|
MESH PHYSIOMESH OPEN 10*10CM
|
Facility
|
OP
|
$3,621.18
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.75 |
| Max. Negotiated Rate |
$3,476.33 |
| Rate for Payer: Aetna Commercial |
$2,788.31
|
| Rate for Payer: Anthem Medicaid |
$1,245.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,824.52
|
| Rate for Payer: Cash Price |
$1,810.59
|
| Rate for Payer: Cigna Commercial |
$3,005.58
|
| Rate for Payer: First Health Commercial |
$3,440.12
|
| Rate for Payer: Humana Commercial |
$3,078.00
|
| Rate for Payer: Humana KY Medicaid |
$1,245.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,258.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,969.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,672.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,086.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,270.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,186.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,715.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,122.57
|
| Rate for Payer: PHCS Commercial |
$3,476.33
|
| Rate for Payer: United Healthcare All Payer |
$3,186.64
|
|
|
MESH PHYSIOMESH OPEN 10*10CM
|
Facility
|
IP
|
$3,621.18
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.75 |
| Max. Negotiated Rate |
$3,476.33 |
| Rate for Payer: Aetna Commercial |
$2,788.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,824.52
|
| Rate for Payer: Cash Price |
$1,810.59
|
| Rate for Payer: Cigna Commercial |
$3,005.58
|
| Rate for Payer: First Health Commercial |
$3,440.12
|
| Rate for Payer: Humana Commercial |
$3,078.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,969.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,672.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,086.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,186.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,715.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,122.57
|
| Rate for Payer: PHCS Commercial |
$3,476.33
|
| Rate for Payer: United Healthcare All Payer |
$3,186.64
|
|
|
MESH PHYSIOMESH OPEN 15*20CM
|
Facility
|
OP
|
$7,037.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.89 |
| Max. Negotiated Rate |
$6,756.14 |
| Rate for Payer: Aetna Commercial |
$5,418.99
|
| Rate for Payer: Anthem Medicaid |
$2,420.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,489.37
|
| Rate for Payer: Cash Price |
$3,518.82
|
| Rate for Payer: Cigna Commercial |
$5,841.25
|
| Rate for Payer: First Health Commercial |
$6,685.77
|
| Rate for Payer: Humana Commercial |
$5,982.00
|
| Rate for Payer: Humana KY Medicaid |
$2,420.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,444.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,770.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,193.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,468.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,193.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,278.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,181.67
|
| Rate for Payer: PHCS Commercial |
$6,756.14
|
| Rate for Payer: United Healthcare All Payer |
$6,193.13
|
|
|
MESH PHYSIOMESH OPEN 15*20CM
|
Facility
|
IP
|
$7,037.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.89 |
| Max. Negotiated Rate |
$6,756.14 |
| Rate for Payer: Aetna Commercial |
$5,418.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,489.37
|
| Rate for Payer: Cash Price |
$3,518.82
|
| Rate for Payer: Cigna Commercial |
$5,841.25
|
| Rate for Payer: First Health Commercial |
$6,685.77
|
| Rate for Payer: Humana Commercial |
$5,982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,770.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,193.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,193.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,278.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,181.67
|
| Rate for Payer: PHCS Commercial |
$6,756.14
|
| Rate for Payer: United Healthcare All Payer |
$6,193.13
|
|
|
MESH PHYSIOMESH OPEN 15*25CM
|
Facility
|
OP
|
$9,748.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.29 |
| Max. Negotiated Rate |
$9,358.43 |
| Rate for Payer: Aetna Commercial |
$7,506.24
|
| Rate for Payer: Anthem Medicaid |
$3,352.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,603.72
|
| Rate for Payer: Cash Price |
$4,874.18
|
| Rate for Payer: Cigna Commercial |
$8,091.14
|
| Rate for Payer: First Health Commercial |
$9,260.94
|
| Rate for Payer: Humana Commercial |
$8,286.11
|
| Rate for Payer: Humana KY Medicaid |
