PINNACLE MULTIHOLE II CUP 48MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 50MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 50MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 54MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 54MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 56MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 56MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 58MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 58MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 60MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 60MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 64MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE MULTIHOLE II CUP 64MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 66MM
|
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
|
|
PINNACLE MULTIHOLE II CUP 66MM
|
Facility
|
IP
|
$10,693.44
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,390.15 |
Max. Negotiated Rate |
$10,265.70 |
Rate for Payer: Aetna Commercial |
$8,233.95
|
Rate for Payer: 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: 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: 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
|
|
PINNACLE R02 MARKER SHEAT
|
Facility
|
IP
|
$514.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$66.88 |
Max. Negotiated Rate |
$493.92 |
Rate for Payer: Aetna Commercial |
$396.16
|
Rate for Payer: Anthem POS/PPO/Traditional |
$401.31
|
Rate for Payer: Cash Price |
$257.25
|
Rate for Payer: Cigna Commercial |
$427.04
|
Rate for Payer: First Health Commercial |
$488.78
|
Rate for Payer: Humana Commercial |
$437.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$421.89
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.70
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$154.35
|
Rate for Payer: Ohio Health Choice Commercial |
$452.76
|
Rate for Payer: Ohio Health Group HMO |
$385.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$102.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$66.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.50
|
Rate for Payer: PHCS Commercial |
$493.92
|
Rate for Payer: United Healthcare All Payer |
$452.76
|
|
PINNACLE R02 MARKER SHEAT
|
Facility
|
OP
|
$514.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$66.88 |
Max. Negotiated Rate |
$493.92 |
Rate for Payer: Aetna Commercial |
$396.16
|
Rate for Payer: Anthem Medicaid |
$176.94
|
Rate for Payer: Anthem POS/PPO/Traditional |
$401.31
|
Rate for Payer: Cash Price |
$257.25
|
Rate for Payer: Cigna Commercial |
$427.04
|
Rate for Payer: First Health Commercial |
$488.78
|
Rate for Payer: Humana Commercial |
$437.32
|
Rate for Payer: Humana KY Medicaid |
$176.94
|
Rate for Payer: Kentucky WC Medicaid |
$178.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$421.89
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$379.70
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$154.35
|
Rate for Payer: Molina Healthcare Medicaid |
$180.49
|
Rate for Payer: Ohio Health Choice Commercial |
$452.76
|
Rate for Payer: Ohio Health Group HMO |
$385.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$102.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$66.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.50
|
Rate for Payer: PHCS Commercial |
$493.92
|
Rate for Payer: United Healthcare All Payer |
$452.76
|
|
PINNACLE R/O II 6CM 5F
|
Facility
|
OP
|
$501.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$65.20 |
Max. Negotiated Rate |
$481.44 |
Rate for Payer: Aetna Commercial |
$386.16
|
Rate for Payer: Anthem Medicaid |
$172.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
Rate for Payer: Cash Price |
$250.75
|
Rate for Payer: Cigna Commercial |
$416.24
|
Rate for Payer: First Health Commercial |
$476.42
|
Rate for Payer: Humana Commercial |
$426.28
|
Rate for Payer: Humana KY Medicaid |
$172.47
|
Rate for Payer: Kentucky WC Medicaid |
$174.22
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
Rate for Payer: Molina Healthcare Medicaid |
$175.93
|
Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
Rate for Payer: Ohio Health Group HMO |
$376.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
Rate for Payer: PHCS Commercial |
$481.44
|
Rate for Payer: United Healthcare All Payer |
$441.32
|
|
PINNACLE R/O II 6CM 5F
|
Facility
|
IP
|
$501.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$65.20 |
Max. Negotiated Rate |
$481.44 |
Rate for Payer: Aetna Commercial |
$386.16
|
Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
Rate for Payer: Cash Price |
$250.75
|
Rate for Payer: Cigna Commercial |
$416.24
|
Rate for Payer: First Health Commercial |
$476.42
|
Rate for Payer: Humana Commercial |
$426.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
Rate for Payer: Ohio Health Group HMO |
$376.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
Rate for Payer: PHCS Commercial |
$481.44
|
Rate for Payer: United Healthcare All Payer |
$441.32
|
|
PINNACLE ROII SHEATH 6CM 6F
|
Facility
|
OP
|
$501.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$65.20 |
Max. Negotiated Rate |
$481.44 |
Rate for Payer: Aetna Commercial |
$386.16
|
Rate for Payer: Anthem Medicaid |
$172.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
Rate for Payer: Cash Price |
