|
MESH VENTRALIGHT ECHO PS 6*8
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
MESH VENTRALIGHT ECHO PS 6 CIR
|
Facility
|
OP
|
$5,344.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.82 |
| Max. Negotiated Rate |
$5,130.96 |
| Rate for Payer: Aetna Commercial |
$4,115.46
|
| Rate for Payer: Anthem Medicaid |
$1,838.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,168.90
|
| Rate for Payer: Cash Price |
$2,672.38
|
| Rate for Payer: Cigna Commercial |
$4,436.14
|
| Rate for Payer: First Health Commercial |
$5,077.51
|
| Rate for Payer: Humana Commercial |
$4,543.04
|
| Rate for Payer: Humana KY Medicaid |
$1,838.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,856.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,382.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,944.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,603.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,874.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,703.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,008.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,068.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.87
|
| Rate for Payer: PHCS Commercial |
$5,130.96
|
| Rate for Payer: United Healthcare All Payer |
$4,703.38
|
|
|
MESH VENTRALIGHT ECHO PS 6 CIR
|
Facility
|
IP
|
$5,344.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$694.82 |
| Max. Negotiated Rate |
$5,130.96 |
| Rate for Payer: Aetna Commercial |
$4,115.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,168.90
|
| Rate for Payer: Cash Price |
$2,672.38
|
| Rate for Payer: Cigna Commercial |
$4,436.14
|
| Rate for Payer: First Health Commercial |
$5,077.51
|
| Rate for Payer: Humana Commercial |
$4,543.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,382.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,944.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,603.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,703.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,008.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,068.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$694.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.87
|
| Rate for Payer: PHCS Commercial |
$5,130.96
|
| Rate for Payer: United Healthcare All Payer |
$4,703.38
|
|
|
MESH VENTRALIGHT ECHO PS 7*9
|
Facility
|
OP
|
$10,679.42
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.32 |
| Max. Negotiated Rate |
$10,252.24 |
| Rate for Payer: Aetna Commercial |
$8,223.15
|
| Rate for Payer: Anthem Medicaid |
$3,672.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.95
|
| Rate for Payer: Cash Price |
$5,339.71
|
| Rate for Payer: Cigna Commercial |
$8,863.92
|
| Rate for Payer: First Health Commercial |
$10,145.45
|
| Rate for Payer: Humana Commercial |
$9,077.51
|
| Rate for Payer: Humana KY Medicaid |
$3,672.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,710.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,757.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,881.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,746.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.89
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.62
|
| Rate for Payer: PHCS Commercial |
$10,252.24
|
| Rate for Payer: United Healthcare All Payer |
$9,397.89
|
|
|
MESH VENTRALIGHT ECHO PS 7*9
|
Facility
|
IP
|
$10,679.42
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.32 |
| Max. Negotiated Rate |
$10,252.24 |
| Rate for Payer: Aetna Commercial |
$8,223.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.95
|
| Rate for Payer: Cash Price |
$5,339.71
|
| Rate for Payer: Cigna Commercial |
$8,863.92
|
| Rate for Payer: First Health Commercial |
$10,145.45
|
| Rate for Payer: Humana Commercial |
$9,077.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,757.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,881.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.89
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.62
|
| Rate for Payer: PHCS Commercial |
$10,252.24
|
| Rate for Payer: United Healthcare All Payer |
$9,397.89
|
|
|
MESH VENTRALIGHT ECHO PS 8*10
|
Facility
|
IP
|
$9,274.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.72 |
| Max. Negotiated Rate |
$8,903.75 |
| Rate for Payer: Aetna Commercial |
$7,141.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,234.30
|
| Rate for Payer: Cash Price |
$4,637.37
|
| Rate for Payer: Cigna Commercial |
$7,698.03
|
| Rate for Payer: First Health Commercial |
$8,811.00
|
| Rate for Payer: Humana Commercial |
$7,883.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,605.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,844.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,782.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,161.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,956.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,854.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,875.17
|
| Rate for Payer: PHCS Commercial |
$8,903.75
|
| Rate for Payer: United Healthcare All Payer |
$8,161.77
|
|
|
MESH VENTRALIGHT ECHO PS 8*10
|
Facility
|
OP
|
$9,274.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,205.72 |
