|
PINNACLE MTL INS NEUT 36 * 56
|
Facility
|
IP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 56
|
Facility
|
OP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem Medicaid |
$4,536.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Humana KY Medicaid |
$4,536.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 58
|
Facility
|
OP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem Medicaid |
$4,536.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Humana KY Medicaid |
$4,536.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 58
|
Facility
|
IP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 60
|
Facility
|
IP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 60
|
Facility
|
OP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem Medicaid |
$4,536.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Humana KY Medicaid |
$4,536.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 62
|
Facility
|
IP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 62
|
Facility
|
OP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem Medicaid |
$4,536.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Humana KY Medicaid |
$4,536.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 64
|
Facility
|
OP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem Medicaid |
$4,536.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Humana KY Medicaid |
$4,536.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 64
|
Facility
|
IP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 66
|
Facility
|
OP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem Medicaid |
$4,536.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Humana KY Medicaid |
$4,536.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,582.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 36 * 66
|
Facility
|
IP
|
$13,191.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.90 |
| Max. Negotiated Rate |
$12,663.84 |
| Rate for Payer: Aetna Commercial |
$10,157.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,289.37
|
| Rate for Payer: Cash Price |
$6,595.75
|
| Rate for Payer: Cigna Commercial |
$10,948.94
|
| Rate for Payer: First Health Commercial |
$12,531.92
|
| Rate for Payer: Humana Commercial |
$11,212.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,817.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,735.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,957.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,608.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,893.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,638.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,714.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,089.36
|
| Rate for Payer: PHCS Commercial |
$12,663.84
|
| Rate for Payer: United Healthcare All Payer |
$11,608.52
|
|
|
PINNACLE MTL INS NEUT 40 * 56
|
Facility
|
IP
|
$20,400.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.01 |
| Max. Negotiated Rate |
$19,584.10 |
| Rate for Payer: Aetna Commercial |
$15,708.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,912.08
|
| Rate for Payer: Cash Price |
$10,200.05
|
| Rate for Payer: Cigna Commercial |
$16,932.08
|
| Rate for Payer: First Health Commercial |
$19,380.10
|
| Rate for Payer: Humana Commercial |
$17,340.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,728.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,055.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,120.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,952.09
|
| Rate for Payer: Ohio Health Group HMO |
$15,300.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,324.03
|
| Rate for Payer: PHCS Commercial |
$19,584.10
|
| Rate for Payer: United Healthcare All Payer |
$17,952.09
|
|
|
PINNACLE MTL INS NEUT 40 * 56
|
Facility
|
OP
|
$20,400.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.01 |
| Max. Negotiated Rate |
$19,584.10 |
| Rate for Payer: Aetna Commercial |
$15,708.08
|
| Rate for Payer: Anthem Medicaid |
$7,015.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,912.08
|
| Rate for Payer: Cash Price |
$10,200.05
|
| Rate for Payer: Cigna Commercial |
$16,932.08
|
| Rate for Payer: First Health Commercial |
$19,380.10
|
| Rate for Payer: Humana Commercial |
$17,340.08
|
| Rate for Payer: Humana KY Medicaid |
$7,015.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,086.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,728.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,055.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,120.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,156.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,952.09
|
| Rate for Payer: Ohio Health Group HMO |
$15,300.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,324.03
|
| Rate for Payer: PHCS Commercial |
$19,584.10
|
| Rate for Payer: United Healthcare All Payer |
$17,952.09
|
|
|
PINNACLE MTL INS NEUT 40 * 58
|
Facility
|
OP
|
$20,400.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.01 |
| Max. Negotiated Rate |
$19,584.10 |
| Rate for Payer: Aetna Commercial |
$15,708.08
|
| Rate for Payer: Anthem Medicaid |
$7,015.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,912.08
|
| Rate for Payer: Cash Price |
$10,200.05
|
| Rate for Payer: Cigna Commercial |
$16,932.08
|
| Rate for Payer: First Health Commercial |
$19,380.10
|
| Rate for Payer: Humana Commercial |
$17,340.08
|
| Rate for Payer: Humana KY Medicaid |
$7,015.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,086.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,728.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,055.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,120.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,156.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,952.09
|
| Rate for Payer: Ohio Health Group HMO |
$15,300.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,324.03
|
| Rate for Payer: PHCS Commercial |
$19,584.10
|
| Rate for Payer: United Healthcare All Payer |
$17,952.09
|
|
|
PINNACLE MTL INS NEUT 40 * 58