$250.75
|
Rate for Payer: Cigna Commercial |
$416.24
|
Rate for Payer: First Health Commercial |
$476.42
|
Rate for Payer: Humana Commercial |
$426.28
|
Rate for Payer: Humana KY Medicaid |
$172.47
|
Rate for Payer: Kentucky WC Medicaid |
$174.22
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
Rate for Payer: Molina Healthcare Medicaid |
$175.93
|
Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
Rate for Payer: Ohio Health Group HMO |
$376.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
Rate for Payer: PHCS Commercial |
$481.44
|
Rate for Payer: United Healthcare All Payer |
$441.32
|
|
PINNACLE ROII SHEATH 6CM 6F
|
Facility
|
IP
|
$501.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$65.20 |
Max. Negotiated Rate |
$481.44 |
Rate for Payer: Aetna Commercial |
$386.16
|
Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
Rate for Payer: Cash Price |
$250.75
|
Rate for Payer: Cigna Commercial |
$416.24
|
Rate for Payer: First Health Commercial |
$476.42
|
Rate for Payer: Humana Commercial |
$426.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
Rate for Payer: Ohio Health Group HMO |
$376.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
Rate for Payer: PHCS Commercial |
$481.44
|
Rate for Payer: United Healthcare All Payer |
$441.32
|
|
PINNACLE ROII SHEATH 6CM 7F
|
Facility
|
IP
|
$501.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$65.20 |
Max. Negotiated Rate |
$481.44 |
Rate for Payer: Aetna Commercial |
$386.16
|
Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
Rate for Payer: Cash Price |
$250.75
|
Rate for Payer: Cigna Commercial |
$416.24
|
Rate for Payer: First Health Commercial |
$476.42
|
Rate for Payer: Humana Commercial |
$426.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
Rate for Payer: Ohio Health Group HMO |
$376.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
Rate for Payer: PHCS Commercial |
$481.44
|
Rate for Payer: United Healthcare All Payer |
$441.32
|
|
PINNACLE ROII SHEATH 6CM 7F
|
Facility
|
OP
|
$501.50
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$65.20 |
Max. Negotiated Rate |
$481.44 |
Rate for Payer: Aetna Commercial |
$386.16
|
Rate for Payer: Anthem Medicaid |
$172.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$391.17
|
Rate for Payer: Cash Price |
$250.75
|
Rate for Payer: Cigna Commercial |
$416.24
|
Rate for Payer: First Health Commercial |
$476.42
|
Rate for Payer: Humana Commercial |
$426.28
|
Rate for Payer: Humana KY Medicaid |
$172.47
|
Rate for Payer: Kentucky WC Medicaid |
$174.22
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$411.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$370.11
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$150.45
|
Rate for Payer: Molina Healthcare Medicaid |
$175.93
|
Rate for Payer: Ohio Health Choice Commercial |
$441.32
|
Rate for Payer: Ohio Health Group HMO |
$376.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$100.30
|
Rate for Payer: Ohio Health Group PPO No Differential |
$65.20
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.46
|
Rate for Payer: PHCS Commercial |
$481.44
|
Rate for Payer: United Healthcare All Payer |
$441.32
|
|
PINNACLE R/O SHEATH 5F 6CM
|
Facility
|
OP
|
$486.88
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$63.29 |
Max. Negotiated Rate |
$467.40 |
Rate for Payer: Aetna Commercial |
$374.90
|
Rate for Payer: Anthem Medicaid |
$167.44
|
Rate for Payer: Anthem POS/PPO/Traditional |
$379.77
|
Rate for Payer: Cash Price |
$243.44
|
Rate for Payer: Cigna Commercial |
$404.11
|
Rate for Payer: First Health Commercial |
$462.54
|
Rate for Payer: Humana Commercial |
$413.85
|
Rate for Payer: Humana KY Medicaid |
$167.44
|
Rate for Payer: Kentucky WC Medicaid |
$169.14
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$399.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$146.06
|
Rate for Payer: Molina Healthcare Medicaid |
$170.80
|
Rate for Payer: Ohio Health Choice Commercial |
$428.45
|
Rate for Payer: Ohio Health Group HMO |
$365.16
|
Rate for Payer: Ohio Health Group PPO Differential |
$97.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$63.29
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.93
|
Rate for Payer: PHCS Commercial |
$467.40
|
Rate for Payer: United Healthcare All Payer |
$428.45
|
|
PINNACLE R/O SHEATH 5F 6CM
|
Facility
|
IP
|
$486.88
|
|
Service Code
|
HCPCS C1894
|
Hospital Charge Code |
27000113
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$63.29 |
Max. Negotiated Rate |
$467.40 |
Rate for Payer: Aetna Commercial |
$374.90
|
Rate for Payer: Anthem POS/PPO/Traditional |
$379.77
|
Rate for Payer: Cash Price |
$243.44
|
Rate for Payer: Cigna Commercial |
$404.11
|
Rate for Payer: First Health Commercial |
$462.54
|
Rate for Payer: Humana Commercial |
$413.85
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$399.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$146.06
|
Rate for Payer: Ohio Health Choice Commercial |
$428.45
|
Rate for Payer: Ohio Health Group HMO |
$365.16
|
Rate for Payer: Ohio Health Group PPO Differential |
$97.38
|
Rate for Payer: Ohio Health Group PPO No Differential |
$63.29
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.93
|
Rate for Payer: PHCS Commercial |
$467.40
|
Rate for Payer: United Healthcare All Payer |
$428.45
|
|