|
MESH PHASIX 4*6 1190200
|
Facility
|
OP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem Medicaid |
$3,896.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Humana KY Medicaid |
$3,896.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,936.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,974.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
|
MESH PHASIX ST 15*20CM
|
Facility
|
OP
|
$25,873.28
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,363.53 |
| Max. Negotiated Rate |
$24,838.35 |
| Rate for Payer: Aetna Commercial |
$19,922.43
|
| Rate for Payer: Anthem Medicaid |
$8,897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,181.16
|
| Rate for Payer: Cash Price |
$12,936.64
|
| Rate for Payer: Cigna Commercial |
$21,474.82
|
| Rate for Payer: First Health Commercial |
$24,579.62
|
| Rate for Payer: Humana Commercial |
$21,992.29
|
| Rate for Payer: Humana KY Medicaid |
$8,897.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,988.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,216.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,094.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,761.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,076.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,768.49
|
| Rate for Payer: Ohio Health Group HMO |
$19,404.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,174.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,363.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,020.72
|
| Rate for Payer: PHCS Commercial |
$24,838.35
|
| Rate for Payer: United Healthcare All Payer |
$22,768.49
|
|
|
MESH PHASIX ST 15*20CM
|
Facility
|
IP
|
$25,873.28
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,363.53 |
| Max. Negotiated Rate |
$24,838.35 |
| Rate for Payer: Aetna Commercial |
$19,922.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,181.16
|
| Rate for Payer: Cash Price |
$12,936.64
|
| Rate for Payer: Cigna Commercial |
$21,474.82
|
| Rate for Payer: First Health Commercial |
$24,579.62
|
| Rate for Payer: Humana Commercial |
$21,992.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,216.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,094.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,761.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,768.49
|
| Rate for Payer: Ohio Health Group HMO |
$19,404.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,174.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,363.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,020.72
|
| Rate for Payer: PHCS Commercial |
$24,838.35
|
| Rate for Payer: United Healthcare All Payer |
$22,768.49
|
|
|
MESH PHASIX ST 20*25CM
|
Facility
|
IP
|
$38,995.39
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.40 |
| Max. Negotiated Rate |
$37,435.57 |
| Rate for Payer: Aetna Commercial |
$30,026.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,416.40
|
| Rate for Payer: Cash Price |
$19,497.70
|
| Rate for Payer: Cigna Commercial |
$32,366.17
|
| Rate for Payer: First Health Commercial |
$37,045.62
|
| Rate for Payer: Humana Commercial |
$33,146.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,976.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,778.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,698.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,315.94
|
| Rate for Payer: Ohio Health Group HMO |
$29,246.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,799.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,069.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,088.57
|
| Rate for Payer: PHCS Commercial |
$37,435.57
|
| Rate for Payer: United Healthcare All Payer |
$34,315.94
|
|
|
MESH PHASIX ST 20*25CM
|
Facility
|
OP
|
$38,995.39
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.40 |
| Max. Negotiated Rate |
$37,435.57 |
| Rate for Payer: Aetna Commercial |
$30,026.45
|
| Rate for Payer: Anthem Medicaid |
$13,410.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,416.40
|
| Rate for Payer: Cash Price |
$19,497.70
|
| Rate for Payer: Cigna Commercial |
$32,366.17
|
| Rate for Payer: First Health Commercial |
$37,045.62
|
| Rate for Payer: Humana Commercial |
$33,146.08
|
| Rate for Payer: Humana KY Medicaid |
$13,410.51
|
| Rate for Payer: Kentucky WC Medicaid |
$13,547.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,976.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,778.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,698.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,679.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,315.94
|
| Rate for Payer: Ohio Health Group HMO |
$29,246.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,799.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,069.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,088.57
|
| Rate for Payer: PHCS Commercial |
$37,435.57
|
| Rate for Payer: United Healthcare All Payer |
$34,315.94
|
|
|
MESH PHASIX ST 25*30CM
|
Facility
|
IP
|
$82,227.51
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,689.58 |
| Max. Negotiated Rate |
$78,938.41 |
| Rate for Payer: Aetna Commercial |
$63,315.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,137.46
|
| Rate for Payer: Cash Price |
$41,113.75
|
| Rate for Payer: Cigna Commercial |
$68,248.83
|
| Rate for Payer: First Health Commercial |