$3,352.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,386.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,993.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,194.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,924.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,419.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,578.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,311.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,949.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,021.99
|
| Rate for Payer: PHCS Commercial |
$9,358.43
|
| Rate for Payer: United Healthcare All Payer |
$8,578.56
|
|
|
MESH PHYSIOMESH OPEN 15*25CM
|
Facility
|
IP
|
$9,748.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.29 |
| Max. Negotiated Rate |
$9,358.43 |
| Rate for Payer: Aetna Commercial |
$7,506.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,603.72
|
| Rate for Payer: Cash Price |
$4,874.18
|
| Rate for Payer: Cigna Commercial |
$8,091.14
|
| Rate for Payer: First Health Commercial |
$9,260.94
|
| Rate for Payer: Humana Commercial |
$8,286.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,993.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,194.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,924.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,578.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,311.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,949.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,021.99
|
| Rate for Payer: PHCS Commercial |
$9,358.43
|
| Rate for Payer: United Healthcare All Payer |
$8,578.56
|
|
|
MESH PHYSIOMESH OPEN 20*30CM
|
Facility
|
IP
|
$10,702.27
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,391.30 |
| Max. Negotiated Rate |
$10,274.18 |
| Rate for Payer: Aetna Commercial |
$8,240.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,347.77
|
| Rate for Payer: Cash Price |
$5,351.14
|
| Rate for Payer: Cigna Commercial |
$8,882.88
|
| Rate for Payer: First Health Commercial |
$10,167.16
|
| Rate for Payer: Humana Commercial |
$9,096.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,775.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,898.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,210.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,418.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,026.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,140.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.70
|
| Rate for Payer: PHCS Commercial |
$10,274.18
|
| Rate for Payer: United Healthcare All Payer |
$9,418.00
|
|
|
MESH PHYSIOMESH OPEN 20*30CM
|
Facility
|
OP
|
$10,702.27
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,391.30 |
| Max. Negotiated Rate |
$10,274.18 |
| Rate for Payer: Aetna Commercial |
$8,240.75
|
| Rate for Payer: Anthem Medicaid |
$3,680.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,347.77
|
| Rate for Payer: Cash Price |
$5,351.14
|
| Rate for Payer: Cigna Commercial |
$8,882.88
|
| Rate for Payer: First Health Commercial |
$10,167.16
|
| Rate for Payer: Humana Commercial |
$9,096.93
|
| Rate for Payer: Humana KY Medicaid |
$3,680.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,717.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,775.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,898.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,210.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,754.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,418.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,026.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,140.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.70
|
| Rate for Payer: PHCS Commercial |
$10,274.18
|
| Rate for Payer: United Healthcare All Payer |
$9,418.00
|
|
|
MESH PLUG ULTRAPRO COMFRT 40MM
|
Facility
|
IP
|
$2,008.18
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.06 |
| Max. Negotiated Rate |
$1,927.85 |
| Rate for Payer: Aetna Commercial |
$1,546.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.38
|
| Rate for Payer: Cash Price |
$1,004.09
|
| Rate for Payer: Cigna Commercial |
$1,666.79
|
| Rate for Payer: First Health Commercial |
$1,907.77
|
| Rate for Payer: Humana Commercial |
$1,706.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,482.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.54
|
| Rate for Payer: PHCS Commercial |
$1,927.85
|
| Rate for Payer: United Healthcare All Payer |
$1,767.20
|
|
|
MESH PLUG ULTRAPRO COMFRT 40MM
|
Facility
|
OP
|
$2,008.18
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.06 |
| Max. Negotiated Rate |
$1,927.85 |
| Rate for Payer: Aetna Commercial |
$1,546.30
|
| Rate for Payer: Anthem Medicaid |
$690.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.38
|
| Rate for Payer: Cash Price |
$1,004.09
|
| Rate for Payer: Cigna Commercial |
$1,666.79
|
