|
MESH VENTRO ST HRNIA 10.8*13.7
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
MESH VENTRO ST HRNIA 10.8*13.7
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
MESH VICRYL KNITTED 12*12
|
Facility
|
OP
|
$6,843.99
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.72 |
| Max. Negotiated Rate |
$6,570.23 |
| Rate for Payer: Aetna Commercial |
$5,269.87
|
| Rate for Payer: Anthem Medicaid |
$2,353.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,338.31
|
| Rate for Payer: Cash Price |
$3,422.00
|
| Rate for Payer: Cigna Commercial |
$5,680.51
|
| Rate for Payer: First Health Commercial |
$6,501.79
|
| Rate for Payer: Humana Commercial |
$5,817.39
|
| Rate for Payer: Humana KY Medicaid |
$2,353.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,612.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,053.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,022.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.64
|
| Rate for Payer: PHCS Commercial |
$6,570.23
|
| Rate for Payer: United Healthcare All Payer |
$6,022.71
|
|
|
MESH VICRYL KNITTED 12*12
|
Facility
|
IP
|
$6,843.99
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.72 |
| Max. Negotiated Rate |
$6,570.23 |
| Rate for Payer: Aetna Commercial |
$5,269.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,338.31
|
| Rate for Payer: Cash Price |
$3,422.00
|
| Rate for Payer: Cigna Commercial |
$5,680.51
|
| Rate for Payer: First Health Commercial |
$6,501.79
|
| Rate for Payer: Humana Commercial |
$5,817.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,612.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,053.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,022.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$889.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.64
|
| Rate for Payer: PHCS Commercial |
$6,570.23
|
| Rate for Payer: United Healthcare All Payer |
$6,022.71
|
|
|
MESH VICRYL KNITTED 6*6
|
Facility
|
OP
|
$3,868.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.87 |
| Max. Negotiated Rate |
$3,713.47 |
| Rate for Payer: Aetna Commercial |
$2,978.51
|
| Rate for Payer: Anthem Medicaid |
$1,330.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.20
|
| Rate for Payer: Cash Price |
$1,934.10
|
| Rate for Payer: Cigna Commercial |
$3,210.61
|
| Rate for Payer: First Health Commercial |
$3,674.79
|
| Rate for Payer: Humana Commercial |
$3,287.97
|
| Rate for Payer: Humana KY Medicaid |
$1,330.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,343.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,171.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,854.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,356.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.14
|
| Rate for Payer: PHCS Commercial |
$3,713.47
|
| Rate for Payer: United Healthcare All Payer |
$3,404.02
|
|
|
MESH VICRYL KNITTED 6*6
|
Facility
|
IP
|
$3,868.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.87 |
| Max. Negotiated Rate |
$3,713.47 |
| Rate for Payer: Aetna Commercial |
$2,978.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.20
|
| Rate for Payer: Cash Price |
$1,934.10
|
| Rate for Payer: Cigna Commercial |
$3,210.61
|
| Rate for Payer: First Health Commercial |
$3,674.79
|
| Rate for Payer: Humana Commercial |
$3,287.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,171.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,854.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.14
|
| Rate for Payer: PHCS Commercial |
$3,713.47
|
| Rate for Payer: United Healthcare All Payer |
$3,404.02
|
|
|
MESH XENMATRIX 10*15CM
|
Facility
|
OP
|
$21,632.71
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,812.25 |
| Max. Negotiated Rate |
$20,767.40 |
| Rate for Payer: Aetna Commercial |
$16,657.19
|
| Rate for Payer: Anthem Medicaid |
$7,439.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,873.51
|
| Rate for Payer: Cash Price |
$10,816.35
|
| Rate for Payer: Cigna Commercial |
$17,955.15
|
| Rate for Payer: First Health Commercial |
$20,551.07
|
| Rate for Payer: Humana Commercial |
$18,387.80
|
| Rate for Payer: Humana KY Medicaid |
$7,439.49
|
| Rate for Payer: Kentucky WC Medicaid |
$7,515.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,738.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,964.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,489.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,588.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,036.78
|
| Rate for Payer: Ohio Health Group HMO |
$16,224.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,326.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,812.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,706.14
|
| Rate for Payer: PHCS Commercial |
$20,767.40
|
| Rate for Payer: United Healthcare All Payer |
$19,036.78
|
|
|
MESH XENMATRIX 10*15CM
|
Facility
|
IP
|
$21,632.71
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,812.25 |
| Max. Negotiated Rate |
$20,767.40 |
| Rate for Payer: Aetna Commercial |
$16,657.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,873.51
|
| Rate for Payer: Cash Price |
$10,816.35
|
| Rate for Payer: Cigna Commercial |
$17,955.15
|
| Rate for Payer: First Health Commercial |
$20,551.07
