|
MESH SURGIMND MP 20CM*30CM*3MM
|
Facility
|
OP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem Medicaid |
$24,258.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Humana KY Medicaid |
$24,258.71
|
| Rate for Payer: Kentucky WC Medicaid |
$24,505.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,745.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
MESH SURGIMND MP 20CM*30CM*3MM
|
Facility
|
IP
|
$70,540.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,170.20 |
| Max. Negotiated Rate |
$67,718.40 |
| Rate for Payer: Aetna Commercial |
$54,315.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,021.20
|
| Rate for Payer: Cash Price |
$35,270.00
|
| Rate for Payer: Cigna Commercial |
$58,548.20
|
| Rate for Payer: First Health Commercial |
$67,013.00
|
| Rate for Payer: Humana Commercial |
$59,959.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,842.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,058.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,075.20
|
| Rate for Payer: Ohio Health Group HMO |
$52,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,170.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,867.40
|
| Rate for Payer: PHCS Commercial |
$67,718.40
|
| Rate for Payer: United Healthcare All Payer |
$62,075.20
|
|
|
MESH ULTRA PRO 3*6
|
Facility
|
IP
|
$2,061.94
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$1,979.46 |
| Rate for Payer: Aetna Commercial |
$1,587.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,608.31
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cigna Commercial |
$1,711.41
|
| Rate for Payer: First Health Commercial |
$1,958.84
|
| Rate for Payer: Humana Commercial |
$1,752.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,690.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,521.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,814.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,546.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.20
|
| Rate for Payer: PHCS Commercial |
$1,979.46
|
| Rate for Payer: United Healthcare All Payer |
$1,814.51
|
|
|
MESH ULTRA PRO 3*6
|
Facility
|
OP
|
$2,061.94
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$1,979.46 |
| Rate for Payer: Aetna Commercial |
$1,587.69
|
| Rate for Payer: Anthem Medicaid |
$709.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,608.31
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cigna Commercial |
$1,711.41
|
| Rate for Payer: First Health Commercial |
$1,958.84
|
| Rate for Payer: Humana Commercial |
$1,752.65
|
| Rate for Payer: Humana KY Medicaid |
$709.10
|
| Rate for Payer: Kentucky WC Medicaid |
$716.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,690.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,521.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$723.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,814.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,546.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.20
|
| Rate for Payer: PHCS Commercial |
$1,979.46
|
| Rate for Payer: United Healthcare All Payer |
$1,814.51
|
|
|
MESH ULTRA PRO 6*6
|
Facility
|
OP
|
$3,124.41
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.17 |
| Max. Negotiated Rate |
$2,999.43 |
| Rate for Payer: Aetna Commercial |
$2,405.80
|
| Rate for Payer: Anthem Medicaid |
$1,074.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.04
|
| Rate for Payer: Cash Price |
$1,562.20
|
| Rate for Payer: Cigna Commercial |
$2,593.26
|
| Rate for Payer: First Health Commercial |
$2,968.19
|
| Rate for Payer: Humana Commercial |
$2,655.75
|
| Rate for Payer: Humana KY Medicaid |
$1,074.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.57
|
| Rate for Payer: PHCS Commercial |
$2,999.43
|
| Rate for Payer: United Healthcare All Payer |
$2,749.48
|
|
|
MESH ULTRA PRO 6*6
|
Facility
|
IP
|
$3,124.41
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.17 |
| Max. Negotiated Rate |
$2,999.43 |
| Rate for Payer: Aetna Commercial |
$2,405.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.04
|
| Rate for Payer: Cash Price |
$1,562.20
|
| Rate for Payer: Cigna Commercial |
$2,593.26
|
| Rate for Payer: First Health Commercial |
$2,968.19
|
| Rate for Payer: Humana Commercial |
$2,655.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.57
|
| Rate for Payer: PHCS Commercial |
$2,999.43
|
| Rate for Payer: United Healthcare All Payer |
$2,749.48
|
|
|
MESH ULTRAPRO ADVANCED 10*15CM
|
Facility
|
OP
|
$1,759.45
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.73 |
| Max. Negotiated Rate |
$1,689.07 |
| Rate for Payer: Aetna Commercial |
$1,354.78
|
| Rate for Payer: Anthem Medicaid |
$605.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.37
|
| Rate for Payer: Cash Price |
$879.73
|
| Rate for Payer: Cigna Commercial |
$1,460.34
|
| Rate for Payer: First Health Commercial |
