|
MERREM 100MG(GEN) 500MG V
|
Facility
|
OP
|
$16.35
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
25002227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$15.70 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Anthem Medicaid |
$5.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12.75
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cigna Commercial |
$13.57
|
| Rate for Payer: First Health Commercial |
$15.53
|
| Rate for Payer: Humana Commercial |
$13.90
|
| Rate for Payer: Humana KY Medicaid |
$5.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$14.39
|
| Rate for Payer: Ohio Health Group HMO |
$12.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.28
|
| Rate for Payer: PHCS Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Payer |
$14.39
|
|
|
MESALAMINE 500MG ER CAP
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
NDC 63304008913
|
| Hospital Charge Code |
25004557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna Commercial |
$17.30
|
| Rate for Payer: Anthem Medicaid |
$7.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.53
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna Commercial |
$18.65
|
| Rate for Payer: First Health Commercial |
$21.35
|
| Rate for Payer: Humana Commercial |
$19.10
|
| Rate for Payer: Humana KY Medicaid |
$7.73
|
| Rate for Payer: Kentucky WC Medicaid |
$7.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.77
|
| Rate for Payer: Ohio Health Group HMO |
$16.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$21.57
|
| Rate for Payer: United Healthcare All Payer |
$19.77
|
|
|
MESALAMINE 500MG ER CAP
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
NDC 63304008913
|
| Hospital Charge Code |
25004557
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna Commercial |
$17.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.53
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna Commercial |
$18.65
|
| Rate for Payer: First Health Commercial |
$21.35
|
| Rate for Payer: Humana Commercial |
$19.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.77
|
| Rate for Payer: Ohio Health Group HMO |
$16.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$21.57
|
| Rate for Payer: United Healthcare All Payer |
$19.77
|
|
|
MESH 3D MAX 4*6 LRG L
|
Facility
|
OP
|
$1,985.14
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.54 |
| Max. Negotiated Rate |
$1,905.73 |
| Rate for Payer: Aetna Commercial |
$1,528.56
|
| Rate for Payer: Anthem Medicaid |
$682.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.41
|
| Rate for Payer: Cash Price |
$992.57
|
| Rate for Payer: Cigna Commercial |
$1,647.67
|
| Rate for Payer: First Health Commercial |
$1,885.88
|
| Rate for Payer: Humana Commercial |
$1,687.37
|
| Rate for Payer: Humana KY Medicaid |
$682.69
|
| Rate for Payer: Kentucky WC Medicaid |
$689.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.75
|
| Rate for Payer: PHCS Commercial |
$1,905.73
|
| Rate for Payer: United Healthcare All Payer |
$1,746.92
|
|
|
MESH 3D MAX 4*6 LRG L
|
Facility
|
IP
|
$1,985.14
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.54 |
| Max. Negotiated Rate |
$1,905.73 |
| Rate for Payer: Aetna Commercial |
$1,528.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.41
|
| Rate for Payer: Cash Price |
$992.57
|
| Rate for Payer: Cigna Commercial |
$1,647.67
|
| Rate for Payer: First Health Commercial |
$1,885.88
|
| Rate for Payer: Humana Commercial |
$1,687.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.75
|
| Rate for Payer: PHCS Commercial |
$1,905.73
|
| Rate for Payer: United Healthcare All Payer |
$1,746.92
|
|
|
MESH 3D MAX 4*6 LRG R
|
Facility
|
IP
|
$1,985.14
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.54 |
| Max. Negotiated Rate |
$1,905.73 |
| Rate for Payer: Aetna Commercial |
$1,528.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.41
|
| Rate for Payer: Cash Price |
$992.57
|
| Rate for Payer: Cigna Commercial |
$1,647.67
|
| Rate for Payer: First Health Commercial |
$1,885.88
|
| Rate for Payer: Humana Commercial |
$1,687.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.75
|
| Rate for Payer: PHCS Commercial |
$1,905.73
|
| Rate for Payer: United Healthcare All Payer |
$1,746.92
|
|
|
MESH 3D MAX 4*6 LRG R
|
Facility
|
OP
|
$1,985.14
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.54 |
| Max. Negotiated Rate |
$1,905.73 |
| Rate for Payer: Aetna Commercial |
$1,528.56
|
| Rate for Payer: Anthem Medicaid |
$682.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,548.41
|
| Rate for Payer: Cash Price |
$992.57
|
| Rate for Payer: Cigna Commercial |
$1,647.67
|
| Rate for Payer: First Health Commercial |
$1,885.88
|
| Rate for Payer: Humana Commercial |
$1,687.37
|
| Rate for Payer: Humana KY Medicaid |
$682.69
|
| Rate for Payer: Kentucky WC Medicaid |
$689.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,465.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,588.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,727.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.75
|
| Rate for Payer: PHCS Commercial |
$1,905.73
|
| Rate for Payer: United Healthcare All Payer |
$1,746.92
|
|
|
MESH 3D MAX 5*7 XLG L
|
Facility
|
IP
|
$2,182.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.82 |
| Max. Negotiated Rate |
$2,095.43 |
| Rate for Payer: Aetna Commercial |
$1,680.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,702.54
|
| Rate for Payer: Cash Price |
$1,091.37
|
| Rate for Payer: Cigna Commercial |
$1,811.67
|
| Rate for Payer: First Health Commercial |
$2,073.60
|
| Rate for Payer: Humana Commercial |
$1,855.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,789.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,610.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,920.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,637.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,898.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.09
