|
PINNACLE MTL INS NEUT 40 * 62
|
Facility
|
IP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
PINNACLE MTL INS NEUT 40 * 62
|
Facility
|
OP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem Medicaid |
$7,264.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Humana KY Medicaid |
$7,264.89
|
| Rate for Payer: Kentucky WC Medicaid |
$7,338.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,410.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
PINNACLE MTL INS NEUT 44 * 64
|
Facility
|
OP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem Medicaid |
$7,264.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Humana KY Medicaid |
$7,264.89
|
| Rate for Payer: Kentucky WC Medicaid |
$7,338.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,410.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
PINNACLE MTL INS NEUT 44 * 64
|
Facility
|
IP
|
$21,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,337.50 |
| Max. Negotiated Rate |
$20,280.00 |
| Rate for Payer: Aetna Commercial |
$16,266.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,477.50
|
| Rate for Payer: Cash Price |
$10,562.50
|
| Rate for Payer: Cigna Commercial |
$17,533.75
|
| Rate for Payer: First Health Commercial |
$20,068.75
|
| Rate for Payer: Humana Commercial |
$17,956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,322.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,590.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,590.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,378.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,576.25
|
| Rate for Payer: PHCS Commercial |
$20,280.00
|
| Rate for Payer: United Healthcare All Payer |
$18,590.00
|
|
|
PINNACLE MTL INS NEUT 44 * 66
|
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 44 * 66
|
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 MULTIHOLE II CUP 48MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 48MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 50MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 50MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 54MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 54MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 56MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 56MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 58MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 58MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 60MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 60MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 64MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 64MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 66MM
|
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: Anthem Medicaid |
$3,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| Rate for Payer: Humana Commercial |
$9,293.86
|
| Rate for Payer: Humana KY Medicaid |
$3,760.19
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,280.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,835.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,621.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE MULTIHOLE II CUP 66MM
|
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: Anthem POS/PPO/Traditional |
$8,528.48
|
| Rate for Payer: Cash Price |
$5,466.98
|
| Rate for Payer: Cigna Commercial |
$9,075.18
|
| Rate for Payer: First Health Commercial |
$10,387.25
|
| 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 POS/PPO/Traditional |
$8,069.26
|
| 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 Group HMO |
$8,200.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,747.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,512.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,544.43
|
| Rate for Payer: PHCS Commercial |
$10,496.59
|
| Rate for Payer: United Healthcare All Payer |
$9,621.88
|
|
|
PINNACLE R02 MARKER SHEAT
|
Facility
|
IP
|
$520.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$499.44 |
| Rate for Payer: Aetna Commercial |
$400.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.80
|
| Rate for Payer: Cash Price |
$260.12
|
| Rate for Payer: Cigna Commercial |
$431.81
|
| Rate for Payer: First Health Commercial |
$494.24
|
| Rate for Payer: Humana Commercial |
$442.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.82
|
| Rate for Payer: Ohio Health Group HMO |
$390.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.97
|
| Rate for Payer: PHCS Commercial |
$499.44
|
| Rate for Payer: United Healthcare All Payer |
$457.82
|
|
|
PINNACLE R02 MARKER SHEAT
|
Facility
|
OP
|
$520.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.07 |
| Max. Negotiated Rate |
$499.44 |
| Rate for Payer: Aetna Commercial |
$400.59
|
| Rate for Payer: Anthem Medicaid |
$178.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.80
|
| Rate for Payer: Cash Price |
$260.12
|
| Rate for Payer: Cigna Commercial |
$431.81
|
| Rate for Payer: First Health Commercial |
$494.24
|
| Rate for Payer: Humana Commercial |
$442.21
|
| Rate for Payer: Humana KY Medicaid |
$178.91
|
| Rate for Payer: Kentucky WC Medicaid |
$180.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.82
|
| Rate for Payer: Ohio Health Group HMO |
$390.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.97
|
| Rate for Payer: PHCS Commercial |
$499.44
|
| Rate for Payer: United Healthcare All Payer |
$457.82
|
|
|
PINNACLE R/O II 6CM 5F
|
Facility
|
IP
|
$506.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.03 |
| Max. Negotiated Rate |
$486.48 |
| Rate for Payer: Aetna Commercial |
$390.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.26
|
| Rate for Payer: Cash Price |
$253.38
|
| Rate for Payer: Cigna Commercial |
$420.60
|
| Rate for Payer: First Health Commercial |
$481.41
|
| Rate for Payer: Humana Commercial |
$430.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.94
|
| Rate for Payer: Ohio Health Group HMO |
$380.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.66
|
| Rate for Payer: PHCS Commercial |
$486.48
|
| Rate for Payer: United Healthcare All Payer |
$445.94
|
|