$78,116.13
|
| Rate for Payer: Humana Commercial |
$69,893.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,426.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,683.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,668.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,360.21
|
| Rate for Payer: Ohio Health Group HMO |
$61,670.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,445.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,689.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,490.53
|
| Rate for Payer: PHCS Commercial |
$78,938.41
|
| Rate for Payer: United Healthcare All Payer |
$72,360.21
|
|
|
MESH PHASIX ST 25*30CM
|
Facility
|
OP
|
$82,227.51
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,689.58 |
| Max. Negotiated Rate |
$78,938.41 |
| Rate for Payer: Aetna Commercial |
$63,315.18
|
| Rate for Payer: Anthem Medicaid |
$28,278.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,137.46
|
| Rate for Payer: Cash Price |
$41,113.75
|
| Rate for Payer: Cigna Commercial |
$68,248.83
|
| Rate for Payer: First Health Commercial |
$78,116.13
|
| Rate for Payer: Humana Commercial |
$69,893.38
|
| Rate for Payer: Humana KY Medicaid |
$28,278.04
|
| Rate for Payer: Kentucky WC Medicaid |
$28,565.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,426.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,683.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,668.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,845.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,360.21
|
| Rate for Payer: Ohio Health Group HMO |
$61,670.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,445.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,689.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,490.53
|
| Rate for Payer: PHCS Commercial |
$78,938.41
|
| Rate for Payer: United Healthcare All Payer |
$72,360.21
|
|
|
MESH PHASIX ST 7*10CM
|
Facility
|
IP
|
$8,349.09
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.38 |
| Max. Negotiated Rate |
$8,015.13 |
| Rate for Payer: Aetna Commercial |
$6,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,512.29
|
| Rate for Payer: Cash Price |
$4,174.55
|
| Rate for Payer: Cigna Commercial |
$6,929.74
|
| Rate for Payer: First Health Commercial |
$7,931.64
|
| Rate for Payer: Humana Commercial |
$7,096.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,846.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,161.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,347.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.22
|
| Rate for Payer: PHCS Commercial |
$8,015.13
|
| Rate for Payer: United Healthcare All Payer |
$7,347.20
|
|
|
MESH PHASIX ST 7*10CM
|
Facility
|
OP
|
$8,349.09
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.38 |
| Max. Negotiated Rate |
$8,015.13 |
| Rate for Payer: Aetna Commercial |
$6,428.80
|
| Rate for Payer: Anthem Medicaid |
$2,871.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,512.29
|
| Rate for Payer: Cash Price |
$4,174.55
|
| Rate for Payer: Cigna Commercial |
$6,929.74
|
| Rate for Payer: First Health Commercial |
$7,931.64
|
| Rate for Payer: Humana Commercial |
$7,096.73
|
| Rate for Payer: Humana KY Medicaid |
$2,871.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,846.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,161.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,347.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.22
|
| Rate for Payer: PHCS Commercial |
$8,015.13
|
| Rate for Payer: United Healthcare All Payer |
$7,347.20
|
|
|
MESH PHASIX W/ECHO 11CM
|
Facility
|
OP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem Medicaid |
$9,106.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Humana KY Medicaid |
$9,106.82
|
| Rate for Payer: Kentucky WC Medicaid |
$9,199.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,289.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
MESH PHASIX W/ECHO 11CM
|
Facility
|
IP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
MESH PHASIX W/ ECHO 15*20CM
|
Facility
|
OP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem Medicaid |
$9,106.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Humana KY Medicaid |
$9,106.82
|
| Rate for Payer: Kentucky WC Medicaid |
$9,199.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,289.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
MESH PHASIX W/ ECHO 15*20CM
|
Facility
|
IP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
MESH PHASIX W/ECHO 15CM
|
Facility
|
IP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
MESH PHASIX W/ECHO 15CM
|
Facility
|
OP
|
$26,481.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.53 |
| Max. Negotiated Rate |
$25,421.76 |
| Rate for Payer: Aetna Commercial |
$20,390.37
|
| Rate for Payer: Anthem Medicaid |
$9,106.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,655.18
|
| Rate for Payer: Cash Price |
$13,240.50
|
| Rate for Payer: Cigna Commercial |
$21,979.23
|
| Rate for Payer: First Health Commercial |
$25,156.95
|
| Rate for Payer: Humana Commercial |
$22,508.85
|
| Rate for Payer: Humana KY Medicaid |
$9,106.82
|
| Rate for Payer: Kentucky WC Medicaid |