| Rate for Payer: First Health Commercial |
$1,907.77
|
| Rate for Payer: Humana Commercial |
$1,706.95
|
| Rate for Payer: Humana KY Medicaid |
$690.61
|
| Rate for Payer: Kentucky WC Medicaid |
$697.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,482.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$704.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.54
|
| Rate for Payer: PHCS Commercial |
$1,927.85
|
| Rate for Payer: United Healthcare All Payer |
$1,767.20
|
|
|
MESH PLUG ULTRAPRO COMFRT 55MM
|
Facility
|
IP
|
$2,008.18
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.06 |
| Max. Negotiated Rate |
$1,927.85 |
| Rate for Payer: Aetna Commercial |
$1,546.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.38
|
| Rate for Payer: Cash Price |
$1,004.09
|
| Rate for Payer: Cigna Commercial |
$1,666.79
|
| Rate for Payer: First Health Commercial |
$1,907.77
|
| Rate for Payer: Humana Commercial |
$1,706.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,482.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.54
|
| Rate for Payer: PHCS Commercial |
$1,927.85
|
| Rate for Payer: United Healthcare All Payer |
$1,767.20
|
|
|
MESH PLUG ULTRAPRO COMFRT 55MM
|
Facility
|
OP
|
$2,008.18
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.06 |
| Max. Negotiated Rate |
$1,927.85 |
| Rate for Payer: Aetna Commercial |
$1,546.30
|
| Rate for Payer: Anthem Medicaid |
$690.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,566.38
|
| Rate for Payer: Cash Price |
$1,004.09
|
| Rate for Payer: Cigna Commercial |
$1,666.79
|
| Rate for Payer: First Health Commercial |
$1,907.77
|
| Rate for Payer: Humana Commercial |
$1,706.95
|
| Rate for Payer: Humana KY Medicaid |
$690.61
|
| Rate for Payer: Kentucky WC Medicaid |
$697.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,646.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,482.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$704.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,767.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,506.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.54
|
| Rate for Payer: PHCS Commercial |
$1,927.85
|
| Rate for Payer: United Healthcare All Payer |
$1,767.20
|
|
|
MESH PROCEED SURG 15*15CM
|
Facility
|
OP
|
$4,245.78
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.95 |
| Max. Negotiated Rate |
$4,075.95 |
| Rate for Payer: Aetna Commercial |
$3,269.25
|
| Rate for Payer: Anthem Medicaid |
$1,460.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,311.71
|
| Rate for Payer: Cash Price |
$2,122.89
|
| Rate for Payer: Cigna Commercial |
$3,524.00
|
| Rate for Payer: First Health Commercial |
$4,033.49
|
| Rate for Payer: Humana Commercial |
$3,608.91
|
| Rate for Payer: Humana KY Medicaid |
$1,460.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,474.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,481.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,133.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,489.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,736.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,184.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.19
|
| Rate for Payer: PHCS Commercial |
$4,075.95
|
| Rate for Payer: United Healthcare All Payer |
$3,736.29
|
|
|
MESH PROCEED SURG 15*15CM
|
Facility
|
IP
|
$4,245.78
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.95 |
| Max. Negotiated Rate |
$4,075.95 |
| Rate for Payer: Aetna Commercial |
$3,269.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,311.71
|
| Rate for Payer: Cash Price |
$2,122.89
|
| Rate for Payer: Cigna Commercial |
$3,524.00
|
| Rate for Payer: First Health Commercial |
$4,033.49
|
| Rate for Payer: Humana Commercial |
$3,608.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,481.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,133.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,736.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,184.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.19
|
| Rate for Payer: PHCS Commercial |
$4,075.95
|
| Rate for Payer: United Healthcare All Payer |
$3,736.29
|
|
|
MESH PROCEED SURG 26*34CM
|
Facility
|
IP
|
$12,597.97
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,637.74 |
| Max. Negotiated Rate |
$12,094.05 |
| Rate for Payer: Aetna Commercial |
$9,700.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,826.42
|
| Rate for Payer: Cash Price |
$6,298.99
|
| Rate for Payer: Cigna Commercial |
$10,456.32
|
| Rate for Payer: First Health Commercial |
$11,968.07
|
| Rate for Payer: Humana Commercial |
