|
PINNACLE ACET CUP MH SZ 52MM
|
Facility
|
IP
|
$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 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 |
$9,075.18
|
| Rate for Payer: Cigna Commercial |
$23,621.02
|
| Rate for Payer: First Health Commercial |
$27,036.11
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$24,190.20
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| 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 |
$8,069.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,002.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,537.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| 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 |
$19,636.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: PHCS Commercial |
$27,320.70
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
| Rate for Payer: United Healthcare All Payer |
$25,043.97
|
|
|
PINNACLE ACET CUP MH SZ 54MM
|
Facility
|
OP
|
$28,459.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,537.72 |
| Max. Negotiated Rate |
$27,320.70 |
| Rate for Payer: Aetna Commercial |
$21,913.48
|
| Rate for Payer: Anthem Medicaid |
$9,787.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,198.07
|
| Rate for Payer: Cash Price |
$14,229.53
|
| Rate for Payer: Cigna Commercial |
$23,621.02
|
| Rate for Payer: First Health Commercial |
$27,036.11
|
| Rate for Payer: Humana Commercial |
$24,190.20
|
| Rate for Payer: Humana KY Medicaid |
$9,787.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,886.68
|
| 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: Molina Healthcare Benefit Exchange |
$8,537.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,983.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,043.97
|
| Rate for Payer: Ohio Health Group HMO |
$21,344.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,767.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,759.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,636.75
|
| Rate for Payer: PHCS Commercial |
$27,320.70
|
| Rate for Payer: United Healthcare All Payer |
$25,043.97
|
|
|
PINNACLE ACET CUP MH SZ 54MM
|
Facility
|
IP
|
$28,459.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,537.72 |
| Max. Negotiated Rate |
$27,320.70 |
| Rate for Payer: Aetna Commercial |
$21,913.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,198.07
|
| Rate for Payer: Cash Price |
$14,229.53
|
| Rate for Payer: Cigna Commercial |
$23,621.02
|
| Rate for Payer: First Health Commercial |
$27,036.11
|
| Rate for Payer: Humana Commercial |
$24,190.20
|
| 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: Molina Healthcare Benefit Exchange |
$8,537.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,043.97
|
| Rate for Payer: Ohio Health Group HMO |
$21,344.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,767.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,759.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,636.75
|
| Rate for Payer: PHCS Commercial |
$27,320.70
|
| Rate for Payer: United Healthcare All Payer |
$25,043.97
|
|
|
PINNACLE ACET CUP MH SZ 56 MM
|
Facility
|
IP
|
$23,498.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,049.62 |
| Max. Negotiated Rate |
$22,558.80 |
| Rate for Payer: Aetna Commercial |
$18,094.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,329.03
|
| Rate for Payer: Cash Price |
$11,749.38
|
| Rate for Payer: Cigna Commercial |
$19,503.96
|
| Rate for Payer: First Health Commercial |
$22,323.81
|
| Rate for Payer: Humana Commercial |
$19,973.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,342.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,049.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,678.90
|
| Rate for Payer: Ohio Health Group HMO |
$17,624.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,443.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,214.14
|
| Rate for Payer: PHCS Commercial |
$22,558.80
|
| Rate for Payer: United Healthcare All Payer |
$20,678.90
|
|
|
PINNACLE ACET CUP MH SZ 56 MM
|
Facility
|
OP
|
$23,498.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,049.62 |
| Max. Negotiated Rate |
$22,558.80 |
| Rate for Payer: Aetna Commercial |
$18,094.04
|
| Rate for Payer: Anthem Medicaid |
$8,081.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,329.03
|
| Rate for Payer: Cash Price |
$11,749.38
|
| Rate for Payer: Cigna Commercial |
$19,503.96
|
| Rate for Payer: First Health Commercial |
$22,323.81
|
| Rate for Payer: Humana Commercial |
$19,973.94
|
| Rate for Payer: Humana KY Medicaid |
$8,081.22
|
| Rate for Payer: Kentucky WC Medicaid |
$8,163.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,342.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,049.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,243.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,678.90
|
| Rate for Payer: Ohio Health Group HMO |
$17,624.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,443.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,214.14
|
| Rate for Payer: PHCS Commercial |
$22,558.80
|
| Rate for Payer: United Healthcare All Payer |
$20,678.90
|
|
|