$9,199.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,714.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,542.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,944.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,289.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,303.28
|
| Rate for Payer: Ohio Health Group HMO |
$19,860.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,296.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,209.11
|
| Rate for Payer: PHCS Commercial |
$25,421.76
|
| Rate for Payer: United Healthcare All Payer |
$23,303.28
|
|
|
MESH PHYSIOMESH 10*15CM
|
Facility
|
IP
|
$4,556.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.31 |
| Max. Negotiated Rate |
$4,373.95 |
| Rate for Payer: Aetna Commercial |
$3,508.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,553.84
|
| Rate for Payer: Cash Price |
$2,278.10
|
| Rate for Payer: Cigna Commercial |
$3,781.65
|
| Rate for Payer: First Health Commercial |
$4,328.39
|
| Rate for Payer: Humana Commercial |
$3,872.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,736.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,362.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,366.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,009.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,417.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,412.42
|
| Rate for Payer: PHCS Commercial |
$4,373.95
|
| Rate for Payer: United Healthcare All Payer |
$4,009.46
|
|
|
MESH PHYSIOMESH 10*15CM
|
Facility
|
OP
|
$4,556.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$592.31 |
| Max. Negotiated Rate |
$4,373.95 |
| Rate for Payer: Aetna Commercial |
$3,508.27
|
| Rate for Payer: Anthem Medicaid |
$1,566.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,553.84
|
| Rate for Payer: Cash Price |
$2,278.10
|
| Rate for Payer: Cigna Commercial |
$3,781.65
|
| Rate for Payer: First Health Commercial |
$4,328.39
|
| Rate for Payer: Humana Commercial |
$3,872.77
|
| Rate for Payer: Humana KY Medicaid |
$1,566.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,582.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,736.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,362.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,366.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,598.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,009.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,417.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$911.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,412.42
|
| Rate for Payer: PHCS Commercial |
$4,373.95
|
| Rate for Payer: United Healthcare All Payer |
$4,009.46
|
|
|
MESH PHYSIOMESH 15*20CM
|
Facility
|
IP
|
$7,262.67
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.15 |
| Max. Negotiated Rate |
$6,972.16 |
| Rate for Payer: Aetna Commercial |
$5,592.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,664.88
|
| Rate for Payer: Cash Price |
$3,631.34
|
| Rate for Payer: Cigna Commercial |
$6,028.02
|
| Rate for Payer: First Health Commercial |
$6,899.54
|
| Rate for Payer: Humana Commercial |
$6,173.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,955.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,359.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,178.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,391.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.43
|
| Rate for Payer: PHCS Commercial |
$6,972.16
|
| Rate for Payer: United Healthcare All Payer |
$6,391.15
|
|
|
MESH PHYSIOMESH 15*20CM
|
Facility
|
OP
|
$7,262.67
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.15 |
| Max. Negotiated Rate |
$6,972.16 |
| Rate for Payer: Aetna Commercial |
$5,592.26
|
| Rate for Payer: Anthem Medicaid |
$2,497.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,664.88
|
| Rate for Payer: Cash Price |
$3,631.34
|
| Rate for Payer: Cigna Commercial |
$6,028.02
|
| Rate for Payer: First Health Commercial |
$6,899.54
|
| Rate for Payer: Humana Commercial |
$6,173.27
|
| Rate for Payer: Humana KY Medicaid |
$2,497.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,523.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,955.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,359.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,178.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,547.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,391.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,447.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.43
|
| Rate for Payer: PHCS Commercial |
$6,972.16
|
| Rate for Payer: United Healthcare All Payer |
$6,391.15
|
|
|
MESH PHYSIOMESH 20*25CM
|
Facility
|
OP
|
$10,027.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$9,625.92 |
| Rate for Payer: Aetna Commercial |
$7,720.79
|
| Rate for Payer: Anthem Medicaid |
$3,448.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,821.06
|
| Rate for Payer: Cash Price |
$5,013.50
|
| Rate for Payer: Cigna Commercial |
$8,322.41
|
| Rate for Payer: First Health Commercial |
$9,525.65
|
| Rate for Payer: Humana Commercial |
$8,522.95
|
| Rate for Payer: Humana KY Medicaid |
$3,448.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,483.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,222.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,517.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,005.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,108.37
|