|
| Rate for Payer: Humana Commercial |
$18,387.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,738.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,964.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,489.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,036.78
|
| Rate for Payer: Ohio Health Group HMO |
$16,224.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,326.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,812.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,706.14
|
| Rate for Payer: PHCS Commercial |
$20,767.40
|
| Rate for Payer: United Healthcare All Payer |
$19,036.78
|
|
|
MESH XENMATRIX 15*20CM
|
Facility
|
OP
|
$34,496.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,484.53 |
| Max. Negotiated Rate |
$33,116.54 |
| Rate for Payer: Aetna Commercial |
$26,562.23
|
| Rate for Payer: Anthem Medicaid |
$11,863.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,907.19
|
| Rate for Payer: Cash Price |
$17,248.20
|
| Rate for Payer: Cigna Commercial |
$28,632.01
|
| Rate for Payer: First Health Commercial |
$32,771.58
|
| Rate for Payer: Humana Commercial |
$29,321.94
|
| Rate for Payer: Humana KY Medicaid |
$11,863.31
|
| Rate for Payer: Kentucky WC Medicaid |
$11,984.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,287.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,458.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,348.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,101.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,356.83
|
| Rate for Payer: Ohio Health Group HMO |
$25,872.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,484.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,693.88
|
| Rate for Payer: PHCS Commercial |
$33,116.54
|
| Rate for Payer: United Healthcare All Payer |
$30,356.83
|
|
|
MESH XENMATRIX 15*20CM
|
Facility
|
IP
|
$34,496.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,484.53 |
| Max. Negotiated Rate |
$33,116.54 |
| Rate for Payer: Aetna Commercial |
$26,562.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,907.19
|
| Rate for Payer: Cash Price |
$17,248.20
|
| Rate for Payer: Cigna Commercial |
$28,632.01
|
| Rate for Payer: First Health Commercial |
$32,771.58
|
| Rate for Payer: Humana Commercial |
$29,321.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,287.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,458.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,348.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,356.83
|
| Rate for Payer: Ohio Health Group HMO |
$25,872.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,484.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,693.88
|
| Rate for Payer: PHCS Commercial |
$33,116.54
|
| Rate for Payer: United Healthcare All Payer |
$30,356.83
|
|
|
MESH XENMATRIX 19*35CM
|
Facility
|
OP
|
$94,138.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,237.94 |
| Max. Negotiated Rate |
$90,372.48 |
| Rate for Payer: Aetna Commercial |
$72,486.26
|
| Rate for Payer: Anthem Medicaid |
$32,374.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,427.64
|
| Rate for Payer: Cash Price |
$47,069.00
|
| Rate for Payer: Cigna Commercial |
$78,134.54
|
| Rate for Payer: First Health Commercial |
$89,431.10
|
| Rate for Payer: Humana Commercial |
$80,017.30
|
| Rate for Payer: Humana KY Medicaid |
$32,374.06
|
| Rate for Payer: Kentucky WC Medicaid |
$32,703.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,193.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,473.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,241.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,023.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,841.44
|
| Rate for Payer: Ohio Health Group HMO |
$70,603.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,237.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,182.78
|
| Rate for Payer: PHCS Commercial |
$90,372.48
|
| Rate for Payer: United Healthcare All Payer |
$82,841.44
|
|
|
MESH XENMATRIX 19*35CM
|
Facility
|
IP
|
$94,138.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,237.94 |
| Max. Negotiated Rate |
$90,372.48 |
| Rate for Payer: Aetna Commercial |
$72,486.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,427.64
|
| Rate for Payer: Cash Price |
$47,069.00
|
| Rate for Payer: Cigna Commercial |
$78,134.54
|
| Rate for Payer: First Health Commercial |
$89,431.10
|
| Rate for Payer: Humana Commercial |
$80,017.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,193.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,473.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,241.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,841.44
|
| Rate for Payer: Ohio Health Group HMO |
$70,603.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,827.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,237.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29,182.78
|
| Rate for Payer: PHCS Commercial |
$90,372.48
|
| Rate for Payer: United Healthcare All Payer |
$82,841.44
|
|
|
MESH XENMATRIX 20*20CM
|
Facility
|
OP
|
$79,104.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,283.57 |
| Max. Negotiated Rate |
$75,940.22 |
| Rate for Payer: Aetna Commercial |
$60,910.39
|