PINNACLE ACET CUP MH SZ 62MM
|
Facility
|
OP
|
$9,153.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.17 |
| Max. Negotiated Rate |
$8,787.74 |
| Rate for Payer: Aetna Commercial |
$7,048.50
|
| Rate for Payer: Anthem Medicaid |
$3,148.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,140.04
|
| Rate for Payer: Cash Price |
$4,576.95
|
| Rate for Payer: Cigna Commercial |
$7,597.74
|
| Rate for Payer: First Health Commercial |
$8,696.20
|
| Rate for Payer: Humana Commercial |
$7,780.81
|
| Rate for Payer: Humana KY Medicaid |
$3,148.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,180.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,506.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,755.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,746.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,211.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,055.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,865.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,323.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,963.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,316.19
|
| Rate for Payer: PHCS Commercial |
$8,787.74
|
| Rate for Payer: United Healthcare All Payer |
$8,055.43
|
|
|
PINNACLE ACET CUP MH SZ 62MM
|
Facility
|
IP
|
$9,153.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,746.17 |
| Max. Negotiated Rate |
$8,787.74 |
| Rate for Payer: Aetna Commercial |
$7,048.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,140.04
|
| Rate for Payer: Cash Price |
$4,576.95
|
| Rate for Payer: Cigna Commercial |
$7,597.74
|
| Rate for Payer: First Health Commercial |
$8,696.20
|
| Rate for Payer: Humana Commercial |
$7,780.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,506.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,755.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,746.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,055.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,865.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,323.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,963.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,316.19
|
| Rate for Payer: PHCS Commercial |
$8,787.74
|
| Rate for Payer: United Healthcare All Payer |
$8,055.43
|
|
|
PINNACLE ACET CUP MULT HL SZ62
|
Facility
|
OP
|
$28,459.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,537.72 |
| Max. Negotiated Rate |
$27,320.70 |
| Rate for Payer: Aetna Commercial |
$21,913.48
|
| Rate for Payer: Anthem Medicaid |
$9,787.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,198.07
|
| Rate for Payer: Cash Price |
$14,229.53
|
| Rate for Payer: Cigna Commercial |
$23,621.02
|
| Rate for Payer: First Health Commercial |
$27,036.11
|
| Rate for Payer: Humana Commercial |
$24,190.20
|
| Rate for Payer: Humana KY Medicaid |
$9,787.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,886.68
|
| 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: Molina Healthcare Benefit Exchange |
$8,537.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,983.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,043.97
|
| Rate for Payer: Ohio Health Group HMO |
$21,344.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,767.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,759.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,636.75
|
| Rate for Payer: PHCS Commercial |
$27,320.70
|
| Rate for Payer: United Healthcare All Payer |
$25,043.97
|
|
|
PINNACLE ACET CUP MULT HL SZ62
|
Facility
|
IP
|
$28,459.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,537.72 |
| Max. Negotiated Rate |
$27,320.70 |
| Rate for Payer: Aetna Commercial |
$21,913.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,198.07
|
| Rate for Payer: Cash Price |
$14,229.53
|
| Rate for Payer: Cigna Commercial |
$23,621.02
|
| Rate for Payer: First Health Commercial |
$27,036.11
|
| Rate for Payer: Humana Commercial |
$24,190.20
|
| 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: Molina Healthcare Benefit Exchange |
$8,537.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,043.97
|
| Rate for Payer: Ohio Health Group HMO |
$21,344.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,767.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,759.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,636.75
|
| Rate for Payer: PHCS Commercial |
$27,320.70
|
| Rate for Payer: United Healthcare All Payer |
$25,043.97
|
|
|
PINNACLE DEST SHEATH 6FR 65CM
|
Facility
|
OP
|
$1,849.10
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.73 |
| Max. Negotiated Rate |
$1,775.14 |
| Rate for Payer: Aetna Commercial |
$1,423.81
|
| Rate for Payer: Anthem Medicaid |
$635.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,442.30
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna Commercial |
$1,534.75
|
| Rate for Payer: First Health Commercial |
$1,756.64
|
| Rate for Payer: Humana Commercial |
$1,571.73
|
| Rate for Payer: Humana KY Medicaid |
$635.91
|
| Rate for Payer: Kentucky WC Medicaid |