| Rate for Payer: PHCS Commercial |
$9,625.92
|
| Rate for Payer: United Healthcare All Payer |
$8,823.76
|
|
|
MESH PHYSIOMESH 20*25CM
|
Facility
|
IP
|
$10,027.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.51 |
| Max. Negotiated Rate |
$9,625.92 |
| Rate for Payer: Aetna Commercial |
$7,720.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,821.06
|
| Rate for Payer: Cash Price |
$5,013.50
|
| Rate for Payer: Cigna Commercial |
$8,322.41
|
| Rate for Payer: First Health Commercial |
$9,525.65
|
| Rate for Payer: Humana Commercial |
$8,522.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,222.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,399.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,823.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,520.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,005.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,108.37
|
| Rate for Payer: PHCS Commercial |
$9,625.92
|
| Rate for Payer: United Healthcare All Payer |
$8,823.76
|
|
|
MESH PHYSIOMESH 30*35CM
|
Facility
|
IP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,838.26 |
| Max. Negotiated Rate |
$13,574.88 |
| Rate for Payer: Aetna Commercial |
$10,888.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,029.59
|
| Rate for Payer: Cash Price |
$7,070.25
|
| Rate for Payer: Cigna Commercial |
$11,736.62
|
| Rate for Payer: First Health Commercial |
$13,433.48
|
| Rate for Payer: Humana Commercial |
$12,019.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,595.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,435.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,242.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,443.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,605.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,838.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,383.56
|
| Rate for Payer: PHCS Commercial |
$13,574.88
|
| Rate for Payer: United Healthcare All Payer |
$12,443.64
|
|
|
MESH PHYSIOMESH 30*35CM
|
Facility
|
OP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,838.26 |
| Max. Negotiated Rate |
$13,574.88 |
| Rate for Payer: Aetna Commercial |
$10,888.18
|
| Rate for Payer: Anthem Medicaid |
$4,862.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,029.59
|
| Rate for Payer: Cash Price |
$7,070.25
|
| Rate for Payer: Cigna Commercial |
$11,736.62
|
| Rate for Payer: First Health Commercial |
$13,433.48
|
| Rate for Payer: Humana Commercial |
$12,019.42
|
| Rate for Payer: Humana KY Medicaid |
$4,862.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,912.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,595.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,435.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,242.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,960.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,443.64
|
| Rate for Payer: Ohio Health Group HMO |
$10,605.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,838.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,383.56
|
| Rate for Payer: PHCS Commercial |
$13,574.88
|
| Rate for Payer: United Healthcare All Payer |
$12,443.64
|
|
|
MESH PHYSIOMESH 30*50CM
|
Facility
|
IP
|
$15,961.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.96 |
| Max. Negotiated Rate |
$15,322.75 |
| Rate for Payer: Aetna Commercial |
$12,290.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,449.74
|
| Rate for Payer: Cash Price |
$7,980.60
|
| Rate for Payer: Cigna Commercial |
$13,247.80
|
| Rate for Payer: First Health Commercial |
$15,163.14
|
| Rate for Payer: Humana Commercial |
$13,567.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,088.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,779.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,788.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,045.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,192.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,074.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,947.97
|
| Rate for Payer: PHCS Commercial |
$15,322.75
|
| Rate for Payer: United Healthcare All Payer |
$14,045.86
|
|
|
MESH PHYSIOMESH 30*50CM
|
Facility
|
OP
|
$15,961.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,074.96 |
| Max. Negotiated Rate |
$15,322.75 |
| Rate for Payer: Aetna Commercial |
$12,290.12
|
| Rate for Payer: Anthem Medicaid |
$5,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,449.74
|
| Rate for Payer: Cash Price |
$7,980.60
|
| Rate for Payer: Cigna Commercial |
$13,247.80
|
| Rate for Payer: First Health Commercial |
$15,163.14
|
| Rate for Payer: Humana Commercial |
$13,567.02
|
| Rate for Payer: Humana KY Medicaid |
$5,489.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,544.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,088.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,779.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,788.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,599.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,045.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,192.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,074.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,947.97
|
| Rate for Payer: PHCS Commercial |
$15,322.75
|
| Rate for Payer: United Healthcare All Payer |
$14,045.86
|
|
