|
MESH BIO A TISS REINF 10*30CM
|
Facility
|
IP
|
$9,997.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,299.71 |
| Max. Negotiated Rate |
$9,597.89 |
| Rate for Payer: Aetna Commercial |
$7,698.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,798.28
|
| Rate for Payer: Cash Price |
$4,998.90
|
| Rate for Payer: Cigna Commercial |
$8,298.17
|
| Rate for Payer: First Health Commercial |
$9,497.91
|
| Rate for Payer: Humana Commercial |
$8,498.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,198.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,378.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,999.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,498.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,999.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,299.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,099.32
|
| Rate for Payer: PHCS Commercial |
$9,597.89
|
| Rate for Payer: United Healthcare All Payer |
$8,798.06
|
|
|
MESH BIO A TISS REINF 10*30CM
|
Facility
|
OP
|
$9,997.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,299.71 |
| Max. Negotiated Rate |
$9,597.89 |
| Rate for Payer: Aetna Commercial |
$7,698.31
|
| Rate for Payer: Anthem Medicaid |
$3,438.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,798.28
|
| Rate for Payer: Cash Price |
$4,998.90
|
| Rate for Payer: Cigna Commercial |
$8,298.17
|
| Rate for Payer: First Health Commercial |
$9,497.91
|
| Rate for Payer: Humana Commercial |
$8,498.13
|
| Rate for Payer: Humana KY Medicaid |
$3,438.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,473.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,198.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,378.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,999.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,507.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,798.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,498.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,999.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,299.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,099.32
|
| Rate for Payer: PHCS Commercial |
$9,597.89
|
| Rate for Payer: United Healthcare All Payer |
$8,798.06
|
|
|
MESH BIO A TISS REINF 20*20CM
|
Facility
|
OP
|
$12,906.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.88 |
| Max. Negotiated Rate |
$12,390.53 |
| Rate for Payer: Aetna Commercial |
$9,938.24
|
| Rate for Payer: Anthem Medicaid |
$4,438.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,067.30
|
| Rate for Payer: Cash Price |
$6,453.40
|
| Rate for Payer: Cigna Commercial |
$10,712.64
|
| Rate for Payer: First Health Commercial |
$12,261.46
|
| Rate for Payer: Humana Commercial |
$10,970.78
|
| Rate for Payer: Humana KY Medicaid |
$4,438.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,483.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,583.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,525.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,872.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,527.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,357.98
|
| Rate for Payer: Ohio Health Group HMO |
$9,680.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,581.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,677.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,001.11
|
| Rate for Payer: PHCS Commercial |
$12,390.53
|
| Rate for Payer: United Healthcare All Payer |
$11,357.98
|
|
|
MESH BIO A TISS REINF 20*20CM
|
Facility
|
IP
|
$12,906.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.88 |
| Max. Negotiated Rate |
$12,390.53 |
| Rate for Payer: Aetna Commercial |
$9,938.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,067.30
|
| Rate for Payer: Cash Price |
$6,453.40
|
| Rate for Payer: Cigna Commercial |
$10,712.64
|
| Rate for Payer: First Health Commercial |
$12,261.46
|
| Rate for Payer: Humana Commercial |
$10,970.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,583.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,525.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,872.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,357.98
|
| Rate for Payer: Ohio Health Group HMO |
$9,680.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,581.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,677.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,001.11
|
| Rate for Payer: PHCS Commercial |
$12,390.53
|
| Rate for Payer: United Healthcare All Payer |
$11,357.98
|
|
|
MESH BIO A TISS REINF 8*8CM
|
Facility
|
OP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem Medicaid |
$1,239.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Humana KY Medicaid |
$1,239.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
|
MESH BIO A TISS REINF 8*8CM
|
Facility
|
IP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
|
MESH BIO A TISS REINF 9*15CM
|
Facility
|
IP
|
$4,706.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.78 |
| Max. Negotiated Rate |
$4,517.76 |
| Rate for Payer: Aetna Commercial |
$3,623.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,670.68
|
| Rate for Payer: Cash Price |
$2,353.00
|
| Rate for Payer: Cigna Commercial |
$3,905.98
|
| Rate for Payer: First Health Commercial |
$4,470.70
|
| Rate for Payer: Humana Commercial |
$4,000.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,858.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,473.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,141.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,529.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,458.86
|
| Rate for Payer: PHCS Commercial |
