|
PINNACLE GRIPTION ACE SHELL 64
|
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 64
|
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 66
|
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 66
|
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 GRIPTN ACE SHEL 50MM
|
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 GRIPTN ACE SHEL 50MM
|
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 GRIPTN ACE SHEL 56MM
|
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 GRIPTN ACE SHEL 56MM
|
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 MTL INS NEUT 28 * 44
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 44
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 46
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 46
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 48
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 48
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 50
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 50
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 52
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 52
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 54
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 54
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 56
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 56
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 58
|
Facility
|
OP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem Medicaid |
$4,295.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Humana KY Medicaid |
$4,295.83
|
| Rate for Payer: Kentucky WC Medicaid |
$4,339.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 58
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
|
PINNACLE MTL INS NEUT 28 * 60
|
Facility
|
IP
|
$12,491.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,747.45 |
| Max. Negotiated Rate |
$11,991.84 |
| Rate for Payer: Aetna Commercial |
$9,618.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,743.37
|
| Rate for Payer: Cash Price |
$6,245.75
|
| Rate for Payer: Cigna Commercial |
$10,367.94
|
| Rate for Payer: First Health Commercial |
$11,866.92
|
| Rate for Payer: Humana Commercial |
$10,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,243.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,218.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,747.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,992.52
|
| Rate for Payer: Ohio Health Group HMO |
$9,368.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,993.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,867.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,619.14
|
| Rate for Payer: PHCS Commercial |
$11,991.84
|
| Rate for Payer: United Healthcare All Payer |
$10,992.52
|
|
