|
PINNACLE ACET CUP 300*50MM
|
Facility
|
OP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem Medicaid |
$5,226.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Humana KY Medicaid |
$5,226.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,279.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,331.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*52MM
|
Facility
|
IP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*52MM
|
Facility
|
OP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem Medicaid |
$5,226.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Humana KY Medicaid |
$5,226.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,279.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,331.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*54MM
|
Facility
|
OP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem Medicaid |
$5,226.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Humana KY Medicaid |
$5,226.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,279.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,331.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*54MM
|
Facility
|
IP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*56MM
|
Facility
|
IP
|
$15,363.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.27 |
| Max. Negotiated Rate |
$14,749.06 |
| Rate for Payer: Aetna Commercial |
$11,829.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,983.61
|
| Rate for Payer: Cash Price |
$7,681.80
|
| Rate for Payer: Cigna Commercial |
$12,751.79
|
| Rate for Payer: First Health Commercial |
$14,595.42
|
| Rate for Payer: Humana Commercial |
$13,059.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,338.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,609.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,519.97
|
| Rate for Payer: Ohio Health Group HMO |
$11,522.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,997.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,762.72
|
| Rate for Payer: PHCS Commercial |
$14,749.06
|
| Rate for Payer: United Healthcare All Payer |
$13,519.97
|
|
|
PINNACLE ACET CUP 300*56MM
|
Facility
|
OP
|
$15,363.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.27 |
| Max. Negotiated Rate |
$14,749.06 |
| Rate for Payer: Aetna Commercial |
$11,829.97
|
| Rate for Payer: Anthem Medicaid |
$5,283.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,983.61
|
| Rate for Payer: Cash Price |
$7,681.80
|
| Rate for Payer: Cigna Commercial |
$12,751.79
|
| Rate for Payer: First Health Commercial |
$14,595.42
|
| Rate for Payer: Humana Commercial |
$13,059.06
|
| Rate for Payer: Humana KY Medicaid |
$5,283.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,598.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,338.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,609.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,389.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,519.97
|
| Rate for Payer: Ohio Health Group HMO |
$11,522.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,072.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,997.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,762.72
|
| Rate for Payer: PHCS Commercial |
$14,749.06
|
| Rate for Payer: United Healthcare All Payer |
$13,519.97
|
|
|
PINNACLE ACET CUP 300*58MM
|
Facility
|
IP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*58MM
|
Facility
|
OP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem Medicaid |
$5,226.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Humana KY Medicaid |
$5,226.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,279.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,331.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*60MM
|
Facility
|
IP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*60MM
|
Facility
|
OP
|
$15,198.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,975.74 |
| Max. Negotiated Rate |
$14,590.08 |
| Rate for Payer: Aetna Commercial |
$11,702.46
|
| Rate for Payer: Anthem Medicaid |
$5,226.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,854.44
|
| Rate for Payer: Cash Price |
$7,599.00
|
| Rate for Payer: Cigna Commercial |
$12,614.34
|
| Rate for Payer: First Health Commercial |
$14,438.10
|
| Rate for Payer: Humana Commercial |
$12,918.30
|
| Rate for Payer: Humana KY Medicaid |
$5,226.59
|
| Rate for Payer: Kentucky WC Medicaid |
$5,279.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,462.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,216.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,559.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,331.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,374.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,398.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,975.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,711.38
|
| Rate for Payer: PHCS Commercial |
$14,590.08
|
| Rate for Payer: United Healthcare All Payer |
$13,374.24
|
|
|
PINNACLE ACET CUP 300*62MM
|
Facility
|
OP
|
$8,900.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.06 |
| Max. Negotiated Rate |
$8,544.41 |
| Rate for Payer: Aetna Commercial |
$6,853.33
|
| Rate for Payer: Anthem Medicaid |
$3,060.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,942.34
|
| Rate for Payer: Cash Price |
$4,450.21
|