$10,708.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,330.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,297.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,779.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,086.21
|
| Rate for Payer: Ohio Health Group HMO |
$9,448.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,519.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,637.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,905.37
|
| Rate for Payer: PHCS Commercial |
$12,094.05
|
| Rate for Payer: United Healthcare All Payer |
$11,086.21
|
|
|
MESH PROCEED SURG 26*34CM
|
Facility
|
OP
|
$12,597.97
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,637.74 |
| Max. Negotiated Rate |
$12,094.05 |
| Rate for Payer: Aetna Commercial |
$9,700.44
|
| Rate for Payer: Anthem Medicaid |
$4,332.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,826.42
|
| Rate for Payer: Cash Price |
$6,298.99
|
| Rate for Payer: Cigna Commercial |
$10,456.32
|
| Rate for Payer: First Health Commercial |
$11,968.07
|
| Rate for Payer: Humana Commercial |
$10,708.27
|
| Rate for Payer: Humana KY Medicaid |
$4,332.44
|
| Rate for Payer: Kentucky WC Medicaid |
$4,376.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,330.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,297.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,779.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,419.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,086.21
|
| Rate for Payer: Ohio Health Group HMO |
$9,448.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,519.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,637.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,905.37
|
| Rate for Payer: PHCS Commercial |
$12,094.05
|
| Rate for Payer: United Healthcare All Payer |
$11,086.21
|
|
|
MESH PROGRIP FLATSHEET 10*15CM
|
Facility
|
OP
|
$3,718.92
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.46 |
| Max. Negotiated Rate |
$3,570.16 |
| Rate for Payer: Aetna Commercial |
$2,863.57
|
| Rate for Payer: Anthem Medicaid |
$1,278.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.76
|
| Rate for Payer: Cash Price |
$1,859.46
|
| Rate for Payer: Cigna Commercial |
$3,086.70
|
| Rate for Payer: First Health Commercial |
$3,532.97
|
| Rate for Payer: Humana Commercial |
$3,161.08
|
| Rate for Payer: Humana KY Medicaid |
$1,278.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,049.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,744.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,272.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,789.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.87
|
| Rate for Payer: PHCS Commercial |
$3,570.16
|
| Rate for Payer: United Healthcare All Payer |
$3,272.65
|
|
|
MESH PROGRIP FLATSHEET 10*15CM
|
Facility
|
IP
|
$3,718.92
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.46 |
| Max. Negotiated Rate |
$3,570.16 |
| Rate for Payer: Aetna Commercial |
$2,863.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.76
|
| Rate for Payer: Cash Price |
$1,859.46
|
| Rate for Payer: Cigna Commercial |
$3,086.70
|
| Rate for Payer: First Health Commercial |
$3,532.97
|
| Rate for Payer: Humana Commercial |
$3,161.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,049.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,744.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,272.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,789.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.87
|
| Rate for Payer: PHCS Commercial |
$3,570.16
|
| Rate for Payer: United Healthcare All Payer |
$3,272.65
|
|
|
MESH PROLENE (2.5*10CM)1*4 PMX
|
Facility
|
OP
|
$1,595.63
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$1,531.80 |
| Rate for Payer: Aetna Commercial |
$1,228.64
|
| Rate for Payer: Anthem Medicaid |
$548.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,244.59
|
| Rate for Payer: Cash Price |
$797.82
|
| Rate for Payer: Cigna Commercial |
$1,324.37
|
| Rate for Payer: First Health Commercial |
$1,515.85
|
| Rate for Payer: Humana Commercial |
$1,356.29
|
| Rate for Payer: Humana KY Medicaid |
$548.74
|
| Rate for Payer: Kentucky WC Medicaid |
$554.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,308.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,177.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$559.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,196.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.65
|
| Rate for Payer: PHCS Commercial |
$1,531.80
|
| Rate for Payer: United Healthcare All Payer |
$1,404.15
|
|
|
MESH PROLENE (2.5*10CM)1*4 PMX
|
Facility
|
IP
|
$1,595.63
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.43 |
| Max. Negotiated Rate |
$1,531.80 |
| Rate for Payer: Aetna Commercial |
