|
PINNACLE ACET CUP MULT HL SZ62
|
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 MULT HL SZ62
|
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 DEST SHEATH 6FR 65CM
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
PINNACLE DEST SHEATH 6FR 65CM
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
PINNACLE DEST SHEATH 7FR 65CM
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
PINNACLE DEST SHEATH 7FR 65CM
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
PINNACLE GRIPTION ACE SHELL 48
|
Facility
|
IP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTION ACE SHELL 48
|
Facility
|
OP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem Medicaid |
$7,640.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Humana KY Medicaid |
$7,640.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,718.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,794.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTION ACE SHELL 52
|
Facility
|
IP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTION ACE SHELL 52
|
Facility
|
OP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem Medicaid |
$7,640.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Humana KY Medicaid |
$7,640.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,718.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,794.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTION ACE SHELL 54
|
Facility
|
OP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem Medicaid |
$7,640.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Humana KY Medicaid |
$7,640.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,718.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,794.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTION ACE SHELL 54
|
Facility
|
IP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTION ACE SHELL 58
|
Facility
|
OP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem Medicaid |
$7,185.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Humana KY Medicaid |
$7,185.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 58
|
Facility
|
IP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 60
|
Facility
|
OP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem Medicaid |
$7,185.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Humana KY Medicaid |
$7,185.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 60
|
Facility
|
IP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 62
|
Facility
|
IP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 62
|
Facility
|
OP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem Medicaid |
$7,185.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Humana KY Medicaid |
$7,185.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 64
|
Facility
|
OP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem Medicaid |
$7,185.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Humana KY Medicaid |
$7,185.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 64
|
Facility
|
IP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 66
|
Facility
|
IP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTION ACE SHELL 66
|
Facility
|
OP
|
$20,892.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.07 |
| Max. Negotiated Rate |
$20,057.14 |
| Rate for Payer: Cigna Commercial |
$17,341.07
|
| Rate for Payer: Aetna Commercial |
$16,087.49
|
| Rate for Payer: Anthem Medicaid |
$7,185.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.42
|
| Rate for Payer: Cash Price |
$10,446.42
|
| Rate for Payer: First Health Commercial |
$19,848.21
|
| Rate for Payer: Humana Commercial |
$17,758.92
|
| Rate for Payer: Humana KY Medicaid |
$7,185.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,132.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.71
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.78
|
| Rate for Payer: PHCS Commercial |
$20,057.14
|
| Rate for Payer: United Healthcare All Payer |
$18,385.71
|
|
|
PINNACLE GRIPTN ACE SHEL 50MM
|
Facility
|
IP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTN ACE SHEL 50MM
|
Facility
|
OP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem Medicaid |
$7,640.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Humana KY Medicaid |
$7,640.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,718.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,794.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
|
PINNACLE GRIPTN ACE SHEL 56MM
|
Facility
|
IP
|
$22,217.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,888.31 |
| Max. Negotiated Rate |
$21,329.09 |
| Rate for Payer: Aetna Commercial |
$17,107.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,329.88
|
| Rate for Payer: Cash Price |
$11,108.90
|
| Rate for Payer: Cigna Commercial |
$18,440.77
|
| Rate for Payer: First Health Commercial |
$21,106.91
|
| Rate for Payer: Humana Commercial |
$18,885.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,218.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,396.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,665.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,551.66
|
| Rate for Payer: Ohio Health Group HMO |
$16,663.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,443.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,887.52
|
| Rate for Payer: PHCS Commercial |
$21,329.09
|
| Rate for Payer: United Healthcare All Payer |
$19,551.66
|
|