| Rate for Payer: Cigna Commercial |
$7,387.36
|
| Rate for Payer: First Health Commercial |
$8,455.41
|
| Rate for Payer: Humana Commercial |
$7,565.37
|
| Rate for Payer: Humana KY Medicaid |
$3,060.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,092.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,298.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,568.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,122.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,832.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,675.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.13
|
| Rate for Payer: PHCS Commercial |
$8,544.41
|
| Rate for Payer: United Healthcare All Payer |
$7,832.38
|
|
|
PINNACLE ACET CUP 300*62MM
|
Facility
|
IP
|
$8,900.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.06 |
| Max. Negotiated Rate |
$8,544.41 |
| Rate for Payer: Aetna Commercial |
$6,853.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,942.34
|
| Rate for Payer: Cash Price |
$4,450.21
|
| Rate for Payer: Cigna Commercial |
$7,387.36
|
| Rate for Payer: First Health Commercial |
$8,455.41
|
| Rate for Payer: Humana Commercial |
$7,565.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,298.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,568.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,832.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,675.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.13
|
| Rate for Payer: PHCS Commercial |
$8,544.41
|
| Rate for Payer: United Healthcare All Payer |
$7,832.38
|
|
|
PINNACLE ACET CUP 300*64MM
|
Facility
|
IP
|
$8,900.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.06 |
| Max. Negotiated Rate |
$8,544.41 |
| Rate for Payer: Aetna Commercial |
$6,853.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,942.34
|
| Rate for Payer: Cash Price |
$4,450.21
|
| Rate for Payer: Cigna Commercial |
$7,387.36
|
| Rate for Payer: First Health Commercial |
$8,455.41
|
| Rate for Payer: Humana Commercial |
$7,565.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,298.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,568.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,832.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,675.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.13
|
| Rate for Payer: PHCS Commercial |
$8,544.41
|
| Rate for Payer: United Healthcare All Payer |
$7,832.38
|
|
|
PINNACLE ACET CUP 300*64MM
|
Facility
|
OP
|
$8,900.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.06 |
| Max. Negotiated Rate |
$8,544.41 |
| Rate for Payer: Aetna Commercial |
$6,853.33
|
| Rate for Payer: Anthem Medicaid |
$3,060.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,942.34
|
| Rate for Payer: Cash Price |
$4,450.21
|
| Rate for Payer: Cigna Commercial |
$7,387.36
|
| Rate for Payer: First Health Commercial |
$8,455.41
|
| Rate for Payer: Humana Commercial |
$7,565.37
|
| Rate for Payer: Humana KY Medicaid |
$3,060.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,092.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,298.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,568.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,122.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,832.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,675.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.13
|
| Rate for Payer: PHCS Commercial |
$8,544.41
|
| Rate for Payer: United Healthcare All Payer |
$7,832.38
|
|
|
PINNACLE ACET CUP 300*66MM
|
Facility
|
OP
|
$8,900.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.06 |
| Max. Negotiated Rate |
$8,544.41 |
| Rate for Payer: Aetna Commercial |
$6,853.33
|
| Rate for Payer: Anthem Medicaid |
$3,060.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,942.34
|
| Rate for Payer: Cash Price |
$4,450.21
|
| Rate for Payer: Cigna Commercial |
$7,387.36
|
| Rate for Payer: First Health Commercial |
$8,455.41
|
| Rate for Payer: Humana Commercial |
$7,565.37
|
| Rate for Payer: Humana KY Medicaid |
$3,060.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,092.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,298.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,568.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,122.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,832.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,675.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.13
|
| Rate for Payer: PHCS Commercial |
$8,544.41
|
| Rate for Payer: United Healthcare All Payer |
$7,832.38
|
|
|
PINNACLE ACET CUP 300*66MM
|
Facility
|
IP
|
$8,900.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,157.06 |
| Max. Negotiated Rate |
$8,544.41 |
| Rate for Payer: Aetna Commercial |
$6,853.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,942.34
|
| Rate for Payer: Cash Price |
$4,450.21
|
| Rate for Payer: Cigna Commercial |
$7,387.36
|
| Rate for Payer: First Health Commercial |
$8,455.41
|
| Rate for Payer: Humana Commercial |
$7,565.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,298.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,568.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,832.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,675.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,759.13
|
| Rate for Payer: PHCS Commercial |
