|
TRIDENT X3 36MM ELE RIM F
|
Facility
|
IP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM F
|
Facility
|
OP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem Medicaid |
$3,248.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Humana KY Medicaid |
$3,248.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM G
|
Facility
|
IP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM G
|
Facility
|
OP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem Medicaid |
$3,248.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Humana KY Medicaid |
$3,248.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM H
|
Facility
|
OP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem Medicaid |
$3,248.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Humana KY Medicaid |
$3,248.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM H
|
Facility
|
IP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM I
|
Facility
|
OP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem Medicaid |
$3,248.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Humana KY Medicaid |
$3,248.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM I
|
Facility
|
IP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM J
|
Facility
|
IP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIDENT X3 36MM ELE RIM J
|
Facility
|
OP
|
$9,445.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.97 |
| Max. Negotiated Rate |
$9,068.08 |
| Rate for Payer: Aetna Commercial |
$7,273.36
|
| Rate for Payer: Anthem Medicaid |
$3,248.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.82
|
| Rate for Payer: Cash Price |
$4,722.96
|
| Rate for Payer: Cigna Commercial |
$7,840.11
|
| Rate for Payer: First Health Commercial |
$8,973.62
|
| Rate for Payer: Humana Commercial |
$8,029.03
|
| Rate for Payer: Humana KY Medicaid |
$3,248.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,971.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.24
|
| Rate for Payer: PHCS Commercial |
$9,068.08
|
| Rate for Payer: United Healthcare All Payer |
$8,312.41
|
|
|
TRIFECTA AORTC VALVE W/GT 19MM
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 19MM
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 25MM
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 25MM
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 27MM
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 27MM
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 29MM
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTC VALVE W/GT 29MM
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTIC VALVE W/GT 21
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTIC VALVE W/GT 21
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTIC VALVE W/GT 23
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIFECTA AORTIC VALVE W/GT 23
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
TRIGLYCERIDE BLOOD
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
TRIGLYCERIDE BLOOD
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.74
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Humana Medicare Advantage |
$5.74
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
TRIGLYCERIDE BLOOD
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$10.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$5.04
|
| Rate for Payer: Healthspan PPO |
$6.03
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
|