| Max. Negotiated Rate |
$8,903.75 |
| Rate for Payer: Aetna Commercial |
$7,141.55
|
| Rate for Payer: Anthem Medicaid |
$3,189.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,234.30
|
| Rate for Payer: Cash Price |
$4,637.37
|
| Rate for Payer: Cigna Commercial |
$7,698.03
|
| Rate for Payer: First Health Commercial |
$8,811.00
|
| Rate for Payer: Humana Commercial |
$7,883.53
|
| Rate for Payer: Humana KY Medicaid |
$3,189.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,222.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,605.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,844.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,782.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,253.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,161.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,956.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,854.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,875.17
|
| Rate for Payer: PHCS Commercial |
$8,903.75
|
| Rate for Payer: United Healthcare All Payer |
$8,161.77
|
|
|
MESH VENTRALIGHT ECHO PS 8 CIR
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
MESH VENTRALIGHT ECHO PS 8 CIR
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
MESH VENTRALIGHT ST 10*13
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
MESH VENTRALIGHT ST 10*13
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
MESH VENTRALIGHT ST 4.5 CIR
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
MESH VENTRALIGHT ST 4.5 CIR
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
MESH VENTRALIGHT ST 4*6
|
Facility
|
IP
|
$3,985.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.05 |
| Max. Negotiated Rate |
$3,825.60 |
| Rate for Payer: Aetna Commercial |
$3,068.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,108.30
|
| Rate for Payer: Cash Price |
$1,992.50
|
| Rate for Payer: Cigna Commercial |
$3,307.55
|
| Rate for Payer: First Health Commercial |
$3,785.75
|
| Rate for Payer: Humana Commercial |
$3,387.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,267.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,940.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,506.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,988.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.35
|
| Rate for Payer: PHCS Commercial |
$3,825.60
|
| Rate for Payer: United Healthcare All Payer |
$3,506.80
|
|
|
MESH VENTRALIGHT ST 4*6
|
Facility
|
OP
|
$3,985.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.05 |
| Max. Negotiated Rate |
$3,825.60 |
| Rate for Payer: Aetna Commercial |
$3,068.45
|
| Rate for Payer: Anthem Medicaid |
$1,370.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,108.30
|
| Rate for Payer: Cash Price |
$1,992.50
|
| Rate for Payer: Cigna Commercial |
$3,307.55
|
| Rate for Payer: First Health Commercial |
$3,785.75
|
| Rate for Payer: Humana Commercial |
$3,387.25
|
| Rate for Payer: Humana KY Medicaid |
$1,370.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,267.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,940.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,397.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,506.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,988.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.35
|
| Rate for Payer: PHCS Commercial |
$3,825.60
|
| Rate for Payer: United Healthcare All Payer |
$3,506.80
|
|
|
MESH VENTRALIGHT ST 6*8
|
Facility
|
OP
|
$7,495.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.35 |
| Max. Negotiated Rate |
$7,195.20 |
| Rate for Payer: Aetna Commercial |
$5,771.15
|
| Rate for Payer: Anthem Medicaid |
$2,577.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,846.10
|
| Rate for Payer: Cash Price |
$3,747.50
|
| Rate for Payer: Cigna Commercial |
$6,220.85
|
| Rate for Payer: First Health Commercial |
$7,120.25
|
| Rate for Payer: Humana Commercial |
$6,370.75
|
| Rate for Payer: Humana KY Medicaid |
$2,577.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,145.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,531.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,248.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,629.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,595.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,323.45
|
| Rate for Payer: PHCS Commercial |
$7,195.20
|
| Rate for Payer: United Healthcare All Payer |
$6,595.60
|
|
|
MESH VENTRALIGHT ST 6*8
|
Facility
|
IP
|
$7,495.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.35 |
| Max. Negotiated Rate |
$7,195.20 |
| Rate for Payer: Aetna Commercial |
$5,771.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,846.10
|
| Rate for Payer: Cash Price |
$3,747.50
|
| Rate for Payer: Cigna Commercial |
$6,220.85
|
| Rate for Payer: First Health Commercial |
$7,120.25
|
| Rate for Payer: Humana Commercial |
$6,370.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,145.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,531.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,248.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,595.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,323.45
|
| Rate for Payer: PHCS Commercial |