$8,544.41
|
| Rate for Payer: United Healthcare All Payer |
$7,832.38
|
|
|
PINNACLE ACET CUP MH SZ 52MM
|
Facility
|
OP
|
$10,693.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.15 |
| Max. Negotiated Rate |
$10,265.70 |
| Rate for Payer: Aetna Commercial |
$8,233.95
|
| Rate for Payer: Aetna Commercial |
$21,277.79
|
| Rate for Payer: Anthem Medicaid |
$3,677.47
|
| Rate for Payer: Anthem Medicaid |
$9,503.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,340.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,554.12
|
| Rate for Payer: Cash Price |
$5,346.72
|
| Rate for Payer: Cash Price |
$13,816.74
|
| Rate for Payer: Cigna Commercial |
$22,935.80
|
| Rate for Payer: Cigna Commercial |
$8,875.56
|
| Rate for Payer: First Health Commercial |
$26,251.82
|
| Rate for Payer: First Health Commercial |
$10,158.77
|
| Rate for Payer: Humana Commercial |
$9,089.42
|
| Rate for Payer: Humana Commercial |
$23,488.47
|
| Rate for Payer: Humana KY Medicaid |
$3,677.47
|
| Rate for Payer: Humana KY Medicaid |
$9,503.16
|
| Rate for Payer: Kentucky WC Medicaid |
$9,599.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,714.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,768.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,659.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,393.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,891.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,290.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,208.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,751.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,693.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,410.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,317.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,020.08
|
| Rate for Payer: Ohio Health Group HMO |
$20,725.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,526.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,390.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,592.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,566.38
|
| Rate for Payer: PHCS Commercial |
$26,528.15
|
| Rate for Payer: PHCS Commercial |
$10,265.70
|
| Rate for Payer: United Healthcare All Payer |
$24,317.47
|
| Rate for Payer: United Healthcare All Payer |
$9,410.23
|
|
|
PINNACLE ACET CUP MH SZ 52MM
|
Facility
|
IP
|
$10,693.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.15 |
| Max. Negotiated Rate |
$10,265.70 |
| Rate for Payer: Aetna Commercial |
$8,233.95
|
| Rate for Payer: Aetna Commercial |
$21,277.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,340.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,554.12
|
| Rate for Payer: Cash Price |
$5,346.72
|
| Rate for Payer: Cash Price |
$13,816.74
|
| Rate for Payer: Cigna Commercial |
$8,875.56
|
| Rate for Payer: Cigna Commercial |
$22,935.80
|
| Rate for Payer: First Health Commercial |
$26,251.82
|
| Rate for Payer: First Health Commercial |
$10,158.77
|
| Rate for Payer: Humana Commercial |
$23,488.47
|
| Rate for Payer: Humana Commercial |
$9,089.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,768.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,659.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,891.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,393.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,290.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,208.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,410.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,317.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,020.08
|
| Rate for Payer: Ohio Health Group HMO |
$20,725.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,526.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,390.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,592.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,566.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.97
|
| Rate for Payer: PHCS Commercial |
$10,265.70
|
| Rate for Payer: PHCS Commercial |
$26,528.15
|
| Rate for Payer: United Healthcare All Payer |
$9,410.23
|
| Rate for Payer: United Healthcare All Payer |
$24,317.47
|
|
|
PINNACLE ACET CUP MH SZ 54MM
|
Facility
|
OP
|
$27,051.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,516.65 |
| Max. Negotiated Rate |
$25,969.08 |
| Rate for Payer: Aetna Commercial |
$20,829.37
|
| Rate for Payer: Anthem Medicaid |
$9,302.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,099.88
|
| Rate for Payer: Cash Price |
$13,525.57
|
| Rate for Payer: Cigna Commercial |
$22,452.44
|
| Rate for Payer: First Health Commercial |
$25,698.57
|
| Rate for Payer: Humana Commercial |
$22,993.46
|
| Rate for Payer: Humana KY Medicaid |
$9,302.88
|
| Rate for Payer: Kentucky WC Medicaid |
$9,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,181.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,963.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,115.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,489.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,804.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,288.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,410.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,516.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,385.85
|
| Rate for Payer: PHCS Commercial |
$25,969.08