$1,671.48
|
| Rate for Payer: Humana Commercial |
$1,495.53
|
| Rate for Payer: Humana KY Medicaid |
$605.07
|
| Rate for Payer: Kentucky WC Medicaid |
$611.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.43
|
| Rate for Payer: PHCS Commercial |
$1,689.07
|
| Rate for Payer: United Healthcare All Payer |
$1,548.32
|
|
|
MESH ULTRAPRO ADVANCED 10*15CM
|
Facility
|
IP
|
$1,759.45
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.73 |
| Max. Negotiated Rate |
$1,689.07 |
| Rate for Payer: Aetna Commercial |
$1,354.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.37
|
| Rate for Payer: Cash Price |
$879.73
|
| Rate for Payer: Cigna Commercial |
$1,460.34
|
| Rate for Payer: First Health Commercial |
$1,671.48
|
| Rate for Payer: Humana Commercial |
$1,495.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.43
|
| Rate for Payer: PHCS Commercial |
$1,689.07
|
| Rate for Payer: United Healthcare All Payer |
$1,548.32
|
|
|
MESH ULTRAPRO ADVANCED 15*15CM
|
Facility
|
IP
|
$1,799.11
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$1,727.15 |
| Rate for Payer: Aetna Commercial |
$1,385.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.31
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna Commercial |
$1,493.26
|
| Rate for Payer: First Health Commercial |
$1,709.15
|
| Rate for Payer: Humana Commercial |
$1,529.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,327.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.72
|
| Rate for Payer: PHCS Commercial |
$1,727.15
|
| Rate for Payer: United Healthcare All Payer |
$1,583.22
|
|
|
MESH ULTRAPRO ADVANCED 15*15CM
|
Facility
|
OP
|
$1,799.11
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.88 |
| Max. Negotiated Rate |
$1,727.15 |
| Rate for Payer: Aetna Commercial |
$1,385.31
|
| Rate for Payer: Anthem Medicaid |
$618.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.31
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna Commercial |
$1,493.26
|
| Rate for Payer: First Health Commercial |
$1,709.15
|
| Rate for Payer: Humana Commercial |
$1,529.24
|
| Rate for Payer: Humana KY Medicaid |
$618.71
|
| Rate for Payer: Kentucky WC Medicaid |
$625.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,327.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.72
|
| Rate for Payer: PHCS Commercial |
$1,727.15
|
| Rate for Payer: United Healthcare All Payer |
$1,583.22
|
|
|
MESH VENTRALEX ST HERNIA LRG C
|
Facility
|
IP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.20 |
| Max. Negotiated Rate |
$4,262.40 |
| Rate for Payer: Aetna Commercial |
$3,418.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,463.20
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cigna Commercial |
$3,685.20
|
| Rate for Payer: First Health Commercial |
$4,218.00
|
| Rate for Payer: Humana Commercial |
$3,774.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,640.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,276.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,332.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,907.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$888.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,376.40
|
| Rate for Payer: PHCS Commercial |
$4,262.40
|
| Rate for Payer: United Healthcare All Payer |
$3,907.20
|
|
|
MESH VENTRALEX ST HERNIA LRG C
|
Facility
|
OP
|
$4,440.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.20 |
| Max. Negotiated Rate |
$4,262.40 |
| Rate for Payer: Aetna Commercial |
$3,418.80
|
| Rate for Payer: Anthem Medicaid |
$1,526.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,463.20
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cigna Commercial |
$3,685.20
|
| Rate for Payer: First Health Commercial |
$4,218.00
|
| Rate for Payer: Humana Commercial |
$3,774.00
|
| Rate for Payer: Humana KY Medicaid |
$1,526.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,542.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,640.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,276.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,332.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,557.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,907.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$888.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,376.40
|
| Rate for Payer: PHCS Commercial |
$4,262.40
|
| Rate for Payer: United Healthcare All Payer |
$3,907.20
|
|
|
MESH VENTRALEX ST HERNIA MED C
|
Facility
|
IP
|
$3,874.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.67 |
| Max. Negotiated Rate |
$3,719.42 |
| Rate for Payer: Aetna Commercial |
$2,983.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.03
|
| Rate for Payer: Cash Price |
$1,937.20
|
| Rate for Payer: Cigna Commercial |
$3,215.75
|
| Rate for Payer: First Health Commercial |
$3,680.68
|
| Rate for Payer: Humana Commercial |