|
Facility
|
IP
|
$20,400.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.01 |
| Max. Negotiated Rate |
$19,584.10 |
| Rate for Payer: Aetna Commercial |
$15,708.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,912.08
|
| Rate for Payer: Cash Price |
$10,200.05
|
| Rate for Payer: Cigna Commercial |
$16,932.08
|
| Rate for Payer: First Health Commercial |
$19,380.10
|
| Rate for Payer: Humana Commercial |
$17,340.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,728.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,055.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,120.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,952.09
|
| Rate for Payer: Ohio Health Group HMO |
$15,300.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,080.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,652.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,324.03
|
| Rate for Payer: PHCS Commercial |
$19,584.10
|
| Rate for Payer: United Healthcare All Payer |
$17,952.09
|
|
|
PINNACLE MTL INS NEUT 40 * 60
|
Facility
|
IP
|
$21,648.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.25 |
| Max. Negotiated Rate |
$20,782.19 |
| Rate for Payer: Aetna Commercial |
$16,669.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,885.53
|
| Rate for Payer: Cash Price |
$10,824.05
|
| Rate for Payer: Cigna Commercial |
$17,967.93
|
| Rate for Payer: First Health Commercial |
$20,565.70
|
| Rate for Payer: Humana Commercial |
$18,400.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,751.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,976.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,494.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,050.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,236.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,329.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,814.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,710.91
|
| Rate for Payer: PHCS Commercial |
$20,782.19
|
| Rate for Payer: United Healthcare All Payer |
$19,050.34
|
|
|
PINNACLE MTL INS NEUT 40 * 60
|
Facility
|
OP
|
$21,648.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,814.25 |
| Max. Negotiated Rate |
$20,782.19 |
| Rate for Payer: Aetna Commercial |
$16,669.04
|
| Rate for Payer: Anthem Medicaid |
$7,444.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,885.53
|
| Rate for Payer: Cash Price |
$10,824.05
|
| Rate for Payer: Cigna Commercial |
$17,967.93
|
| Rate for Payer: First Health Commercial |
$20,565.70
|
| Rate for Payer: Humana Commercial |
$18,400.89
|
| Rate for Payer: Humana KY Medicaid |
$7,444.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,520.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,751.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,976.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,494.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,594.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,050.34
|
| Rate for Payer: Ohio Health Group HMO |
$16,236.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,329.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,814.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,710.91
|
| Rate for Payer: PHCS Commercial |
$20,782.19
|
| Rate for Payer: United Healthcare All Payer |
$19,050.34
|
|
|
PINNACLE MTL INS NEUT 40 * 62
|
Facility
|
IP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
PINNACLE MTL INS NEUT 40 * 62
|
Facility
|
OP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem Medicaid |
$7,048.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Humana KY Medicaid |
$7,048.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,119.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
PINNACLE MTL INS NEUT 44 * 64
|
Facility
|
IP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
PINNACLE MTL INS NEUT 44 * 64
|
Facility
|
OP
|
$20,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.35 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$15,781.15
|
| Rate for Payer: Anthem Medicaid |
$7,048.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,986.10
|
| Rate for Payer: Cash Price |
$10,247.50
|
| Rate for Payer: Cigna Commercial |
$17,010.85
|
| Rate for Payer: First Health Commercial |
$19,470.25
|
| Rate for Payer: Humana Commercial |
$17,420.75
|
| Rate for Payer: Humana KY Medicaid |
$7,048.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,119.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,805.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,125.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,148.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,035.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,664.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,353.45
|
| Rate for Payer: PHCS Commercial |
$19,675.20
|
| Rate for Payer: United Healthcare All Payer |
$18,035.60
|
|
|
PINNACLE MTL INS NEUT 44 * 66
|
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 44 * 66
|
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 MULTIHOLE II CUP 48MM
|
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: Anthem Medicaid |
$3,677.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,340.88
|
| Rate for Payer: Cash Price |
$5,346.72
|
| Rate for Payer: Cigna Commercial |
$8,875.56
|
| Rate for Payer: First Health Commercial |
$10,158.77
|
| Rate for Payer: Humana Commercial |
$9,089.42
|
| Rate for Payer: Humana KY Medicaid |
$3,677.47
|
| 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 POS/PPO/Traditional |
$7,891.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,208.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,751.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,410.23
|
| Rate for Payer: Ohio Health Group HMO |
$8,020.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,138.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,390.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,314.97
|
| Rate for Payer: PHCS Commercial |
$10,265.70
|
| Rate for Payer: United Healthcare All Payer |
$9,410.23
|
|