|
| Rate for Payer: United Healthcare All Payer |
$23,804.99
|
|
|
PINNACLE ACET CUP MH SZ 54MM
|
Facility
|
IP
|
$27,051.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,516.65 |
| Max. Negotiated Rate |
$25,969.08 |
| Rate for Payer: Aetna Commercial |
$20,829.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,099.88
|
| Rate for Payer: Cash Price |
$13,525.57
|
| Rate for Payer: Cigna Commercial |
$22,452.44
|
| Rate for Payer: First Health Commercial |
$25,698.57
|
| Rate for Payer: Humana Commercial |
$22,993.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,181.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,963.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,115.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,804.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,288.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,410.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,516.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,385.85
|
| Rate for Payer: PHCS Commercial |
$25,969.08
|
| Rate for Payer: United Healthcare All Payer |
$23,804.99
|
|
|
PINNACLE ACET CUP MH SZ 56 MM
|
Facility
|
IP
|
$22,805.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.71 |
| Max. Negotiated Rate |
$21,893.23 |
| Rate for Payer: Aetna Commercial |
$17,560.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,788.25
|
| Rate for Payer: Cash Price |
$11,402.73
|
| Rate for Payer: Cigna Commercial |
$18,928.52
|
| Rate for Payer: First Health Commercial |
$21,665.18
|
| Rate for Payer: Humana Commercial |
$19,384.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,700.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,830.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,841.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,068.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,104.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,561.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,069.69
|
| Rate for Payer: PHCS Commercial |
$21,893.23
|
| Rate for Payer: United Healthcare All Payer |
$20,068.80
|
|
|
PINNACLE ACET CUP MH SZ 56 MM
|
Facility
|
OP
|
$22,805.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.71 |
| Max. Negotiated Rate |
$21,893.23 |
| Rate for Payer: Aetna Commercial |
$17,560.20
|
| Rate for Payer: Anthem Medicaid |
$7,842.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,788.25
|
| Rate for Payer: Cash Price |
$11,402.73
|
| Rate for Payer: Cigna Commercial |
$18,928.52
|
| Rate for Payer: First Health Commercial |
$21,665.18
|
| Rate for Payer: Humana Commercial |
$19,384.63
|
| Rate for Payer: Humana KY Medicaid |
$7,842.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,922.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,700.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,830.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,841.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,000.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,068.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,104.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,561.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,964.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,069.69
|
| Rate for Payer: PHCS Commercial |
$21,893.23
|
| Rate for Payer: United Healthcare All Payer |
$20,068.80
|
|
|
PINNACLE ACET CUP MH SZ 62MM
|
Facility
|
OP
|
$8,953.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.01 |
| Max. Negotiated Rate |
$8,595.74 |
| Rate for Payer: Aetna Commercial |
$6,894.50
|
| Rate for Payer: Anthem Medicaid |
$3,079.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,984.04
|
| Rate for Payer: Cash Price |
$4,476.95
|
| Rate for Payer: Cigna Commercial |
$7,431.74
|
| Rate for Payer: First Health Commercial |
$8,506.20
|
| Rate for Payer: Humana Commercial |
$7,610.82
|
| Rate for Payer: Humana KY Medicaid |
$3,079.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,342.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,686.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,141.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,879.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,715.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,790.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,775.71
|
| Rate for Payer: PHCS Commercial |
$8,595.74
|
| Rate for Payer: United Healthcare All Payer |
$7,879.43
|
|
|
PINNACLE ACET CUP MH SZ 62MM
|
Facility
|
IP
|
$8,953.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.01 |
| Max. Negotiated Rate |
$8,595.74 |
| Rate for Payer: Aetna Commercial |
$6,894.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,984.04
|
| Rate for Payer: Cash Price |
$4,476.95
|
| Rate for Payer: Cigna Commercial |
$7,431.74
|
| Rate for Payer: First Health Commercial |
$8,506.20
|
| Rate for Payer: Humana Commercial |
$7,610.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,342.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,686.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,879.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,715.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,790.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,775.71
|
| Rate for Payer: PHCS Commercial |
$8,595.74
|
| Rate for Payer: United Healthcare All Payer |
$7,879.43
|
|