$3,293.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,409.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,201.06
|
| Rate for Payer: PHCS Commercial |
$3,719.42
|
| Rate for Payer: United Healthcare All Payer |
$3,409.47
|
|
|
MESH VENTRALEX ST HERNIA MED C
|
Facility
|
OP
|
$3,874.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.67 |
| Max. Negotiated Rate |
$3,719.42 |
| Rate for Payer: Aetna Commercial |
$2,983.29
|
| Rate for Payer: Anthem Medicaid |
$1,332.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.03
|
| Rate for Payer: Cash Price |
$1,937.20
|
| Rate for Payer: Cigna Commercial |
$3,215.75
|
| Rate for Payer: First Health Commercial |
$3,680.68
|
| Rate for Payer: Humana Commercial |
$3,293.24
|
| Rate for Payer: Humana KY Medicaid |
$1,332.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,345.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,409.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$774.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,201.06
|
| Rate for Payer: PHCS Commercial |
$3,719.42
|
| Rate for Payer: United Healthcare All Payer |
$3,409.47
|
|
|
MESH VENTRALEX ST HERNIA SM CI
|
Facility
|
IP
|
$3,583.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.82 |
| Max. Negotiated Rate |
$3,439.87 |
| Rate for Payer: Aetna Commercial |
$2,759.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.90
|
| Rate for Payer: Cash Price |
$1,791.60
|
| Rate for Payer: Cigna Commercial |
$2,974.06
|
| Rate for Payer: First Health Commercial |
$3,404.04
|
| Rate for Payer: Humana Commercial |
$3,045.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,687.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.79
|
| Rate for Payer: PHCS Commercial |
$3,439.87
|
| Rate for Payer: United Healthcare All Payer |
$3,153.22
|
|
|
MESH VENTRALEX ST HERNIA SM CI
|
Facility
|
OP
|
$3,583.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.82 |
| Max. Negotiated Rate |
$3,439.87 |
| Rate for Payer: Aetna Commercial |
$2,759.06
|
| Rate for Payer: Anthem Medicaid |
$1,232.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.90
|
| Rate for Payer: Cash Price |
$1,791.60
|
| Rate for Payer: Cigna Commercial |
$2,974.06
|
| Rate for Payer: First Health Commercial |
$3,404.04
|
| Rate for Payer: Humana Commercial |
$3,045.72
|
| Rate for Payer: Humana KY Medicaid |
$1,232.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,687.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.79
|
| Rate for Payer: PHCS Commercial |
$3,439.87
|
| Rate for Payer: United Healthcare All Payer |
$3,153.22
|
|
|
MESH VENTRALIGHT ECHO PS
|
Facility
|
OP
|
$4,482.35
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.71 |
| Max. Negotiated Rate |
$4,303.06 |
| Rate for Payer: Aetna Commercial |
$3,451.41
|
| Rate for Payer: Anthem Medicaid |
$1,541.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,496.23
|
| Rate for Payer: Cash Price |
$2,241.18
|
| Rate for Payer: Cigna Commercial |
$3,720.35
|
| Rate for Payer: First Health Commercial |
$4,258.23
|
| Rate for Payer: Humana Commercial |
$3,810.00
|
| Rate for Payer: Humana KY Medicaid |
$1,541.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,557.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,675.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,944.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.53
|
| Rate for Payer: PHCS Commercial |
$4,303.06
|
| Rate for Payer: United Healthcare All Payer |
$3,944.47
|
|
|
MESH VENTRALIGHT ECHO PS
|
Facility
|
IP
|
$4,482.35
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.71 |
| Max. Negotiated Rate |
$4,303.06 |
| Rate for Payer: Aetna Commercial |
$3,451.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,496.23
|
| Rate for Payer: Cash Price |
$2,241.18
|
| Rate for Payer: Cigna Commercial |
$3,720.35
|
| Rate for Payer: First Health Commercial |
$4,258.23
|
| Rate for Payer: Humana Commercial |
$3,810.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,675.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,944.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.53
|
| Rate for Payer: PHCS Commercial |
$4,303.06
|
| Rate for Payer: United Healthcare All Payer |
$3,944.47
|
|
|
MESH VENTRALIGHT ECHO PS 10*13
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
MESH VENTRALIGHT ECHO PS 10*13
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
MESH VENTRALIGHT ECHO PS 4*6
|
Facility
|
OP
|
$4,991.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.85 |
| Max. Negotiated Rate |
$4,791.50 |
| Rate for Payer: Aetna Commercial |
$3,843.19
|
| Rate for Payer: Anthem Medicaid |
$1,716.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,893.10
|
| Rate for Payer: Cash Price |
$2,495.57
|
| Rate for Payer: Cigna Commercial |
$4,142.65
|
| Rate for Payer: First Health Commercial |
$4,741.59
|
| Rate for Payer: Humana Commercial |
