: Cash Price |
$8,295.75
|
| Rate for Payer: Cigna Commercial |
$13,770.94
|
| Rate for Payer: First Health Commercial |
$15,761.92
|
| Rate for Payer: Humana Commercial |
$14,102.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,605.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,244.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,977.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,600.52
|
| Rate for Payer: Ohio Health Group HMO |
$12,443.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,273.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,434.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,448.14
|
| Rate for Payer: PHCS Commercial |
$15,927.84
|
| Rate for Payer: United Healthcare All Payer |
$14,600.52
|
|
|
GENERATOR PULSE SCRR 5136
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5136
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5142
|
Facility
|
IP
|
$22,966.25
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,889.88 |
| Max. Negotiated Rate |
$22,047.60 |
| Rate for Payer: Aetna Commercial |
$17,684.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,913.67
|
| Rate for Payer: Cash Price |
$11,483.12
|
| Rate for Payer: Cigna Commercial |
$19,061.99
|
| Rate for Payer: First Health Commercial |
$21,817.94
|
| Rate for Payer: Humana Commercial |
$19,521.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,832.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,949.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,889.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,210.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,224.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,980.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,846.71
|
| Rate for Payer: PHCS Commercial |
$22,047.60
|
| Rate for Payer: United Healthcare All Payer |
$20,210.30
|
|
|
GENERATOR PULSE SCRR 5142
|
Facility
|
OP
|
$22,966.25
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,889.88 |
| Max. Negotiated Rate |
$22,047.60 |
| Rate for Payer: Aetna Commercial |
$17,684.01
|
| Rate for Payer: Anthem Medicaid |
$7,898.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,913.67
|
| Rate for Payer: Cash Price |
$11,483.12
|
| Rate for Payer: Cigna Commercial |
$19,061.99
|
| Rate for Payer: First Health Commercial |
$21,817.94
|
| Rate for Payer: Humana Commercial |
$19,521.31
|
| Rate for Payer: Humana KY Medicaid |
$7,898.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,978.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,832.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,949.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,889.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,056.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,210.30
|
| Rate for Payer: Ohio Health Group HMO |
$17,224.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,980.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,846.71
|
| Rate for Payer: PHCS Commercial |
$22,047.60
|
| Rate for Payer: United Healthcare All Payer |
$20,210.30
|
|
|
GENERATOR PULSE SCRR 5157 M/S
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5157 M/S
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5160
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5160
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5172
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 5172
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| 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 SCRR 530
|
Facility
|
OP
|
$22,632.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,789.75 |
| Max. Negotiated Rate |
$21,727.20 |
| Rate for Payer: Aetna Commercial |
$17,427.03
|
| Rate for Payer: Anthem Medicaid |
$7,783.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,653.35
|
| Rate for Payer: Cash Price |
$11,316.25
|
| Rate for Payer: Cigna Commercial |
$18,784.97
|
| Rate for Payer: First Health Commercial |
$21,500.88
|
| Rate for Payer: Humana Commercial |
$19,237.62
|
| Rate for Payer: Humana KY Medicaid |
$7,783.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,862.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,558.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,702.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,789.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,939.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,916.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,690.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,616.42
|
| Rate for Payer: PHCS Commercial |
$21,727.20
|
| Rate for Payer: United Healthcare All Payer |
$19,916.60
|
|
|
GENERATOR PULSE SCRR 530
|
Facility
|
IP
|
$22,632.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,789.75 |
| Max. Negotiated Rate |
$21,727.20 |
| Rate for Payer: Aetna Commercial |
$17,427.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,653.35
|
| Rate for Payer: Cash Price |
$11,316.25
|
| Rate for Payer: Cigna Commercial |
$18,784.97
|
| Rate for Payer: First Health Commercial |
$21,500.88
|
| Rate for Payer: Humana Commercial |
$19,237.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,558.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,702.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,789.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,916.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,690.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,616.42
|
| Rate for Payer: PHCS Commercial |
$21,727.20
|
| Rate for Payer: United Healthcare All Payer |
$19,916.60
|
|
|
GENERATOR PULSE SCRR 540
|
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
|
|
|
GENERATOR PULSE SCRR 540
|
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 560
|
Facility
|
IP
|
$22,632.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,789.75 |
| Max. Negotiated Rate |
$21,727.20 |
| Rate for Payer: Aetna Commercial |
$17,427.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,653.35
|
| Rate for Payer: Cash Price |
$11,316.25
|
| Rate for Payer: Cigna Commercial |
$18,784.97
|
| Rate for Payer: First Health Commercial |
$21,500.88
|
| Rate for Payer: Humana Commercial |
$19,237.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,558.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,702.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,789.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,916.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,690.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,616.42
|
| Rate for Payer: PHCS Commercial |
$21,727.20
|
| Rate for Payer: United Healthcare All Payer |
$19,916.60
|
|
