|
MESH 3D MAX 5*7 XLG L
|
Facility
|
IP
|
$2,163.05
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.20 |
| Max. Negotiated Rate |
$2,076.53 |
| Rate for Payer: Aetna Commercial |
$1,665.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,687.18
|
| Rate for Payer: Cash Price |
$1,081.53
|
| Rate for Payer: Cigna Commercial |
$1,795.33
|
| Rate for Payer: First Health Commercial |
$2,054.90
|
| Rate for Payer: Humana Commercial |
$1,838.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,622.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.55
|
| Rate for Payer: PHCS Commercial |
$2,076.53
|
| Rate for Payer: United Healthcare All Payer |
$1,903.48
|
|
|
MESH 3D MAX 5*7 XLG R
|
Facility
|
OP
|
$3,309.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.24 |
| Max. Negotiated Rate |
$3,177.12 |
| Rate for Payer: Aetna Commercial |
$2,548.32
|
| Rate for Payer: Anthem Medicaid |
$1,138.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,581.41
|
| Rate for Payer: Cash Price |
$1,654.75
|
| Rate for Payer: Cigna Commercial |
$2,746.88
|
| Rate for Payer: First Health Commercial |
$3,144.02
|
| Rate for Payer: Humana Commercial |
$2,813.08
|
| Rate for Payer: Humana KY Medicaid |
$1,138.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,713.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,442.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,912.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,482.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.94
|
| Rate for Payer: PHCS Commercial |
$3,177.12
|
| Rate for Payer: United Healthcare All Payer |
$2,912.36
|
|
|
MESH 3D MAX 5*7 XLG R
|
Facility
|
IP
|
$3,309.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.24 |
| Max. Negotiated Rate |
$3,177.12 |
| Rate for Payer: Aetna Commercial |
$2,548.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,581.41
|
| Rate for Payer: Cash Price |
$1,654.75
|
| Rate for Payer: Cigna Commercial |
$2,746.88
|
| Rate for Payer: First Health Commercial |
$3,144.02
|
| Rate for Payer: Humana Commercial |
$2,813.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,713.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,442.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,912.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,482.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.94
|
| Rate for Payer: PHCS Commercial |
$3,177.12
|
| Rate for Payer: United Healthcare All Payer |
$2,912.36
|
|
|
MESH 3D MAX MID LG LFT
|
Facility
|
OP
|
$3,645.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.87 |
| Max. Negotiated Rate |
$3,499.34 |
| Rate for Payer: Aetna Commercial |
$2,806.77
|
| Rate for Payer: Anthem Medicaid |
$1,253.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,843.22
|
| Rate for Payer: Cash Price |
$1,822.58
|
| Rate for Payer: Cigna Commercial |
$3,025.47
|
| Rate for Payer: First Health Commercial |
$3,462.89
|
| Rate for Payer: Humana Commercial |
$3,098.38
|
| Rate for Payer: Humana KY Medicaid |
$1,253.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,266.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,989.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,690.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,278.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,207.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,733.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.00
|
| Rate for Payer: PHCS Commercial |
$3,499.34
|
| Rate for Payer: United Healthcare All Payer |
$3,207.73
|
|
|
MESH 3D MAX MID LG LFT
|
Facility
|
IP
|
$3,645.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.87 |
| Max. Negotiated Rate |
$3,499.34 |
| Rate for Payer: Aetna Commercial |
$2,806.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,843.22
|
| Rate for Payer: Cash Price |
$1,822.58
|
| Rate for Payer: Cigna Commercial |
$3,025.47
|
| Rate for Payer: First Health Commercial |
$3,462.89
|
| Rate for Payer: Humana Commercial |
$3,098.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,989.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,690.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,207.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,733.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.00
|
| Rate for Payer: PHCS Commercial |
$3,499.34
|
| Rate for Payer: United Healthcare All Payer |
$3,207.73
|
|
|
MESH 3D MAX MID LG RIGHT
|
Facility
|
IP
|
$3,078.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.16 |
| Max. Negotiated Rate |
$2,955.02 |
| Rate for Payer: Aetna Commercial |
$2,370.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,400.96
|
| Rate for Payer: Cash Price |
$1,539.08
|
| Rate for Payer: Cigna Commercial |
$2,554.86
|
| Rate for Payer: First Health Commercial |
$2,924.24
|
| Rate for Payer: Humana Commercial |
$2,616.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,524.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,271.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$923.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,708.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,308.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$400.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$954.23
|
| Rate for Payer: PHCS Commercial |
$2,955.02
|
| Rate for Payer: United Healthcare All Payer |
$2,708.77
|
|
|
MESH 3D MAX MID LG RIGHT
|
Facility
|
OP
|
$3,078.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.16 |
| Max. Negotiated Rate |
$2,955.02 |
| Rate for Payer: Aetna Commercial |
$2,370.18
|
| Rate for Payer: Anthem Medicaid |
$1,058.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,400.96
|