$4,517.76
|
| Rate for Payer: United Healthcare All Payer |
$4,141.28
|
|
|
MESH BIO A TISS REINF 9*15CM
|
Facility
|
OP
|
$4,706.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.78 |
| Max. Negotiated Rate |
$4,517.76 |
| Rate for Payer: Aetna Commercial |
$3,623.62
|
| Rate for Payer: Anthem Medicaid |
$1,618.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,670.68
|
| Rate for Payer: Cash Price |
$2,353.00
|
| Rate for Payer: Cigna Commercial |
$3,905.98
|
| Rate for Payer: First Health Commercial |
$4,470.70
|
| Rate for Payer: Humana Commercial |
$4,000.10
|
| Rate for Payer: Humana KY Medicaid |
$1,618.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,858.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,473.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,141.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,529.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,458.86
|
| Rate for Payer: PHCS Commercial |
$4,517.76
|
| Rate for Payer: United Healthcare All Payer |
$4,141.28
|
|
|
MESH DCELL 214 6*16CM MICROPER
|
Facility
|
OP
|
$14,038.12
|
|
|
Service Code
|
HCPCS Q4122
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,824.96 |
| Max. Negotiated Rate |
$13,476.60 |
| Rate for Payer: Aetna Commercial |
$10,809.35
|
| Rate for Payer: Anthem Medicaid |
$4,827.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,949.73
|
| Rate for Payer: Cash Price |
$7,019.06
|
| Rate for Payer: Cigna Commercial |
$11,651.64
|
| Rate for Payer: First Health Commercial |
$13,336.21
|
| Rate for Payer: Humana Commercial |
$11,932.40
|
| Rate for Payer: Humana KY Medicaid |
$4,827.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,876.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,511.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,360.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,211.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,924.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,353.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,528.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,807.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,351.82
|
| Rate for Payer: PHCS Commercial |
$13,476.60
|
| Rate for Payer: United Healthcare All Payer |
$12,353.55
|
|
|
MESH DCELL 214 6*16CM MICROPER
|
Facility
|
IP
|
$14,038.12
|
|
|
Service Code
|
HCPCS Q4122
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,824.96 |
| Max. Negotiated Rate |
$13,476.60 |
| Rate for Payer: Aetna Commercial |
$10,809.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,949.73
|
| Rate for Payer: Cash Price |
$7,019.06
|
| Rate for Payer: Cigna Commercial |
$11,651.64
|
| Rate for Payer: First Health Commercial |
$13,336.21
|
| Rate for Payer: Humana Commercial |
$11,932.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,511.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,360.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,211.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,353.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,528.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,807.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,824.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,351.82
|
| Rate for Payer: PHCS Commercial |
$13,476.60
|
| Rate for Payer: United Healthcare All Payer |
$12,353.55
|
|
|
MESH DCELL 216 8*20CM MICROPER
|
Facility
|
IP
|
$22,695.88
|
|
|
Service Code
|
HCPCS Q4122
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,950.46 |
| Max. Negotiated Rate |
$21,788.04 |
| Rate for Payer: Aetna Commercial |
$17,475.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,702.79
|
| Rate for Payer: Cash Price |
$11,347.94
|
| Rate for Payer: Cigna Commercial |
$18,837.58
|
| Rate for Payer: First Health Commercial |
$21,561.09
|
| Rate for Payer: Humana Commercial |
$19,291.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,610.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,749.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,808.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,972.37
|
| Rate for Payer: Ohio Health Group HMO |
$17,021.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,539.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,035.72
|
| Rate for Payer: PHCS Commercial |
$21,788.04
|
| Rate for Payer: United Healthcare All Payer |
$19,972.37
|
|
|
MESH DCELL 216 8*20CM MICROPER
|
Facility
|
OP
|
$22,695.88
|
|
|
Service Code
|
HCPCS Q4122
|
| Hospital Charge Code |
27000078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,950.46 |
| Max. Negotiated Rate |
$21,788.04 |
| Rate for Payer: Aetna Commercial |
$17,475.83
|
| Rate for Payer: Anthem Medicaid |
$7,805.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,702.79
|
| Rate for Payer: Cash Price |
$11,347.94
|
| Rate for Payer: Cigna Commercial |
$18,837.58
|
| Rate for Payer: First Health Commercial |
$21,561.09
|
| Rate for Payer: Humana Commercial |
$19,291.50
|
| Rate for Payer: Humana KY Medicaid |
$7,805.11
|
| Rate for Payer: Kentucky WC Medicaid |
$7,884.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,610.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,749.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,808.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,961.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,972.37
|
| Rate for Payer: Ohio Health Group HMO |
$17,021.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,539.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,035.72
|
| Rate for Payer: PHCS Commercial |
$21,788.04
|
| Rate for Payer: United Healthcare All Payer |
$19,972.37
|
|
