|
PINNACLE R/O II 6CM 5F
|
Facility
|
OP
|
$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 Medicaid |
$174.27
|
| 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: Humana KY Medicaid |
$174.27
|
| Rate for Payer: Kentucky WC Medicaid |
$176.04
|
| 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: Molina Healthcare Medicaid |
$177.77
|
| 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
|
|
|
PINNACLE ROII SHEATH 6CM 6F
|
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
|
|
|
PINNACLE ROII SHEATH 6CM 6F
|
Facility
|
OP
|
$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 Medicaid |
$174.27
|
| 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: Humana KY Medicaid |
$174.27
|
| Rate for Payer: Kentucky WC Medicaid |
$176.04
|
| 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: Molina Healthcare Medicaid |
$177.77
|
| 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
|
|
|
PINNACLE ROII SHEATH 6CM 7F
|
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
|
|
|
PINNACLE ROII SHEATH 6CM 7F
|
Facility
|
OP
|
$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 Medicaid |
$174.27
|
| 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: Humana KY Medicaid |
$174.27
|
| Rate for Payer: Kentucky WC Medicaid |
$176.04
|
| 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: Molina Healthcare Medicaid |
$177.77
|
| 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
|
|
|
PINNACLE SECTOR II CUP 48MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 48MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 50MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 50MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 52MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 52MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 54MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 54MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 56MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 56MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 58MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 58MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 60MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 60MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 62MM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 62MM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PINNACLE SECTOR II CUP 64MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 64MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 66MM
|
Facility
|
OP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem Medicaid |
$3,221.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Humana KY Medicaid |
$3,221.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
|
PINNACLE SECTOR II CUP 66MM
|
Facility
|
IP
|
$9,368.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.56 |
| Max. Negotiated Rate |
$8,993.78 |
| Rate for Payer: Aetna Commercial |
$7,213.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.45
|
| Rate for Payer: Cash Price |
$4,684.26
|
| Rate for Payer: Cigna Commercial |
$7,775.87
|
| Rate for Payer: First Health Commercial |
$8,900.09
|
| Rate for Payer: Humana Commercial |
$7,963.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,682.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,244.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,464.28
|
| Rate for Payer: PHCS Commercial |
$8,993.78
|
| Rate for Payer: United Healthcare All Payer |
$8,244.30
|
|