$1,228.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,244.59
|
| Rate for Payer: Cash Price |
$797.82
|
| Rate for Payer: Cigna Commercial |
$1,324.37
|
| Rate for Payer: First Health Commercial |
$1,515.85
|
| Rate for Payer: Humana Commercial |
$1,356.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,308.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,177.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,404.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,196.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$319.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.65
|
| Rate for Payer: PHCS Commercial |
$1,531.80
|
| Rate for Payer: United Healthcare All Payer |
$1,404.15
|
|
|
MESH PROLENE(30*30CM)12*12 PML
|
Facility
|
IP
|
$3,177.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.03 |
| Max. Negotiated Rate |
$3,050.04 |
| Rate for Payer: Aetna Commercial |
$2,446.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,478.15
|
| Rate for Payer: Cash Price |
$1,588.56
|
| Rate for Payer: Cigna Commercial |
$2,637.01
|
| Rate for Payer: First Health Commercial |
$3,018.26
|
| Rate for Payer: Humana Commercial |
$2,700.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,605.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,344.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,795.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,382.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$984.91
|
| Rate for Payer: PHCS Commercial |
$3,050.04
|
| Rate for Payer: United Healthcare All Payer |
$2,795.87
|
|
|
MESH PROLENE(30*30CM)12*12 PML
|
Facility
|
OP
|
$3,177.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.03 |
| Max. Negotiated Rate |
$3,050.04 |
| Rate for Payer: Aetna Commercial |
$2,446.38
|
| Rate for Payer: Anthem Medicaid |
$1,092.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,478.15
|
| Rate for Payer: Cash Price |
$1,588.56
|
| Rate for Payer: Cigna Commercial |
$2,637.01
|
| Rate for Payer: First Health Commercial |
$3,018.26
|
| Rate for Payer: Humana Commercial |
$2,700.55
|
| Rate for Payer: Humana KY Medicaid |
$1,092.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,103.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,605.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,344.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,114.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,795.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,382.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$984.91
|
| Rate for Payer: PHCS Commercial |
$3,050.04
|
| Rate for Payer: United Healthcare All Payer |
$2,795.87
|
|
|
MESH PROLENE (4.6*10.2CM)1.8*4
|
Facility
|
IP
|
$1,847.33
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.15 |
| Max. Negotiated Rate |
$1,773.44 |
| Rate for Payer: Aetna Commercial |
$1,422.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.92
|
| Rate for Payer: Cash Price |
$923.66
|
| Rate for Payer: Cigna Commercial |
$1,533.28
|
| Rate for Payer: First Health Commercial |
$1,754.96
|
| Rate for Payer: Humana Commercial |
$1,570.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.67
|
| Rate for Payer: PHCS Commercial |
$1,773.44
|
| Rate for Payer: United Healthcare All Payer |
$1,625.65
|
|
|
MESH PROLENE (4.6*10.2CM)1.8*4
|
Facility
|
OP
|
$1,847.33
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.15 |
| Max. Negotiated Rate |
$1,773.44 |
| Rate for Payer: Aetna Commercial |
$1,422.44
|
| Rate for Payer: Anthem Medicaid |
$635.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.92
|
| Rate for Payer: Cash Price |
$923.66
|
| Rate for Payer: Cigna Commercial |
$1,533.28
|
| Rate for Payer: First Health Commercial |
$1,754.96
|
| Rate for Payer: Humana Commercial |
$1,570.23
|
| Rate for Payer: Humana KY Medicaid |
$635.30
|
| Rate for Payer: Kentucky WC Medicaid |
$641.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.67
|
| Rate for Payer: PHCS Commercial |
$1,773.44
|
| Rate for Payer: United Healthcare All Payer |
$1,625.65
|
|
|
MESH PROLENE(6.1*13.7C)2.4*5.4
|
Facility
|
IP
|
$1,962.79
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.16 |
| Max. Negotiated Rate |
$1,884.28 |
| Rate for Payer: Aetna Commercial |
$1,511.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.98
|
| Rate for Payer: Cash Price |
$981.40
|
| Rate for Payer: Cigna Commercial |
$1,629.12
|
| Rate for Payer: First Health Commercial |
$1,864.65
|
| Rate for Payer: Humana Commercial |
$1,668.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,472.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.46
|
| Rate for Payer: PHCS Commercial |
$1,884.28
|
| Rate for Payer: United Healthcare All Payer |
$1,727.26
|
|