| Rate for Payer: Cash Price |
$1,539.08
|
| Rate for Payer: Cigna Commercial |
$2,554.86
|
| Rate for Payer: First Health Commercial |
$2,924.24
|
| Rate for Payer: Humana Commercial |
$2,616.43
|
| Rate for Payer: Humana KY Medicaid |
$1,058.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,069.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,524.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,271.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$923.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,708.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,308.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$400.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$954.23
|
| Rate for Payer: PHCS Commercial |
$2,955.02
|
| Rate for Payer: United Healthcare All Payer |
$2,708.77
|
|
|
MESH 3D MAX MID XL RIGHT
|
Facility
|
OP
|
$3,168.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.94 |
| Max. Negotiated Rate |
$3,042.05 |
| Rate for Payer: Aetna Commercial |
$2,439.98
|
| Rate for Payer: Anthem Medicaid |
$1,089.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,471.66
|
| Rate for Payer: Cash Price |
$1,584.40
|
| Rate for Payer: Cigna Commercial |
$2,630.10
|
| Rate for Payer: First Health Commercial |
$3,010.36
|
| Rate for Payer: Humana Commercial |
$2,693.48
|
| Rate for Payer: Humana KY Medicaid |
$1,089.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,598.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,338.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,111.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,788.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,376.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.33
|
| Rate for Payer: PHCS Commercial |
$3,042.05
|
| Rate for Payer: United Healthcare All Payer |
$2,788.54
|
|
|
MESH 3D MAX MID XL RIGHT
|
Facility
|
IP
|
$3,168.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.94 |
| Max. Negotiated Rate |
$3,042.05 |
| Rate for Payer: Aetna Commercial |
$2,439.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,471.66
|
| Rate for Payer: Cash Price |
$1,584.40
|
| Rate for Payer: Cigna Commercial |
$2,630.10
|
| Rate for Payer: First Health Commercial |
$3,010.36
|
| Rate for Payer: Humana Commercial |
$2,693.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,598.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,338.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,788.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,376.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.33
|
| Rate for Payer: PHCS Commercial |
$3,042.05
|
| Rate for Payer: United Healthcare All Payer |
$2,788.54
|
|
|
MESH 4.5 COMPOSIX L/P
|
Facility
|
IP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.60
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
MESH 4.5 COMPOSIX L/P
|
Facility
|
OP
|
$4,160.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,993.60 |
| Rate for Payer: Aetna Commercial |
$3,203.20
|
| Rate for Payer: Anthem Medicaid |
$1,430.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,244.80
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cigna Commercial |
$3,452.80
|
| Rate for Payer: First Health Commercial |
$3,952.00
|
| Rate for Payer: Humana Commercial |
$3,536.00
|
| Rate for Payer: Humana KY Medicaid |
$1,430.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,445.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,411.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,070.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,248.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,459.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,660.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.60
|
| Rate for Payer: PHCS Commercial |
$3,993.60
|
| Rate for Payer: United Healthcare All Payer |
$3,660.80
|
|
|
MESH 6*8 COMPOSIX L/P
|
Facility
|
OP
|
$4,958.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.54 |
| Max. Negotiated Rate |
$4,759.68 |
| Rate for Payer: Aetna Commercial |
$3,817.66
|
| Rate for Payer: Anthem Medicaid |
$1,705.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,867.24
|
| Rate for Payer: Cash Price |
$2,479.00
|
| Rate for Payer: Cigna Commercial |
$4,115.14
|
| Rate for Payer: First Health Commercial |
$4,710.10
|
| Rate for Payer: Humana Commercial |
$4,214.30
|
| Rate for Payer: Humana KY Medicaid |
$1,705.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,722.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,065.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,659.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,487.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,739.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,363.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,718.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$991.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$644.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.98
|
| Rate for Payer: PHCS Commercial |
$4,759.68
|
| Rate for Payer: United Healthcare All Payer |
$4,363.04
|
|
|
MESH 6*8 COMPOSIX L/P
|
Facility
|
IP
|
$4,958.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$644.54 |
| Max. Negotiated Rate |
$4,759.68 |
| Rate for Payer: Aetna Commercial |
$3,817.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,867.24
|
| Rate for Payer: Cash Price |
$2,479.00
|
| Rate for Payer: Cigna Commercial |
$4,115.14
|
| Rate for Payer: First Health Commercial |
$4,710.10
|
| Rate for Payer: Humana Commercial |
