|
PINNACLE SECTOR II CUP 48MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 48MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 50MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 50MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 52MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PINNACLE SECTOR II CUP 52MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PINNACLE SECTOR II CUP 54MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PINNACLE SECTOR II CUP 54MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PINNACLE SECTOR II CUP 56MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 56MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 58MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 58MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 60MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 60MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 62MM
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PINNACLE SECTOR II CUP 62MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PINNACLE SECTOR II CUP 64MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 64MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 66MM
|
Facility
|
OP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem Medicaid |
$3,153.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Humana KY Medicaid |
$3,153.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SECTOR II CUP 66MM
|
Facility
|
IP
|
$9,168.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,191.91 |
| Max. Negotiated Rate |
$8,801.78 |
| Rate for Payer: Aetna Commercial |
$7,059.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,151.45
|
| Rate for Payer: Cash Price |
$4,584.26
|
| Rate for Payer: Cigna Commercial |
$7,609.87
|
| Rate for Payer: First Health Commercial |
$8,710.09
|
| Rate for Payer: Humana Commercial |
$7,793.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,518.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,766.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,750.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,068.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,876.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,833.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,191.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.24
|
| Rate for Payer: PHCS Commercial |
$8,801.78
|
| Rate for Payer: United Healthcare All Payer |
$8,068.30
|
|
|
PINNACLE SHEATH 10F
|
Facility
|
IP
|
$163.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.23
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cigna Commercial |
$135.39
|
| Rate for Payer: First Health Commercial |
$154.96
|
| Rate for Payer: Humana Commercial |
$138.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.55
|
| Rate for Payer: Ohio Health Group HMO |
$122.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.57
|
| Rate for Payer: PHCS Commercial |
$156.60
|
| Rate for Payer: United Healthcare All Payer |
$143.55
|
|
|
PINNACLE SHEATH 10F
|
Facility
|
OP
|
$163.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Anthem Medicaid |
$56.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.23
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cigna Commercial |
$135.39
|
| Rate for Payer: First Health Commercial |
$154.96
|
| Rate for Payer: Humana Commercial |
$138.65
|
| Rate for Payer: Humana KY Medicaid |
$56.10
|
| Rate for Payer: Kentucky WC Medicaid |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.55
|
| Rate for Payer: Ohio Health Group HMO |
$122.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.57
|
| Rate for Payer: PHCS Commercial |
$156.60
|
| Rate for Payer: United Healthcare All Payer |
$143.55
|
|
|
PINNACLE SHEATH 11F
|
Facility
|
OP
|
$1,533.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.36 |
| Max. Negotiated Rate |
$1,472.16 |
| Rate for Payer: Aetna Commercial |
$1,180.80
|
| Rate for Payer: Anthem Medicaid |
$527.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,196.13
|
| Rate for Payer: Cash Price |
$766.75
|
| Rate for Payer: Cigna Commercial |
$1,272.80
|
| Rate for Payer: First Health Commercial |
$1,456.82
|
| Rate for Payer: Humana Commercial |
$1,303.48
|
| Rate for Payer: Humana KY Medicaid |
$527.37
|
| Rate for Payer: Kentucky WC Medicaid |
$532.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,257.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,131.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,349.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,150.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$475.38
|
| Rate for Payer: PHCS Commercial |
$1,472.16
|
| Rate for Payer: United Healthcare All Payer |
$1,349.48
|
|
|
PINNACLE SHEATH 11F
|
Facility
|
IP
|
$1,533.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.36 |
| Max. Negotiated Rate |
$1,472.16 |
| Rate for Payer: Aetna Commercial |
$1,180.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,196.13
|
| Rate for Payer: Cash Price |
$766.75
|
| Rate for Payer: Cigna Commercial |
$1,272.80
|
| Rate for Payer: First Health Commercial |
$1,456.82
|
| Rate for Payer: Humana Commercial |
$1,303.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,257.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,131.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,349.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,150.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$475.38
|
| Rate for Payer: PHCS Commercial |
$1,472.16
|
| Rate for Payer: United Healthcare All Payer |
$1,349.48
|
|
|
PINNACLE SHEATH 25CM 5FR
|
Facility
|
IP
|
$494.68
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$474.89 |
| Rate for Payer: Aetna Commercial |
$380.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.85
|
| Rate for Payer: Cash Price |
$247.34
|
| Rate for Payer: Cigna Commercial |
$410.58
|
| Rate for Payer: First Health Commercial |
$469.95
|
| Rate for Payer: Humana Commercial |
$420.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.32
|
| Rate for Payer: Ohio Health Group HMO |
$371.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.35
|
| Rate for Payer: PHCS Commercial |
$474.89
|
| Rate for Payer: United Healthcare All Payer |
$435.32
|
|
