|
PINNACLE SHEATH 10F
|
Facility
|
IP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
PINNACLE SHEATH 10F
|
Facility
|
OP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem Medicaid |
$57.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Humana KY Medicaid |
$57.45
|
| Rate for Payer: Kentucky WC Medicaid |
$58.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
PINNACLE SHEATH 11F
|
Facility
|
OP
|
$1,507.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.34 |
| Max. Negotiated Rate |
$1,447.49 |
| Rate for Payer: Aetna Commercial |
$1,161.01
|
| Rate for Payer: Anthem Medicaid |
$518.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,176.08
|
| Rate for Payer: Cash Price |
$753.90
|
| Rate for Payer: Cigna Commercial |
$1,251.47
|
| Rate for Payer: First Health Commercial |
$1,432.41
|
| Rate for Payer: Humana Commercial |
$1,281.63
|
| Rate for Payer: Humana KY Medicaid |
$518.53
|
| Rate for Payer: Kentucky WC Medicaid |
$523.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,236.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,112.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$528.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,326.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,130.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,311.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.38
|
| Rate for Payer: PHCS Commercial |
$1,447.49
|
| Rate for Payer: United Healthcare All Payer |
$1,326.86
|
|
|
PINNACLE SHEATH 11F
|
Facility
|
IP
|
$1,507.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.34 |
| Max. Negotiated Rate |
$1,447.49 |
| Rate for Payer: Aetna Commercial |
$1,161.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,176.08
|
| Rate for Payer: Cash Price |
$753.90
|
| Rate for Payer: Cigna Commercial |
$1,251.47
|
| Rate for Payer: First Health Commercial |
$1,432.41
|
| Rate for Payer: Humana Commercial |
$1,281.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,236.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,112.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,326.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,130.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,311.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,040.38
|
| Rate for Payer: PHCS Commercial |
$1,447.49
|
| Rate for Payer: United Healthcare All Payer |
$1,326.86
|
|
|
PINNACLE SHEATH 25CM 5FR
|
Facility
|
IP
|
$499.66
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.90 |
| Max. Negotiated Rate |
$479.67 |
| Rate for Payer: Aetna Commercial |
$384.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.73
|
| Rate for Payer: Cash Price |
$249.83
|
| Rate for Payer: Cigna Commercial |
$414.72
|
| Rate for Payer: First Health Commercial |
$474.68
|
| Rate for Payer: Humana Commercial |
$424.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.70
|
| Rate for Payer: Ohio Health Group HMO |
$374.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.77
|
| Rate for Payer: PHCS Commercial |
$479.67
|
| Rate for Payer: United Healthcare All Payer |
$439.70
|
|
|
PINNACLE SHEATH 25CM 5FR
|
Facility
|
OP
|
$499.66
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.90 |
| Max. Negotiated Rate |
$479.67 |
| Rate for Payer: Aetna Commercial |
$384.74
|
| Rate for Payer: Anthem Medicaid |
$171.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.73
|
| Rate for Payer: Cash Price |
$249.83
|
| Rate for Payer: Cigna Commercial |
$414.72
|
| Rate for Payer: First Health Commercial |
$474.68
|
| Rate for Payer: Humana Commercial |
$424.71
|
| Rate for Payer: Humana KY Medicaid |
$171.83
|
| Rate for Payer: Kentucky WC Medicaid |
$173.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.70
|
| Rate for Payer: Ohio Health Group HMO |
$374.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$434.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$344.77
|
| Rate for Payer: PHCS Commercial |
$479.67
|
| Rate for Payer: United Healthcare All Payer |
$439.70
|
|
|
PINNACLE SHEATH 25CM 7FR
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem Medicaid |
$190.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Humana KY Medicaid |
$190.52
|
| Rate for Payer: Kentucky WC Medicaid |
$192.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
PINNACLE SHEATH 25CM 7FR
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
PINNACLE SHEATH 4FR
|
Facility
|
OP
|
$452.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem Medicaid |
$155.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Humana KY Medicaid |
$155.70
|
| Rate for Payer: Kentucky WC Medicaid |
