|
TRIDENT X3 36MM ELE RIM G
|
Facility
|
IP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM G
|
Facility
|
OP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem Medicaid |
$3,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Humana KY Medicaid |
$3,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM H
|
Facility
|
OP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem Medicaid |
$3,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Humana KY Medicaid |
$3,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM H
|
Facility
|
IP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM I
|
Facility
|
OP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem Medicaid |
$3,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Humana KY Medicaid |
$3,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM I
|
Facility
|
IP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM J
|
Facility
|
IP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 36MM ELE RIM J
|
Facility
|
OP
|
$9,645.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.78 |
| Max. Negotiated Rate |
$9,260.08 |
| Rate for Payer: Aetna Commercial |
$7,427.36
|
| Rate for Payer: Anthem Medicaid |
$3,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.82
|
| Rate for Payer: Cash Price |
$4,822.96
|
| Rate for Payer: Cigna Commercial |
$8,006.11
|
| Rate for Payer: First Health Commercial |
$9,163.62
|
| Rate for Payer: Humana Commercial |
$8,199.03
|
| Rate for Payer: Humana KY Medicaid |
$3,317.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.68
|
| Rate for Payer: PHCS Commercial |
$9,260.08
|
| Rate for Payer: United Healthcare All Payer |
$8,488.41
|
|
|
TRIDENT X3 POLY INSRT 10*
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT X3 POLY INSRT 10*
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT X3 POLY INSRT 10*H
|
Facility
|
OP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,711.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Humana KY Medicaid |
$2,711.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIDENT X3 POLY INSRT 10*H
|
Facility
|
IP
|
$7,883.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,365.11 |
| Max. Negotiated Rate |
$7,568.35 |
| Rate for Payer: Aetna Commercial |
$6,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,149.29
|
| Rate for Payer: Cash Price |
$3,941.85
|
| Rate for Payer: Cigna Commercial |
$6,543.47
|
| Rate for Payer: First Health Commercial |
$7,489.52
|
| Rate for Payer: Humana Commercial |
$6,701.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,464.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,818.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,365.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,937.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.75
|
| Rate for Payer: PHCS Commercial |
$7,568.35
|
| Rate for Payer: United Healthcare All Payer |
$6,937.66
|
|
|
TRIFECTA AORTC VALVE W/GT 19MM
|
Facility
|
IP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 19MM
|
Facility
|
OP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem Medicaid |
$7,651.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Humana KY Medicaid |
$7,651.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,729.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 25MM
|
Facility
|
OP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem Medicaid |
$7,651.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Humana KY Medicaid |
$7,651.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,729.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 25MM
|
Facility
|
IP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 27MM
|
Facility
|
OP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem Medicaid |
$7,651.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Humana KY Medicaid |
$7,651.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,729.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 27MM
|
Facility
|
IP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 29MM
|
Facility
|
OP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem Medicaid |
$7,651.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Humana KY Medicaid |
$7,651.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,729.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTC VALVE W/GT 29MM
|
Facility
|
IP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTIC VALVE W/GT 21
|
Facility
|
OP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem Medicaid |
$7,651.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Humana KY Medicaid |
$7,651.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,729.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTIC VALVE W/GT 21
|
Facility
|
IP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTIC VALVE W/GT 23
|
Facility
|
IP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIFECTA AORTIC VALVE W/GT 23
|
Facility
|
OP
|
$22,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,675.00 |
| Max. Negotiated Rate |
$21,360.00 |
| Rate for Payer: Aetna Commercial |
$17,132.50
|
| Rate for Payer: Anthem Medicaid |
$7,651.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,355.00
|
| Rate for Payer: Cash Price |
$11,125.00
|
| Rate for Payer: Cigna Commercial |
$18,467.50
|
| Rate for Payer: First Health Commercial |
$21,137.50
|
| Rate for Payer: Humana Commercial |
$18,912.50
|
| Rate for Payer: Humana KY Medicaid |
$7,651.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7,729.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,245.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,420.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,805.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,580.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,357.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,352.50
|
| Rate for Payer: PHCS Commercial |
$21,360.00
|
| Rate for Payer: United Healthcare All Payer |
$19,580.00
|
|
|
TRIGLYCERIDE BLOOD
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
30000539
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$47.40 |
| Rate for Payer: Aetna Commercial |
$10.58
|
| Rate for Payer: Ambetter Exchange |
$5.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$5.04
|
| Rate for Payer: Healthspan PPO |
$6.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.74
|
| Rate for Payer: Multiplan PHCS |
$47.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.46
|
| Rate for Payer: UHCCP Medicaid |
$27.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.74
|
|
