|
PINNACLE GRIPTN ACE SHEL 56MM
|
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 MTL INS NEUT 28 * 44
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 44
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 46
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 46
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 48
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 48
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 50
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 50
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 52
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 52
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 54
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 54
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 56
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 56
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 58
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 58
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 60
|
Facility
|
OP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem Medicaid |
$4,210.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Humana KY Medicaid |
$4,210.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,253.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 28 * 60
|
Facility
|
IP
|
$12,242.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,591.52 |
| Max. Negotiated Rate |
$11,752.80 |
| Rate for Payer: Aetna Commercial |
$9,426.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,549.15
|
| Rate for Payer: Cash Price |
$6,121.25
|
| Rate for Payer: Cigna Commercial |
$10,161.28
|
| Rate for Payer: First Health Commercial |
$11,630.38
|
| Rate for Payer: Humana Commercial |
$10,406.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,038.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,034.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,672.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,773.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,448.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,591.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.18
|
| Rate for Payer: PHCS Commercial |
$11,752.80
|
| Rate for Payer: United Healthcare All Payer |
$10,773.40
|
|
|
PINNACLE MTL INS NEUT 36 * 50
|
Facility
|
IP
|
$13,687.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.43 |
| Max. Negotiated Rate |
$13,140.38 |
| Rate for Payer: Aetna Commercial |
$10,539.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,676.56
|
| Rate for Payer: Cash Price |
$6,843.95
|
| Rate for Payer: Cigna Commercial |
$11,360.96
|
| Rate for Payer: First Health Commercial |
$13,003.50
|
| Rate for Payer: Humana Commercial |
$11,634.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,224.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,101.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,106.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,045.35
|
| Rate for Payer: Ohio Health Group HMO |
$10,265.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,737.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,243.25
|
| Rate for Payer: PHCS Commercial |
$13,140.38
|
| Rate for Payer: United Healthcare All Payer |
$12,045.35
|
|
|
PINNACLE MTL INS NEUT 36 * 50
|
Facility
|
OP
|
$13,687.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.43 |
| Max. Negotiated Rate |
$13,140.38 |
| Rate for Payer: Aetna Commercial |
$10,539.68
|
| Rate for Payer: Anthem Medicaid |
$4,707.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,676.56
|
| Rate for Payer: Cash Price |
$6,843.95
|
| Rate for Payer: Cigna Commercial |
$11,360.96
|
| Rate for Payer: First Health Commercial |
$13,003.50
|
| Rate for Payer: Humana Commercial |
$11,634.72
|
| Rate for Payer: Humana KY Medicaid |
$4,707.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,755.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,224.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,101.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,106.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,801.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,045.35
|
| Rate for Payer: Ohio Health Group HMO |
$10,265.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,737.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,243.25
|
| Rate for Payer: PHCS Commercial |
$13,140.38
|
| Rate for Payer: United Healthcare All Payer |
$12,045.35
|
|
|
PINNACLE MTL INS NEUT 36 * 52
|
Facility
|
OP
|
$13,687.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.43 |
| Max. Negotiated Rate |
$13,140.38 |
| Rate for Payer: Aetna Commercial |
$10,539.68
|
| Rate for Payer: Anthem Medicaid |
$4,707.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,676.56
|
| Rate for Payer: Cash Price |
$6,843.95
|
| Rate for Payer: Cigna Commercial |
$11,360.96
|
| Rate for Payer: First Health Commercial |
$13,003.50
|
| Rate for Payer: Humana Commercial |
$11,634.72
|
| Rate for Payer: Humana KY Medicaid |
$4,707.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4,755.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,224.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,101.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,106.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,801.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,045.35
|
| Rate for Payer: Ohio Health Group HMO |
$10,265.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,737.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,243.25
|
| Rate for Payer: PHCS Commercial |
$13,140.38
|
| Rate for Payer: United Healthcare All Payer |
$12,045.35
|
|
|
PINNACLE MTL INS NEUT 36 * 52
|
Facility
|
IP
|
$13,687.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,779.43 |
| Max. Negotiated Rate |
$13,140.38 |
| Rate for Payer: Aetna Commercial |
$10,539.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,676.56
|
| Rate for Payer: Cash Price |
$6,843.95
|
| Rate for Payer: Cigna Commercial |
$11,360.96
|
| Rate for Payer: First Health Commercial |
$13,003.50
|
| Rate for Payer: Humana Commercial |
$11,634.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,224.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,101.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,106.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,045.35
|
| Rate for Payer: Ohio Health Group HMO |
$10,265.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,737.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,243.25
|
| Rate for Payer: PHCS Commercial |
$13,140.38
|
| Rate for Payer: United Healthcare All Payer |
$12,045.35
|
|
|
PINNACLE MTL INS NEUT 36 * 54
|
Facility
|
IP
|
$14,207.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,846.95 |
| Max. Negotiated Rate |
$13,639.01 |
| Rate for Payer: Aetna Commercial |
$10,939.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,081.69
|
| Rate for Payer: Cash Price |
$7,103.65
|
| Rate for Payer: Cigna Commercial |
$11,792.06
|
| Rate for Payer: First Health Commercial |
$13,496.94
|
| Rate for Payer: Humana Commercial |
$12,076.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,649.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,484.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,502.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,655.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,404.26
|
| Rate for Payer: PHCS Commercial |
$13,639.01
|
| Rate for Payer: United Healthcare All Payer |
$12,502.42
|
|
|
PINNACLE MTL INS NEUT 36 * 54
|
Facility
|
OP
|
$14,207.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,846.95 |
| Max. Negotiated Rate |
$13,639.01 |
| Rate for Payer: Aetna Commercial |
$10,939.62
|
| Rate for Payer: Anthem Medicaid |
$4,885.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,081.69
|
| Rate for Payer: Cash Price |
$7,103.65
|
| Rate for Payer: Cigna Commercial |
$11,792.06
|
| Rate for Payer: First Health Commercial |
$13,496.94
|
| Rate for Payer: Humana Commercial |
$12,076.20
|
| Rate for Payer: Humana KY Medicaid |
$4,885.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,935.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,649.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,484.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,983.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,502.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,655.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,404.26
|
| Rate for Payer: PHCS Commercial |
$13,639.01
|
| Rate for Payer: United Healthcare All Payer |
$12,502.42
|
|