$157.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
PINNACLE SHEATH 4FR
|
Facility
|
IP
|
$452.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
PINNACLE SHEATH 5FR
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem Medicaid |
$523.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Humana KY Medicaid |
$523.76
|
| Rate for Payer: Kentucky WC Medicaid |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
PINNACLE SHEATH 5FR
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
PINNACLE SHEATH 6F 25CM
|
Facility
|
OP
|
$807.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$621.77
|
| Rate for Payer: Anthem Medicaid |
$277.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.85
|
| Rate for Payer: Cash Price |
$403.75
|
| Rate for Payer: Cigna Commercial |
$670.23
|
| Rate for Payer: First Health Commercial |
$767.12
|
| Rate for Payer: Humana Commercial |
$686.38
|
| Rate for Payer: Humana KY Medicaid |
$277.70
|
| Rate for Payer: Kentucky WC Medicaid |
$280.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.60
|
| Rate for Payer: Ohio Health Group HMO |
$605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.17
|
| Rate for Payer: PHCS Commercial |
$775.20
|
| Rate for Payer: United Healthcare All Payer |
$710.60
|
|
|
PINNACLE SHEATH 6F 25CM
|
Facility
|
IP
|
$807.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$621.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.85
|
| Rate for Payer: Cash Price |
$403.75
|
| Rate for Payer: Cigna Commercial |
$670.23
|
| Rate for Payer: First Health Commercial |
$767.12
|
| Rate for Payer: Humana Commercial |
$686.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.60
|
| Rate for Payer: Ohio Health Group HMO |
$605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.17
|
| Rate for Payer: PHCS Commercial |
$775.20
|
| Rate for Payer: United Healthcare All Payer |
$710.60
|
|
|
PINNACLE SHEATH 7F 25CM
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PINNACLE SHEATH 7F 25CM
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PINNACLE SHEATH 7FR10CM R/O II
|
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 SHEATH 7FR10CM R/O II
|
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 SHEATH 8FR INTRODUCER
|
Facility
|
IP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
PINNACLE SHEATH 8FR INTRODUCER
|
Facility
|
OP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem Medicaid |
$57.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Humana KY Medicaid |
$57.45
|
| Rate for Payer: Kentucky WC Medicaid |
$58.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
PINNACLE SHEATH 9FR INTRODUCER
|
Facility
|
IP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
PINNACLE SHEATH 9FR INTRODUCER
|
Facility
|
OP
|
$167.06
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$128.64
|
| Rate for Payer: Anthem Medicaid |
$57.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.31
|
| Rate for Payer: Cash Price |
$83.53
|
| Rate for Payer: Cigna Commercial |
$138.66
|
| Rate for Payer: First Health Commercial |
$158.71
|
| Rate for Payer: Humana Commercial |
$142.00
|
| Rate for Payer: Humana KY Medicaid |
$57.45
|
| Rate for Payer: Kentucky WC Medicaid |
$58.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.01
|
| Rate for Payer: Ohio Health Group HMO |
$125.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.27
|
| Rate for Payer: PHCS Commercial |
$160.38
|
| Rate for Payer: United Healthcare All Payer |
$147.01
|
|
|
PINNACLE TIF TIP 10CM 5F
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem Medicaid |
$162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Humana KY Medicaid |
$162.66
|
| Rate for Payer: Kentucky WC Medicaid |
$164.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
PINNACLE TIF TIP 10CM 5F
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
|
PINNACLE TIF TIP 10CM 6FR
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$454.08 |
| Rate for Payer: Aetna Commercial |
$364.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$368.94
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cigna Commercial |
$392.59
|
| Rate for Payer: First Health Commercial |
$449.35
|
| Rate for Payer: Humana Commercial |
$402.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$387.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$416.24
|
| Rate for Payer: Ohio Health Group HMO |
$354.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$378.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.37
|
| Rate for Payer: PHCS Commercial |
$454.08
|
| Rate for Payer: United Healthcare All Payer |
$416.24
|
|