$642.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,516.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,364.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,627.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.88
|
| Rate for Payer: PHCS Commercial |
$1,775.14
|
| Rate for Payer: United Healthcare All Payer |
$1,627.21
|
|
|
PINNACLE DEST SHEATH 6FR 65CM
|
Facility
|
IP
|
$1,849.10
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.73 |
| Max. Negotiated Rate |
$1,775.14 |
| Rate for Payer: Aetna Commercial |
$1,423.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,442.30
|
| Rate for Payer: Cash Price |
$924.55
|
| Rate for Payer: Cigna Commercial |
$1,534.75
|
| Rate for Payer: First Health Commercial |
$1,756.64
|
| Rate for Payer: Humana Commercial |
$1,571.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,516.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,364.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,627.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.88
|
| Rate for Payer: PHCS Commercial |
$1,775.14
|
| Rate for Payer: United Healthcare All Payer |
$1,627.21
|
|
|
PINNACLE DEST SHEATH 7FR 65CM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PINNACLE DEST SHEATH 7FR 65CM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PINNACLE GRIPTION ACE SHELL 48
|
Facility
|
IP
|
$22,895.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,868.50 |
| Max. Negotiated Rate |
$21,979.20 |
| Rate for Payer: Aetna Commercial |
$17,629.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,858.10
|
| Rate for Payer: Cash Price |
$11,447.50
|
| Rate for Payer: Cigna Commercial |
$19,002.85
|
| Rate for Payer: First Health Commercial |
$21,750.25
|
| Rate for Payer: Humana Commercial |
$19,460.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,773.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,896.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,868.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,147.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,171.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,918.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,797.55
|
| Rate for Payer: PHCS Commercial |
$21,979.20
|
| Rate for Payer: United Healthcare All Payer |
$20,147.60
|
|
|
PINNACLE GRIPTION ACE SHELL 48
|
Facility
|
OP
|
$22,895.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,868.50 |
| Max. Negotiated Rate |
$21,979.20 |
| Rate for Payer: Aetna Commercial |
$17,629.15
|
| Rate for Payer: Anthem Medicaid |
$7,873.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,858.10
|
| Rate for Payer: Cash Price |
$11,447.50
|
| Rate for Payer: Cigna Commercial |
$19,002.85
|
| Rate for Payer: First Health Commercial |
$21,750.25
|
| Rate for Payer: Humana Commercial |
$19,460.75
|
| Rate for Payer: Humana KY Medicaid |
$7,873.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,953.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,773.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,896.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,868.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,031.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,147.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,171.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,918.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,797.55
|
| Rate for Payer: PHCS Commercial |
$21,979.20
|
| Rate for Payer: United Healthcare All Payer |
$20,147.60
|
|
|
PINNACLE GRIPTION ACE SHELL 52
|
Facility
|
OP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem Medicaid |
$2,475.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Humana KY Medicaid |
$2,475.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
PINNACLE GRIPTION ACE SHELL 52
|
Facility
|
IP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
PINNACLE GRIPTION ACE SHELL 54
|
Facility
|
IP
|
$22,895.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,868.50 |
| Max. Negotiated Rate |
$21,979.20 |
| Rate for Payer: Aetna Commercial |
$17,629.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,858.10
|
| Rate for Payer: Cash Price |
$11,447.50
|
| Rate for Payer: Cigna Commercial |
$19,002.85
|
| Rate for Payer: First Health Commercial |
$21,750.25
|
| Rate for Payer: Humana Commercial |
$19,460.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,773.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,896.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,868.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,147.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,171.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,918.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,797.55
|
| Rate for Payer: PHCS Commercial |
$21,979.20
|
| Rate for Payer: United Healthcare All Payer |
$20,147.60
|
|
|
PINNACLE GRIPTION ACE SHELL 54
|
Facility
|
OP
|
$22,895.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,868.50 |
| Max. Negotiated Rate |
$21,979.20 |
| Rate for Payer: Aetna Commercial |
$17,629.15
|
| Rate for Payer: Anthem Medicaid |
$7,873.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,858.10
|
| Rate for Payer: Cash Price |
$11,447.50
|