|
MESH DUAL 20CM*30CM
|
Facility
|
OP
|
$8,661.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.05 |
| Max. Negotiated Rate |
$8,315.42 |
| Rate for Payer: Aetna Commercial |
$6,669.66
|
| Rate for Payer: Anthem Medicaid |
$2,978.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,756.28
|
| Rate for Payer: Cash Price |
$4,330.95
|
| Rate for Payer: Cigna Commercial |
$7,189.38
|
| Rate for Payer: First Health Commercial |
$8,228.80
|
| Rate for Payer: Humana Commercial |
$7,362.62
|
| Rate for Payer: Humana KY Medicaid |
$2,978.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,009.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,102.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,392.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,038.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,622.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,496.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.19
|
| Rate for Payer: PHCS Commercial |
$8,315.42
|
| Rate for Payer: United Healthcare All Payer |
$7,622.47
|
|
|
MESH DUAL 20CM*30CM
|
Facility
|
IP
|
$8,661.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.05 |
| Max. Negotiated Rate |
$8,315.42 |
| Rate for Payer: Aetna Commercial |
$6,669.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,756.28
|
| Rate for Payer: Cash Price |
$4,330.95
|
| Rate for Payer: Cigna Commercial |
$7,189.38
|
| Rate for Payer: First Health Commercial |
$8,228.80
|
| Rate for Payer: Humana Commercial |
$7,362.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,102.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,392.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,598.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,622.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,496.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.19
|
| Rate for Payer: PHCS Commercial |
$8,315.42
|
| Rate for Payer: United Healthcare All Payer |
$7,622.47
|
|
|
MESHED BILAYER WND MATRIX 4*10
|
Facility
|
IP
|
$17,984.40
|
|
|
Service Code
|
HCPCS Q4105
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,337.97 |
| Max. Negotiated Rate |
$17,265.02 |
| Rate for Payer: Aetna Commercial |
$13,847.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,027.83
|
| Rate for Payer: Cash Price |
$8,992.20
|
| Rate for Payer: Cigna Commercial |
$14,927.05
|
| Rate for Payer: First Health Commercial |
$17,085.18
|
| Rate for Payer: Humana Commercial |
$15,286.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,747.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,272.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,395.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,826.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,488.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,575.16
|
| Rate for Payer: PHCS Commercial |
$17,265.02
|
| Rate for Payer: United Healthcare All Payer |
$15,826.27
|
|
|
MESHED BILAYER WND MATRIX 4*10
|
Facility
|
OP
|
$17,984.40
|
|
|
Service Code
|
HCPCS Q4105
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,337.97 |
| Max. Negotiated Rate |
$17,265.02 |
| Rate for Payer: Aetna Commercial |
$13,847.99
|
| Rate for Payer: Anthem Medicaid |
$6,184.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,027.83
|
| Rate for Payer: Cash Price |
$8,992.20
|
| Rate for Payer: Cigna Commercial |
$14,927.05
|
| Rate for Payer: First Health Commercial |
$17,085.18
|
| Rate for Payer: Humana Commercial |
$15,286.74
|
| Rate for Payer: Humana KY Medicaid |
$6,184.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,247.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,747.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,272.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,395.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,308.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,826.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,488.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,575.16
|
| Rate for Payer: PHCS Commercial |
$17,265.02
|
| Rate for Payer: United Healthcare All Payer |
$15,826.27
|
|
|
MESHED BILAYER WND MATRIX 4*5
|
Facility
|
IP
|
$13,034.55
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,694.49 |
| Max. Negotiated Rate |
$12,513.17 |
| Rate for Payer: Aetna Commercial |
$10,036.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,166.95
|
| Rate for Payer: Cash Price |
$6,517.27
|
| Rate for Payer: Cigna Commercial |
$10,818.68
|
| Rate for Payer: First Health Commercial |
$12,382.82
|
| Rate for Payer: Humana Commercial |
$11,079.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,688.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,619.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,910.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,470.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,775.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,606.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,694.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,040.71
|
| Rate for Payer: PHCS Commercial |
$12,513.17
|
| Rate for Payer: United Healthcare All Payer |
$11,470.40
|
|
|
MESHED BILAYER WND MATRIX 4*5
|
Facility
|
OP
|
$13,034.55
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,694.49 |
| Max. Negotiated Rate |
$12,513.17 |
| Rate for Payer: Aetna Commercial |
$10,036.60
|
| Rate for Payer: Anthem Medicaid |
$4,482.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,166.95
|
| Rate for Payer: Cash Price |
$6,517.27
|
| Rate for Payer: Cigna Commercial |
$10,818.68
|
| Rate for Payer: First Health Commercial |
$12,382.82
|
| Rate for Payer: Humana Commercial |
