|
PIN FINGER DISLOCATION
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
76102603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
PIN FINGER DISLOCATION
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
76102603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.10 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
PIN FINGER DISLOCATION
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 26776
|
| Hospital Charge Code |
761P2603
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.27 |
| Max. Negotiated Rate |
$700.72 |
| Rate for Payer: Aetna Commercial |
$618.54
|
| Rate for Payer: Ambetter Exchange |
$430.66
|
| Rate for Payer: Anthem Medicaid |
$199.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$430.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$516.79
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$700.72
|
| Rate for Payer: Healthspan PPO |
$560.27
|
| Rate for Payer: Humana Medicaid |
$199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$535.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$430.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.26
|
| Rate for Payer: Molina Healthcare Passport |
$199.27
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$559.86
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$430.66
|
|
|
PIN GUIDE 3.2MMX343MM
|
Facility
|
IP
|
$1,923.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$1,846.27 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.10
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cigna Commercial |
$1,596.26
|
| Rate for Payer: First Health Commercial |
$1,827.04
|
| Rate for Payer: Humana Commercial |
$1,634.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.01
|
| Rate for Payer: PHCS Commercial |
$1,846.27
|
| Rate for Payer: United Healthcare All Payer |
$1,692.42
|
|
|
PIN GUIDE 3.2MMX343MM
|
Facility
|
OP
|
$1,923.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$1,846.27 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Anthem Medicaid |
$661.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.10
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cigna Commercial |
$1,596.26
|
| Rate for Payer: First Health Commercial |
$1,827.04
|
| Rate for Payer: Humana Commercial |
$1,634.72
|
| Rate for Payer: Humana KY Medicaid |
$661.39
|
| Rate for Payer: Kentucky WC Medicaid |
$668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.01
|
| Rate for Payer: PHCS Commercial |
$1,846.27
|
| Rate for Payer: United Healthcare All Payer |
$1,692.42
|
|
|
PIN HAND DISLOCATION
|
Facility
|
IP
|
$948.00
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
76100731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.40 |
| Max. Negotiated Rate |
$910.08 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.12
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
PIN HAND DISLOCATION
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
76100731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.86 |
| Max. Negotiated Rate |
$794.87 |
| Rate for Payer: Aetna Commercial |
$704.90
|
| Rate for Payer: Ambetter Exchange |
$488.22
|
| Rate for Payer: Anthem Medicaid |
$301.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$488.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$488.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$585.86
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$794.87
|
| Rate for Payer: Healthspan PPO |
$638.49
|
| Rate for Payer: Humana Medicaid |
$301.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$607.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$488.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$488.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.90
|
| Rate for Payer: Molina Healthcare Passport |
$301.86
|
| Rate for Payer: Multiplan PHCS |
$568.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.69
|
| Rate for Payer: UHCCP Medicaid |
$331.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$488.22
|
|
|
PIN HAND DISLOCATION
|
Facility
|
OP
|
$948.00
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
76100731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.02 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$729.96
|
| Rate for Payer: Anthem Medicaid |
$326.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$739.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$786.84
|
| Rate for Payer: First Health Commercial |
$900.60
|
| Rate for Payer: Humana Commercial |
$805.80
|
| Rate for Payer: Humana KY Medicaid |
$326.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$329.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$777.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$699.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$834.24
|
| Rate for Payer: Ohio Health Group HMO |
$711.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$758.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.12
|
| Rate for Payer: PHCS Commercial |
$910.08
|
| Rate for Payer: United Healthcare All Payer |
$834.24
|
|
|
PIN HAND DISLOCATION(P
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
761P0731
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.86 |
| Max. Negotiated Rate |
$794.87 |
| Rate for Payer: Aetna Commercial |
$704.90
|
| Rate for Payer: Ambetter Exchange |
$488.22
|
| Rate for Payer: Anthem Medicaid |
$301.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$488.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$488.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$585.86
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cash Price |
$474.00
|
| Rate for Payer: Cigna Commercial |
$794.87
|
| Rate for Payer: Healthspan PPO |
$638.49
|
| Rate for Payer: Humana Medicaid |
$301.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$607.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$488.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$488.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.90
|
| Rate for Payer: Molina Healthcare Passport |
$301.86
|
| Rate for Payer: Multiplan PHCS |
$568.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.69
|
| Rate for Payer: UHCCP Medicaid |
$331.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$488.22
|
|
|
PIN MIS RIMMED 3.2*45MM
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
PIN MIS RIMMED 3.2*45MM
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
PINNACLE ACET CUP 100*48MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*48MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*50MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*50MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*52MM
|
Facility
|
IP
|
$9,100.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.13 |
| Max. Negotiated Rate |
$8,736.41 |
| Rate for Payer: Aetna Commercial |
$7,007.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.34
|
| Rate for Payer: Cash Price |
$4,550.21
|
| Rate for Payer: Cigna Commercial |
$7,553.36
|
| Rate for Payer: First Health Commercial |
$8,645.41
|
| Rate for Payer: Humana Commercial |
$7,735.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,462.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,716.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,008.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,825.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,280.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,917.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,279.30
|
| Rate for Payer: PHCS Commercial |
$8,736.41
|
| Rate for Payer: United Healthcare All Payer |
$8,008.38
|
|
|
PINNACLE ACET CUP 100*52MM
|
Facility
|
OP
|
$9,100.43
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,730.13 |
| Max. Negotiated Rate |
$8,736.41 |
| Rate for Payer: Aetna Commercial |
$7,007.33
|
| Rate for Payer: Anthem Medicaid |
$3,129.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.34
|
| Rate for Payer: Cash Price |
$4,550.21
|
| Rate for Payer: Cigna Commercial |
$7,553.36
|
| Rate for Payer: First Health Commercial |
$8,645.41
|
| Rate for Payer: Humana Commercial |
$7,735.37
|
| Rate for Payer: Humana KY Medicaid |
$3,129.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,161.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,462.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,716.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,192.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,008.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,825.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,280.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,917.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,279.30
|
| Rate for Payer: PHCS Commercial |
$8,736.41
|
| Rate for Payer: United Healthcare All Payer |
$8,008.38
|
|
|
PINNACLE ACET CUP 100*54MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*54MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*56MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*56MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*58MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*58MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*60MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE ACET CUP 100*60MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