$7,195.20
|
| Rate for Payer: United Healthcare All Payer |
$6,595.60
|
|
|
MESH VENTRIO ST HERNIA 3.1*4.7
|
Facility
|
IP
|
$4,260.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.90 |
| Max. Negotiated Rate |
$4,090.37 |
| Rate for Payer: Aetna Commercial |
$3,280.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.42
|
| Rate for Payer: Cash Price |
$2,130.40
|
| Rate for Payer: Cigna Commercial |
$3,536.46
|
| Rate for Payer: First Health Commercial |
$4,047.76
|
| Rate for Payer: Humana Commercial |
$3,621.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.85
|
| Rate for Payer: PHCS Commercial |
$4,090.37
|
| Rate for Payer: United Healthcare All Payer |
$3,749.50
|
|
|
MESH VENTRIO ST HERNIA 3.1*4.7
|
Facility
|
OP
|
$4,260.80
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.90 |
| Max. Negotiated Rate |
$4,090.37 |
| Rate for Payer: Aetna Commercial |
$3,280.82
|
| Rate for Payer: Anthem Medicaid |
$1,465.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.42
|
| Rate for Payer: Cash Price |
$2,130.40
|
| Rate for Payer: Cigna Commercial |
$3,536.46
|
| Rate for Payer: First Health Commercial |
$4,047.76
|
| Rate for Payer: Humana Commercial |
$3,621.68
|
| Rate for Payer: Humana KY Medicaid |
$1,465.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.85
|
| Rate for Payer: PHCS Commercial |
$4,090.37
|
| Rate for Payer: United Healthcare All Payer |
$3,749.50
|
|
|
MESH VENTRIO ST HERNIA 5.4*7.0
|
Facility
|
OP
|
$7,104.44
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.58 |
| Max. Negotiated Rate |
$6,820.26 |
| Rate for Payer: Aetna Commercial |
$5,470.42
|
| Rate for Payer: Anthem Medicaid |
$2,443.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.46
|
| Rate for Payer: Cash Price |
$3,552.22
|
| Rate for Payer: Cigna Commercial |
$5,896.69
|
| Rate for Payer: First Health Commercial |
$6,749.22
|
| Rate for Payer: Humana Commercial |
$6,038.77
|
| Rate for Payer: Humana KY Medicaid |
$2,443.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,328.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.38
|
| Rate for Payer: PHCS Commercial |
$6,820.26
|
| Rate for Payer: United Healthcare All Payer |
$6,251.91
|
|
|
MESH VENTRIO ST HERNIA 5.4*7.0
|
Facility
|
IP
|
$7,104.44
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.58 |
| Max. Negotiated Rate |
$6,820.26 |
| Rate for Payer: Aetna Commercial |
$5,470.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.46
|
| Rate for Payer: Cash Price |
$3,552.22
|
| Rate for Payer: Cigna Commercial |
$5,896.69
|
| Rate for Payer: First Health Commercial |
$6,749.22
|
| Rate for Payer: Humana Commercial |
$6,038.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,243.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,328.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.38
|
| Rate for Payer: PHCS Commercial |
$6,820.26
|
| Rate for Payer: United Healthcare All Payer |
$6,251.91
|
|
|
MESH VENTRIO ST HERNIA 6.1*10.
|
Facility
|
OP
|
$9,484.98
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.05 |
| Max. Negotiated Rate |
$9,105.58 |
| Rate for Payer: Aetna Commercial |
$7,303.43
|
| Rate for Payer: Anthem Medicaid |
$3,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,398.28
|
| Rate for Payer: Cash Price |
$4,742.49
|
| Rate for Payer: Cigna Commercial |
$7,872.53
|
| Rate for Payer: First Health Commercial |
$9,010.73
|
| Rate for Payer: Humana Commercial |
$8,062.23
|
| Rate for Payer: Humana KY Medicaid |
$3,261.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,295.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,777.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,845.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,327.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,346.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,113.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,233.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.34
|
| Rate for Payer: PHCS Commercial |
$9,105.58
|
| Rate for Payer: United Healthcare All Payer |
$8,346.78
|
|
|
MESH VENTRIO ST HERNIA 6.1*10.
|
Facility
|
IP
|
$9,484.98
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,233.05 |
| Max. Negotiated Rate |
$9,105.58 |
| Rate for Payer: Aetna Commercial |
$7,303.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,398.28
|
| Rate for Payer: Cash Price |
$4,742.49
|
| Rate for Payer: Cigna Commercial |
$7,872.53
|
| Rate for Payer: First Health Commercial |
$9,010.73
|
| Rate for Payer: Humana Commercial |
$8,062.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,777.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,845.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,346.78
|
| Rate for Payer: Ohio Health Group HMO |
$7,113.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,897.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,233.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.34
|
| Rate for Payer: PHCS Commercial |
$9,105.58
|
| Rate for Payer: United Healthcare All Payer |
$8,346.78
|
|
|
MESH VENTRIO ST HRNIA 8.7*10.7
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
MESH VENTRIO ST HRNIA 8.7*10.7
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