| Rate for Payer: Anthem Medicaid |
$27,204.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,701.43
|
| Rate for Payer: Cash Price |
$39,552.20
|
| Rate for Payer: Cigna Commercial |
$65,656.65
|
| Rate for Payer: First Health Commercial |
$75,149.18
|
| Rate for Payer: Humana Commercial |
$67,238.74
|
| Rate for Payer: Humana KY Medicaid |
$27,204.00
|
| Rate for Payer: Kentucky WC Medicaid |
$27,480.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,865.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,379.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,731.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,749.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,611.87
|
| Rate for Payer: Ohio Health Group HMO |
$59,328.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,820.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,283.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,522.36
|
| Rate for Payer: PHCS Commercial |
$75,940.22
|
| Rate for Payer: United Healthcare All Payer |
$69,611.87
|
|
|
MESH XENMATRIX 20*20CM
|
Facility
|
IP
|
$79,104.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,283.57 |
| Max. Negotiated Rate |
$75,940.22 |
| Rate for Payer: Aetna Commercial |
$60,910.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,701.43
|
| Rate for Payer: Cash Price |
$39,552.20
|
| Rate for Payer: Cigna Commercial |
$65,656.65
|
| Rate for Payer: First Health Commercial |
$75,149.18
|
| Rate for Payer: Humana Commercial |
$67,238.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,865.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,379.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,731.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,611.87
|
| Rate for Payer: Ohio Health Group HMO |
$59,328.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,820.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,283.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,522.36
|
| Rate for Payer: PHCS Commercial |
$75,940.22
|
| Rate for Payer: United Healthcare All Payer |
$69,611.87
|
|
|
MESH XENMATRIX 20*25CM
|
Facility
|
OP
|
$79,104.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,283.57 |
| Max. Negotiated Rate |
$75,940.22 |
| Rate for Payer: Aetna Commercial |
$60,910.39
|
| Rate for Payer: Anthem Medicaid |
$27,204.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,701.43
|
| Rate for Payer: Cash Price |
$39,552.20
|
| Rate for Payer: Cigna Commercial |
$65,656.65
|
| Rate for Payer: First Health Commercial |
$75,149.18
|
| Rate for Payer: Humana Commercial |
$67,238.74
|
| Rate for Payer: Humana KY Medicaid |
$27,204.00
|
| Rate for Payer: Kentucky WC Medicaid |
$27,480.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,865.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,379.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,731.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,749.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,611.87
|
| Rate for Payer: Ohio Health Group HMO |
$59,328.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,820.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,283.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,522.36
|
| Rate for Payer: PHCS Commercial |
$75,940.22
|
| Rate for Payer: United Healthcare All Payer |
$69,611.87
|
|
|
MESH XENMATRIX 20*25CM
|
Facility
|
IP
|
$79,104.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,283.57 |
| Max. Negotiated Rate |
$75,940.22 |
| Rate for Payer: Aetna Commercial |
$60,910.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,701.43
|
| Rate for Payer: Cash Price |
$39,552.20
|
| Rate for Payer: Cigna Commercial |
$65,656.65
|
| Rate for Payer: First Health Commercial |
$75,149.18
|
| Rate for Payer: Humana Commercial |
$67,238.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,865.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,379.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,731.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,611.87
|
| Rate for Payer: Ohio Health Group HMO |
$59,328.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,820.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,283.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,522.36
|
| Rate for Payer: PHCS Commercial |
$75,940.22
|
| Rate for Payer: United Healthcare All Payer |
$69,611.87
|
|
|
MESH Y UPSYLON
|
Facility
|
IP
|
$5,260.54
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.87 |
| Max. Negotiated Rate |
$5,050.12 |
| Rate for Payer: Aetna Commercial |
$4,050.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,103.22
|
| Rate for Payer: Cash Price |
$2,630.27
|
| Rate for Payer: Cigna Commercial |
$4,366.25
|
| Rate for Payer: First Health Commercial |
$4,997.51
|
| Rate for Payer: Humana Commercial |
$4,471.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,313.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,882.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,578.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,629.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,945.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,052.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,630.77
|
| Rate for Payer: PHCS Commercial |
$5,050.12