| Rate for Payer: Cigna Commercial |
$19,002.85
|
| Rate for Payer: First Health Commercial |
$21,750.25
|
| Rate for Payer: Humana Commercial |
$19,460.75
|
| Rate for Payer: Humana KY Medicaid |
$7,873.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,953.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,773.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,896.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,868.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,031.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,147.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,171.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,918.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,797.55
|
| Rate for Payer: PHCS Commercial |
$21,979.20
|
| Rate for Payer: United Healthcare All Payer |
$20,147.60
|
|
|
PINNACLE GRIPTION ACE SHELL 58
|
Facility
|
IP
|
$21,533.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.12 |
| Max. Negotiated Rate |
$20,672.40 |
| Rate for Payer: Aetna Commercial |
$16,580.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.33
|
| Rate for Payer: Cash Price |
$10,766.88
|
| Rate for Payer: Cigna Commercial |
$17,873.01
|
| Rate for Payer: First Health Commercial |
$20,457.06
|
| Rate for Payer: Humana Commercial |
$18,303.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.29
|
| Rate for Payer: PHCS Commercial |
$20,672.40
|
| Rate for Payer: United Healthcare All Payer |
$18,949.70
|
|
|
PINNACLE GRIPTION ACE SHELL 58
|
Facility
|
OP
|
$21,533.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.12 |
| Max. Negotiated Rate |
$20,672.40 |
| Rate for Payer: Aetna Commercial |
$16,580.99
|
| Rate for Payer: Anthem Medicaid |
$7,405.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.33
|
| Rate for Payer: Cash Price |
$10,766.88
|
| Rate for Payer: Cigna Commercial |
$17,873.01
|
| Rate for Payer: First Health Commercial |
$20,457.06
|
| Rate for Payer: Humana Commercial |
$18,303.69
|
| Rate for Payer: Humana KY Medicaid |
$7,405.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,480.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.29
|
| Rate for Payer: PHCS Commercial |
$20,672.40
|
| Rate for Payer: United Healthcare All Payer |
$18,949.70
|
|
|
PINNACLE GRIPTION ACE SHELL 60
|
Facility
|
IP
|
$21,533.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.12 |
| Max. Negotiated Rate |
$20,672.40 |
| Rate for Payer: Aetna Commercial |
$16,580.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.33
|
| Rate for Payer: Cash Price |
$10,766.88
|
| Rate for Payer: Cigna Commercial |
$17,873.01
|
| Rate for Payer: First Health Commercial |
$20,457.06
|
| Rate for Payer: Humana Commercial |
$18,303.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.29
|
| Rate for Payer: PHCS Commercial |
$20,672.40
|
| Rate for Payer: United Healthcare All Payer |
$18,949.70
|
|
|
PINNACLE GRIPTION ACE SHELL 60
|
Facility
|
OP
|
$21,533.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.12 |
| Max. Negotiated Rate |
$20,672.40 |
| Rate for Payer: Aetna Commercial |
$16,580.99
|
| Rate for Payer: Anthem Medicaid |
$7,405.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.33
|
| Rate for Payer: Cash Price |
$10,766.88
|
| Rate for Payer: Cigna Commercial |
$17,873.01
|
| Rate for Payer: First Health Commercial |
$20,457.06
|
| Rate for Payer: Humana Commercial |
$18,303.69
|
| Rate for Payer: Humana KY Medicaid |
$7,405.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,480.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.29
|
| Rate for Payer: PHCS Commercial |
$20,672.40
|
| Rate for Payer: United Healthcare All Payer |
$18,949.70
|
|
|
PINNACLE GRIPTION ACE SHELL 62
|
Facility
|
OP
|
$21,533.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.12 |
| Max. Negotiated Rate |
$20,672.40 |
| Rate for Payer: Aetna Commercial |
$16,580.99
|
| Rate for Payer: Anthem Medicaid |
$7,405.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.33
|
| Rate for Payer: Cash Price |
$10,766.88
|
| Rate for Payer: Cigna Commercial |
$17,873.01
|
| Rate for Payer: First Health Commercial |
$20,457.06
|
| Rate for Payer: Humana Commercial |
$18,303.69
|
| Rate for Payer: Humana KY Medicaid |
$7,405.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,480.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.29
|
| Rate for Payer: PHCS Commercial |
$20,672.40
|
| Rate for Payer: United Healthcare All Payer |
$18,949.70
|
|
|
PINNACLE GRIPTION ACE SHELL 62
|
Facility
|
IP
|
$21,533.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.12 |
| Max. Negotiated Rate |
$20,672.40 |
| Rate for Payer: Aetna Commercial |
$16,580.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.33
|
| Rate for Payer: Cash Price |
$10,766.88
|
| Rate for Payer: Cigna Commercial |
$17,873.01
|
| Rate for Payer: First Health Commercial |
$20,457.06
|
| Rate for Payer: Humana Commercial |
$18,303.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,227.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.29
|
| Rate for Payer: PHCS Commercial |
$20,672.40
|
| Rate for Payer: United Healthcare All Payer |
$18,949.70
|
|
