|
GENERATOR PULSE SCRR 560
|
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 562
|
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 562
|
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 565
|
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 565
|
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 840
|
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 840
|
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 SESR01
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
GENERATOR PULSE SCRR SESR01
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
GENERATOR PULSE SCRR SSR303
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
GENERATOR PULSE SCRR SSR303
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
GENERATOR PULSE SSIR 5180
|
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 SSIR 5180
|
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 SCRR 338 851/130 050
|
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 SCRR 338 851/130 050
|
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 VERSA DCRR VEDR01
|
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 VERSA DCRR VEDR01
|
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 VICTORY DCRR 5810
|
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 VICTORY DCRR 5810
|
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 VICTORY DCRR 5816
|
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 VICTORY DCRR 5816
|
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 VICTORY SCRR 5610
|
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 VICTORY SCRR 5610
|
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 WW ALPHA PRIME 16
|
Facility
|
IP
|
$82,320.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,696.00 |
| Max. Negotiated Rate |
$79,027.20 |
| Rate for Payer: Aetna Commercial |
$63,386.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,209.60
|
| Rate for Payer: Cash Price |
$41,160.00
|
| Rate for Payer: Cigna Commercial |
$68,325.60
|
| Rate for Payer: First Health Commercial |
$78,204.00
|
| Rate for Payer: Humana Commercial |
$69,972.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,502.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,752.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,696.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,441.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,740.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,618.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,800.80
|
| Rate for Payer: PHCS Commercial |
$79,027.20
|
| Rate for Payer: United Healthcare All Payer |
$72,441.60
|
|
|
GENERATOR WW ALPHA PRIME 16
|
Facility
|
OP
|
$82,320.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,696.00 |
| Max. Negotiated Rate |
$79,027.20 |
| Rate for Payer: Aetna Commercial |
$63,386.40
|
| Rate for Payer: Anthem Medicaid |
$28,309.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,209.60
|
| Rate for Payer: Cash Price |
$41,160.00
|
| Rate for Payer: Cigna Commercial |
$68,325.60
|
| Rate for Payer: First Health Commercial |
$78,204.00
|
| Rate for Payer: Humana Commercial |
$69,972.00
|
| Rate for Payer: Humana KY Medicaid |
$28,309.85
|
| Rate for Payer: Kentucky WC Medicaid |
$28,597.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,502.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,752.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,696.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,877.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,441.60
|
| Rate for Payer: Ohio Health Group HMO |
$61,740.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,618.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,800.80
|
| Rate for Payer: PHCS Commercial |
$79,027.20
|
| Rate for Payer: United Healthcare All Payer |
$72,441.60
|
|