|
| Rate for Payer: United Healthcare All Payer |
$4,629.28
|
|
|
MESH Y UPSYLON
|
Facility
|
OP
|
$5,260.54
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.87 |
| Max. Negotiated Rate |
$5,050.12 |
| Rate for Payer: Aetna Commercial |
$4,050.62
|
| Rate for Payer: Anthem Medicaid |
$1,809.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,103.22
|
| Rate for Payer: Cash Price |
$2,630.27
|
| Rate for Payer: Cigna Commercial |
$4,366.25
|
| Rate for Payer: First Health Commercial |
$4,997.51
|
| Rate for Payer: Humana Commercial |
$4,471.46
|
| Rate for Payer: Humana KY Medicaid |
$1,809.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,827.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,313.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,882.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,578.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,845.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,629.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,945.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,052.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,630.77
|
| Rate for Payer: PHCS Commercial |
$5,050.12
|
| Rate for Payer: United Healthcare All Payer |
$4,629.28
|
|
|
MESNEX 400 MG TABLET
|
Facility
|
IP
|
$150.59
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25003209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.58 |
| Max. Negotiated Rate |
$144.57 |
| Rate for Payer: Aetna Commercial |
$115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.46
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$124.99
|
| Rate for Payer: First Health Commercial |
$143.06
|
| Rate for Payer: Humana Commercial |
$128.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.52
|
| Rate for Payer: Ohio Health Group HMO |
$112.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.68
|
| Rate for Payer: PHCS Commercial |
$144.57
|
| Rate for Payer: United Healthcare All Payer |
$132.52
|
|
|
MESNEX 400 MG TABLET
|
Facility
|
OP
|
$150.59
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25003209
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.58 |
| Max. Negotiated Rate |
$144.57 |
| Rate for Payer: Aetna Commercial |
$115.95
|
| Rate for Payer: Anthem Medicaid |
$51.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.46
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$124.99
|
| Rate for Payer: First Health Commercial |
$143.06
|
| Rate for Payer: Humana Commercial |
$128.00
|
| Rate for Payer: Humana KY Medicaid |
$51.79
|
| Rate for Payer: Kentucky WC Medicaid |
$52.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.52
|
| Rate for Payer: Ohio Health Group HMO |
$112.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.68
|
| Rate for Payer: PHCS Commercial |
$144.57
|
| Rate for Payer: United Healthcare All Payer |
$132.52
|
|
|
MESNEX(MESNA)200MG(1000MG/10ML
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25002630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
MESNEX(MESNA)200MG(1000MG/10ML
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
25002630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.79
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
MESTINON (PYRIDOSTIG 60MG/1TAB
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
NDC 68084049401
|
| Hospital Charge Code |
25000963
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Anthem Medicaid |
$3.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.32
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna Commercial |
$7.79
|
| Rate for Payer: First Health Commercial |
$8.91
|
| Rate for Payer: Humana Commercial |
$7.97
|
| Rate for Payer: Humana KY Medicaid |
$3.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
MESTINON (PYRIDOSTIG 60MG/1TAB
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 68084049401
|
| Hospital Charge Code |
25000963
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.32
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cigna Commercial |
$7.79
|
| Rate for Payer: First Health Commercial |
$8.91
|
| Rate for Payer: Humana Commercial |
$7.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.25
|
| Rate for Payer: Ohio Health Group HMO |
$7.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.91
|
| Rate for Payer: PHCS Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Payer |
$8.25
|
|
|
MESTINON TMSP 180 MG TABLET
|
Facility
|
OP
|
$76.33
|
|
|
Service Code
|
NDC 187301330
|
| Hospital Charge Code |
25000964
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$73.28 |
| Rate for Payer: Aetna Commercial |
$58.77
|
| Rate for Payer: Anthem Medicaid |
$26.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.54
|
| Rate for Payer: Cash Price |
$38.16
|
| Rate for Payer: Cigna Commercial |
$63.35
|
| Rate for Payer: First Health Commercial |
$72.51
|
| Rate for Payer: Humana Commercial |
$64.88
|
| Rate for Payer: Humana KY Medicaid |
$26.25
|
| Rate for Payer: Kentucky WC Medicaid |
$26.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.17
|
| Rate for Payer: Ohio Health Group HMO |
$57.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.66
|
| Rate for Payer: PHCS Commercial |
$73.28
|
| Rate for Payer: United Healthcare All Payer |
$67.17
|
|