$4,214.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,065.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,659.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,487.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,363.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,718.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$991.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$644.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.98
|
| Rate for Payer: PHCS Commercial |
$4,759.68
|
| Rate for Payer: United Healthcare All Payer |
$4,363.04
|
|
|
MESHAGRAPH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESHAGRAPH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESH ALLODERM CONTOUR 9.6*19.3
|
Facility
|
IP
|
$17,602.80
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.36 |
| Max. Negotiated Rate |
$16,898.69 |
| Rate for Payer: Aetna Commercial |
$13,554.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,730.18
|
| Rate for Payer: Cash Price |
$8,801.40
|
| Rate for Payer: Cigna Commercial |
$14,610.32
|
| Rate for Payer: First Health Commercial |
$16,722.66
|
| Rate for Payer: Humana Commercial |
$14,962.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,434.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,990.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,280.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,490.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,202.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,520.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,288.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,456.87
|
| Rate for Payer: PHCS Commercial |
$16,898.69
|
| Rate for Payer: United Healthcare All Payer |
$15,490.46
|
|
|
MESH ALLODERM CONTOUR 9.6*19.3
|
Facility
|
OP
|
$17,602.80
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,288.36 |
| Max. Negotiated Rate |
$16,898.69 |
| Rate for Payer: Aetna Commercial |
$13,554.16
|
| Rate for Payer: Anthem Medicaid |
$6,053.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,730.18
|
| Rate for Payer: Cash Price |
$8,801.40
|
| Rate for Payer: Cigna Commercial |
$14,610.32
|
| Rate for Payer: First Health Commercial |
$16,722.66
|
| Rate for Payer: Humana Commercial |
$14,962.38
|
| Rate for Payer: Humana KY Medicaid |
$6,053.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,115.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,434.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,990.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,280.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,175.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,490.46
|
| Rate for Payer: Ohio Health Group HMO |
$13,202.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,520.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,288.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,456.87
|
| Rate for Payer: PHCS Commercial |
$16,898.69
|
| Rate for Payer: United Healthcare All Payer |
$15,490.46
|
|
|
MESH ALLODRM PRF CONT 9.6*19.3
|
Facility
|
OP
|
$18,006.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.78 |
| Max. Negotiated Rate |
$17,285.76 |
| Rate for Payer: Aetna Commercial |
$13,864.62
|
| Rate for Payer: Anthem Medicaid |
$6,192.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,044.68
|
| Rate for Payer: Cash Price |
$9,003.00
|
| Rate for Payer: Cigna Commercial |
$14,944.98
|
| Rate for Payer: First Health Commercial |
$17,105.70
|
| Rate for Payer: Humana Commercial |
$15,305.10
|
| Rate for Payer: Humana KY Medicaid |
$6,192.26
|
| Rate for Payer: Kentucky WC Medicaid |
$6,255.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,764.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,288.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,401.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,316.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,845.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,504.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,601.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,581.86
|
| Rate for Payer: PHCS Commercial |
$17,285.76
|
| Rate for Payer: United Healthcare All Payer |
$15,845.28
|
|
|
MESH ALLODRM PRF CONT 9.6*19.3
|
Facility
|
IP
|
$18,006.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,340.78 |
| Max. Negotiated Rate |
$17,285.76 |
| Rate for Payer: Aetna Commercial |
$13,864.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,044.68
|
| Rate for Payer: Cash Price |
$9,003.00
|
| Rate for Payer: Cigna Commercial |
$14,944.98
|
| Rate for Payer: First Health Commercial |
$17,105.70
|
| Rate for Payer: Humana Commercial |
$15,305.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,764.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,288.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,401.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,845.28
|
| Rate for Payer: Ohio Health Group HMO |
$13,504.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,601.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,581.86
|
| Rate for Payer: PHCS Commercial |
$17,285.76
|
| Rate for Payer: United Healthcare All Payer |
$15,845.28
|
|
|
MESH BILAYER WOUND MATRIX 2*2
|
Facility
|
OP
|
$22,049.90
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.49 |
| Max. Negotiated Rate |
$21,167.90 |
| Rate for Payer: Aetna Commercial |
$16,978.42
|
| Rate for Payer: Anthem Medicaid |
$7,582.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,198.92
|
| Rate for Payer: Cash Price |
$11,024.95
|
| Rate for Payer: Cigna Commercial |
$18,301.42
|
| Rate for Payer: First Health Commercial |
$20,947.40
|
| Rate for Payer: Humana Commercial |
$18,742.42
|
| Rate for Payer: Humana KY Medicaid |