$4,242.48
|
| Rate for Payer: Humana KY Medicaid |
$1,716.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,733.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,092.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,683.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,497.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,750.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,392.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,743.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.26
|
| Rate for Payer: PHCS Commercial |
$4,791.50
|
| Rate for Payer: United Healthcare All Payer |
$4,392.21
|
|
|
MESH VENTRALIGHT ECHO PS 4*6
|
Facility
|
IP
|
$4,991.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.85 |
| Max. Negotiated Rate |
$4,791.50 |
| Rate for Payer: Aetna Commercial |
$3,843.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,893.10
|
| Rate for Payer: Cash Price |
$2,495.57
|
| Rate for Payer: Cigna Commercial |
$4,142.65
|
| Rate for Payer: First Health Commercial |
$4,741.59
|
| Rate for Payer: Humana Commercial |
$4,242.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,092.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,683.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,497.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,392.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,743.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$648.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.26
|
| Rate for Payer: PHCS Commercial |
$4,791.50
|
| Rate for Payer: United Healthcare All Payer |
$4,392.21
|
|
|
MESH VENTRALIGHT ECHO PS 6*10
|
Facility
|
IP
|
$11,039.46
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.13 |
| Max. Negotiated Rate |
$10,597.88 |
| Rate for Payer: Aetna Commercial |
$8,500.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,610.78
|
| Rate for Payer: Cash Price |
$5,519.73
|
| Rate for Payer: Cigna Commercial |
$9,162.75
|
| Rate for Payer: First Health Commercial |
$10,487.49
|
| Rate for Payer: Humana Commercial |
$9,383.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,052.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,147.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,311.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,714.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,279.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,207.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,422.23
|
| Rate for Payer: PHCS Commercial |
$10,597.88
|
| Rate for Payer: United Healthcare All Payer |
$9,714.72
|
|
|
MESH VENTRALIGHT ECHO PS 6*10
|
Facility
|
OP
|
$11,039.46
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.13 |
| Max. Negotiated Rate |
$10,597.88 |
| Rate for Payer: Aetna Commercial |
$8,500.38
|
| Rate for Payer: Anthem Medicaid |
$3,796.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,610.78
|
| Rate for Payer: Cash Price |
$5,519.73
|
| Rate for Payer: Cigna Commercial |
$9,162.75
|
| Rate for Payer: First Health Commercial |
$10,487.49
|
| Rate for Payer: Humana Commercial |
$9,383.54
|
| Rate for Payer: Humana KY Medicaid |
$3,796.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,835.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,052.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,147.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,311.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,872.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,714.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,279.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,207.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,422.23
|
| Rate for Payer: PHCS Commercial |
$10,597.88
|
| Rate for Payer: United Healthcare All Payer |
$9,714.72
|
|
|
MESH VENTRALIGHT ECHO PS 6*8
|
Facility
|
OP
|
$6,976.33
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.92 |
| Max. Negotiated Rate |
$6,697.28 |
| Rate for Payer: Aetna Commercial |
$5,371.77
|
| Rate for Payer: Anthem Medicaid |
$2,399.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,441.54
|
| Rate for Payer: Cash Price |
$3,488.16
|
| Rate for Payer: Cigna Commercial |
$5,790.35
|
| Rate for Payer: First Health Commercial |
$6,627.51
|
| Rate for Payer: Humana Commercial |
$5,929.88
|
| Rate for Payer: Humana KY Medicaid |
$2,399.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,423.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,720.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,148.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,447.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,139.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,232.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.66
|
| Rate for Payer: PHCS Commercial |
$6,697.28
|
| Rate for Payer: United Healthcare All Payer |
$6,139.17
|
|
