|
PINNACLE ACET CUP 100*64MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 100*64MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 100*66MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 100*66MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*48MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*48MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*50MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*50MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*52MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*52MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*54MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*54MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*56MM
|
Facility
|
IP
|
$15,873.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,762.11 |
| Max. Negotiated Rate |
$15,238.75 |
| Rate for Payer: Aetna Commercial |
$12,222.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,381.49
|
| Rate for Payer: Cash Price |
$7,936.85
|
| Rate for Payer: Cigna Commercial |
$13,175.17
|
| Rate for Payer: First Health Commercial |
$15,080.01
|
| Rate for Payer: Humana Commercial |
$13,492.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,016.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,714.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,968.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,905.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,698.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,810.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,952.85
|
| Rate for Payer: PHCS Commercial |
$15,238.75
|
| Rate for Payer: United Healthcare All Payer |
$13,968.86
|
|
|
PINNACLE ACET CUP 300*56MM
|
Facility
|
OP
|
$15,873.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,762.11 |
| Max. Negotiated Rate |
$15,238.75 |
| Rate for Payer: Aetna Commercial |
$12,222.75
|
| Rate for Payer: Anthem Medicaid |
$5,458.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,381.49
|
| Rate for Payer: Cash Price |
$7,936.85
|
| Rate for Payer: Cigna Commercial |
$13,175.17
|
| Rate for Payer: First Health Commercial |
$15,080.01
|
| Rate for Payer: Humana Commercial |
$13,492.65
|
| Rate for Payer: Humana KY Medicaid |
$5,458.97
|
| Rate for Payer: Kentucky WC Medicaid |
$5,514.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,016.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,714.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,762.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,568.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,968.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,905.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,698.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,810.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,952.85
|
| Rate for Payer: PHCS Commercial |
$15,238.75
|
| Rate for Payer: United Healthcare All Payer |
$13,968.86
|
|
|
PINNACLE ACET CUP 300*58MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*58MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*60MM
|
Facility
|
OP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem Medicaid |
$5,400.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Humana KY Medicaid |
$5,400.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,455.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*60MM
|
Facility
|
IP
|
$15,703.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,711.05 |
| Max. Negotiated Rate |
$15,075.36 |
| Rate for Payer: Aetna Commercial |
$12,091.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,248.73
|
| Rate for Payer: Cash Price |
$7,851.75
|
| Rate for Payer: Cigna Commercial |
$13,033.91
|
| Rate for Payer: First Health Commercial |
$14,918.33
|
| Rate for Payer: Humana Commercial |
$13,347.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,876.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,589.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,711.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,819.08
|
| Rate for Payer: Ohio Health Group HMO |
$11,777.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,562.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,662.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,835.42
|
| Rate for Payer: PHCS Commercial |
$15,075.36
|
| Rate for Payer: United Healthcare All Payer |
$13,819.08
|
|
|
PINNACLE ACET CUP 300*62MM
|
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 300*62MM
|
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 300*64MM
|
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 300*64MM
|
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 300*66MM
|
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 300*66MM
|
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 MH SZ 52MM
|
Facility
|
OP
|
$10,933.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,280.18 |
| Max. Negotiated Rate |
$10,496.59 |
| Rate for Payer: Aetna Commercial |
$8,419.14
|
| Rate for Payer: Aetna Commercial |
$21,913.48
|
| Rate for Payer: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem Medicaid |
$9,787.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,198.07
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cash Price |
$14,229.53
|
| Rate for Payer: Cigna Commercial |
$23,621.02
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$27,036.11
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana Commercial |
$24,190.20
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| Rate for Payer: Humana KY Medicaid |
$9,787.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,886.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,798.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,965.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,336.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,002.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,983.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,043.97
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group HMO |
$21,344.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,767.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,759.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,636.75
|
| Rate for Payer: PHCS Commercial |
$27,320.70
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$25,043.97
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