$11,079.37
|
| Rate for Payer: Humana KY Medicaid |
$4,482.58
|
| Rate for Payer: Kentucky WC Medicaid |
$4,528.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,688.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,619.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,910.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,572.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,470.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,775.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,606.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,694.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,040.71
|
| Rate for Payer: PHCS Commercial |
$12,513.17
|
| Rate for Payer: United Healthcare All Payer |
$11,470.40
|
|
|
MESH FLAT 10*14
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
MESH FLAT 10*14
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
MESH FLAT 3*6
|
Facility
|
OP
|
$1,949.55
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$1,871.57 |
| Rate for Payer: Aetna Commercial |
$1,501.15
|
| Rate for Payer: Anthem Medicaid |
$670.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.65
|
| Rate for Payer: Cash Price |
$974.78
|
| Rate for Payer: Cigna Commercial |
$1,618.13
|
| Rate for Payer: First Health Commercial |
$1,852.07
|
| Rate for Payer: Humana Commercial |
$1,657.12
|
| Rate for Payer: Humana KY Medicaid |
$670.45
|
| Rate for Payer: Kentucky WC Medicaid |
$677.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.36
|
| Rate for Payer: PHCS Commercial |
$1,871.57
|
| Rate for Payer: United Healthcare All Payer |
$1,715.60
|
|
|
MESH FLAT 3*6
|
Facility
|
IP
|
$1,949.55
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$1,871.57 |
| Rate for Payer: Aetna Commercial |
$1,501.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.65
|
| Rate for Payer: Cash Price |
$974.78
|
| Rate for Payer: Cigna Commercial |
$1,618.13
|
| Rate for Payer: First Health Commercial |
$1,852.07
|
| Rate for Payer: Humana Commercial |
$1,657.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.36
|
| Rate for Payer: PHCS Commercial |
$1,871.57
|
| Rate for Payer: United Healthcare All Payer |
$1,715.60
|
|
|
MESH FLEXHD PLIABLE PRE THCK L
|
Facility
|
IP
|
$78,638.49
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,223.00 |
| Max. Negotiated Rate |
$75,492.95 |
| Rate for Payer: Aetna Commercial |
$60,551.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,338.02
|
| Rate for Payer: Cash Price |
$39,319.24
|
| Rate for Payer: Cigna Commercial |
$65,269.95
|
| Rate for Payer: First Health Commercial |
$74,706.57
|
| Rate for Payer: Humana Commercial |
$66,842.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,483.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,035.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,591.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,201.87
|
| Rate for Payer: Ohio Health Group HMO |
$58,978.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,727.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,377.93
|
| Rate for Payer: PHCS Commercial |
$75,492.95
|
| Rate for Payer: United Healthcare All Payer |
$69,201.87
|
|
|
MESH FLEXHD PLIABLE PRE THCK L
|
Facility
|
OP
|
$78,638.49
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,223.00 |
| Max. Negotiated Rate |
$75,492.95 |
| Rate for Payer: Aetna Commercial |
$60,551.64
|
| Rate for Payer: Anthem Medicaid |
$27,043.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,338.02
|
| Rate for Payer: Cash Price |
$39,319.24
|
| Rate for Payer: Cigna Commercial |
$65,269.95
|
| Rate for Payer: First Health Commercial |
$74,706.57
|
| Rate for Payer: Humana Commercial |
$66,842.72
|
| Rate for Payer: Humana KY Medicaid |
$27,043.78
|
| Rate for Payer: Kentucky WC Medicaid |
$27,319.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,483.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,035.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,591.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,586.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,201.87
|
| Rate for Payer: Ohio Health Group HMO |
$58,978.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,727.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,377.93
|
| Rate for Payer: PHCS Commercial |
$75,492.95
|
| Rate for Payer: United Healthcare All Payer |
$69,201.87
|
|
|
MESH FLEXHD PLIABLE PRE THIN L
|
Facility
|
OP
|
$78,638.49
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,223.00 |
| Max. Negotiated Rate |
$75,492.95 |
| Rate for Payer: Aetna Commercial |
$60,551.64
|
| Rate for Payer: Anthem Medicaid |
$27,043.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,338.02
|
| Rate for Payer: Cash Price |
$39,319.24
|
| Rate for Payer: Cigna Commercial |
$65,269.95
|
| Rate for Payer: First Health Commercial |
$74,706.57
|
| Rate for Payer: Humana Commercial |
$66,842.72
|
| Rate for Payer: Humana KY Medicaid |
$27,043.78
|
| Rate for Payer: Kentucky WC Medicaid |
$27,319.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,483.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,035.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,591.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,586.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,201.87
|
| Rate for Payer: Ohio Health Group HMO |
$58,978.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,727.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,223.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,377.93
|
| Rate for Payer: PHCS Commercial |
$75,492.95
|
| Rate for Payer: United Healthcare All Payer |
$69,201.87
|
|