$7,582.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,080.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,272.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,735.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,403.91
|
| Rate for Payer: Ohio Health Group HMO |
$16,537.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,835.47
|
| Rate for Payer: PHCS Commercial |
$21,167.90
|
| Rate for Payer: United Healthcare All Payer |
$19,403.91
|
|
|
MESH BILAYER WOUND MATRIX 2*2
|
Facility
|
IP
|
$22,049.90
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.49 |
| Max. Negotiated Rate |
$21,167.90 |
| Rate for Payer: Aetna Commercial |
$16,978.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,198.92
|
| Rate for Payer: Cash Price |
$11,024.95
|
| Rate for Payer: Cigna Commercial |
$18,301.42
|
| Rate for Payer: First Health Commercial |
$20,947.40
|
| Rate for Payer: Humana Commercial |
$18,742.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,080.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,272.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,614.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,403.91
|
| Rate for Payer: Ohio Health Group HMO |
$16,537.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,835.47
|
| Rate for Payer: PHCS Commercial |
$21,167.90
|
| Rate for Payer: United Healthcare All Payer |
$19,403.91
|
|
|
MESH BILAYER WOUND MATRIX 4*10
|
Facility
|
OP
|
$24,601.25
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.16 |
| Max. Negotiated Rate |
$23,617.20 |
| Rate for Payer: PHCS Commercial |
$23,617.20
|
| Rate for Payer: United Healthcare All Payer |
$21,649.10
|
| Rate for Payer: Aetna Commercial |
$18,942.96
|
| Rate for Payer: Anthem Medicaid |
$8,460.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,188.98
|
| Rate for Payer: Cash Price |
$12,300.62
|
| Rate for Payer: Cigna Commercial |
$20,419.04
|
| Rate for Payer: First Health Commercial |
$23,371.19
|
| Rate for Payer: Humana Commercial |
$20,911.06
|
| Rate for Payer: Humana KY Medicaid |
$8,460.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,546.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,173.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,155.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,380.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,630.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,649.10
|
| Rate for Payer: Ohio Health Group HMO |
$18,450.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,920.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,626.39
|
|
|
MESH BILAYER WOUND MATRIX 4*10
|
Facility
|
IP
|
$24,601.25
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.16 |
| Max. Negotiated Rate |
$23,617.20 |
| Rate for Payer: Aetna Commercial |
$18,942.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,188.98
|
| Rate for Payer: Cash Price |
$12,300.62
|
| Rate for Payer: Cigna Commercial |
$20,419.04
|
| Rate for Payer: First Health Commercial |
$23,371.19
|
| Rate for Payer: Humana Commercial |
$20,911.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,173.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,155.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,380.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,649.10
|
| Rate for Payer: Ohio Health Group HMO |
$18,450.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,920.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,626.39
|
| Rate for Payer: PHCS Commercial |
$23,617.20
|
| Rate for Payer: United Healthcare All Payer |
$21,649.10
|
|
|
MESH BILAYER WOUND MATRIX 4*5
|
Facility
|
OP
|
$13,644.10
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.73 |
| Max. Negotiated Rate |
$13,098.34 |
| Rate for Payer: Aetna Commercial |
$10,505.96
|
| Rate for Payer: Anthem Medicaid |
$4,692.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,642.40
|
| Rate for Payer: Cash Price |
$6,822.05
|
| Rate for Payer: Cigna Commercial |
$11,324.60
|
| Rate for Payer: First Health Commercial |
$12,961.90
|
| Rate for Payer: Humana Commercial |
$11,597.48
|
| Rate for Payer: Humana KY Medicaid |
$4,692.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,739.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,188.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,069.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,093.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,786.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,006.81
|
| Rate for Payer: Ohio Health Group HMO |
$10,233.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,229.67
|
| Rate for Payer: PHCS Commercial |
$13,098.34
|
| Rate for Payer: United Healthcare All Payer |
$12,006.81
|
|
|
MESH BILAYER WOUND MATRIX 4*5
|
Facility
|
IP
|
$13,644.10
|
|
|
Service Code
|
HCPCS C9363
|
| Hospital Charge Code |
27000001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.73 |
| Max. Negotiated Rate |
$13,098.34 |
| Rate for Payer: Aetna Commercial |
$10,505.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,642.40
|
| Rate for Payer: Cash Price |
$6,822.05
|
| Rate for Payer: Cigna Commercial |
$11,324.60
|
| Rate for Payer: First Health Commercial |
$12,961.90
|
| Rate for Payer: Humana Commercial |
$11,597.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,188.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,069.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,093.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,006.81
|
| Rate for Payer: Ohio Health Group HMO |
$10,233.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,229.67
|
| Rate for Payer: PHCS Commercial |
$13,098.34
|
| Rate for Payer: United Healthcare All Payer |
$12,006.81
|
|