|
| Rate for Payer: PHCS Commercial |
$2,095.43
|
| Rate for Payer: United Healthcare All Payer |
$1,920.81
|
|
|
MESH 3D MAX 5*7 XLG L
|
Facility
|
OP
|
$2,182.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.82 |
| Max. Negotiated Rate |
$2,095.43 |
| Rate for Payer: Aetna Commercial |
$1,680.71
|
| Rate for Payer: Anthem Medicaid |
$750.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,702.54
|
| Rate for Payer: Cash Price |
$1,091.37
|
| Rate for Payer: Cigna Commercial |
$1,811.67
|
| Rate for Payer: First Health Commercial |
$2,073.60
|
| Rate for Payer: Humana Commercial |
$1,855.33
|
| Rate for Payer: Humana KY Medicaid |
$750.64
|
| Rate for Payer: Kentucky WC Medicaid |
$758.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,789.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,610.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,920.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,637.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,898.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.09
|
| Rate for Payer: PHCS Commercial |
$2,095.43
|
| Rate for Payer: United Healthcare All Payer |
$1,920.81
|
|
|
MESH 3D MAX 5*7 XLG R
|
Facility
|
OP
|
$2,182.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.82 |
| Max. Negotiated Rate |
$2,095.43 |
| Rate for Payer: Aetna Commercial |
$1,680.71
|
| Rate for Payer: Anthem Medicaid |
$750.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,702.54
|
| Rate for Payer: Cash Price |
$1,091.37
|
| Rate for Payer: Cigna Commercial |
$1,811.67
|
| Rate for Payer: First Health Commercial |
$2,073.60
|
| Rate for Payer: Humana Commercial |
$1,855.33
|
| Rate for Payer: Humana KY Medicaid |
$750.64
|
| Rate for Payer: Kentucky WC Medicaid |
$758.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,789.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,610.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,920.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,637.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,898.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.09
|
| Rate for Payer: PHCS Commercial |
$2,095.43
|
| Rate for Payer: United Healthcare All Payer |
$1,920.81
|
|
|
MESH 3D MAX 5*7 XLG R
|
Facility
|
IP
|
$2,182.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.82 |
| Max. Negotiated Rate |
$2,095.43 |
| Rate for Payer: Aetna Commercial |
$1,680.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,702.54
|
| Rate for Payer: Cash Price |
$1,091.37
|
| Rate for Payer: Cigna Commercial |
$1,811.67
|
| Rate for Payer: First Health Commercial |
$2,073.60
|
| Rate for Payer: Humana Commercial |
$1,855.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,789.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,610.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,920.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,637.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,898.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.09
|
| Rate for Payer: PHCS Commercial |
$2,095.43
|
| Rate for Payer: United Healthcare All Payer |
$1,920.81
|
|
|
MESH 3D MAX MID LG LFT
|
Facility
|
OP
|
$2,940.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.26 |
| Max. Negotiated Rate |
$2,823.24 |
| Rate for Payer: Aetna Commercial |
$2,264.48
|
| Rate for Payer: Anthem Medicaid |
$1,011.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.89
|
| Rate for Payer: Cash Price |
$1,470.44
|
| Rate for Payer: Cigna Commercial |
$2,440.93
|
| Rate for Payer: First Health Commercial |
$2,793.84
|
| Rate for Payer: Humana Commercial |
$2,499.75
|
| Rate for Payer: Humana KY Medicaid |
$1,011.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,587.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.21
|
| Rate for Payer: PHCS Commercial |
$2,823.24
|
| Rate for Payer: United Healthcare All Payer |
$2,587.97
|
|
|
MESH 3D MAX MID LG LFT
|
Facility
|
IP
|
$2,940.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.26 |
| Max. Negotiated Rate |
$2,823.24 |
| Rate for Payer: Aetna Commercial |
$2,264.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.89
|
| Rate for Payer: Cash Price |
$1,470.44
|
| Rate for Payer: Cigna Commercial |
$2,440.93
|
| Rate for Payer: First Health Commercial |
$2,793.84
|
| Rate for Payer: Humana Commercial |
$2,499.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,587.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.21
|
| Rate for Payer: PHCS Commercial |
$2,823.24
|
| Rate for Payer: United Healthcare All Payer |
$2,587.97
|
|
|
MESH 3D MAX MID LG RIGHT
|
Facility
|
IP
|
$2,940.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.26 |
| Max. Negotiated Rate |
$2,823.24 |
| Rate for Payer: Aetna Commercial |
$2,264.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.89
|
| Rate for Payer: Cash Price |
$1,470.44
|
| Rate for Payer: Cigna Commercial |
$2,440.93
|
| Rate for Payer: First Health Commercial |
$2,793.84
|
| Rate for Payer: Humana Commercial |
$2,499.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,587.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.21
|
| Rate for Payer: PHCS Commercial |
$2,823.24
|
| Rate for Payer: United Healthcare All Payer |
$2,587.97
|
|
|
MESH 3D MAX MID LG RIGHT
|
Facility
|
OP
|
$2,940.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.26 |
| Max. Negotiated Rate |
$2,823.24 |
| Rate for Payer: Aetna Commercial |
$2,264.48
|
| Rate for Payer: Anthem Medicaid |
$1,011.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.89
|
| Rate for Payer: Cash Price |
$1,470.44
|
| Rate for Payer: Cigna Commercial |
$2,440.93
|
| Rate for Payer: First Health Commercial |
$2,793.84
|
| Rate for Payer: Humana Commercial |
$2,499.75
|
| Rate for Payer: Humana KY Medicaid |
$1,011.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,587.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,352.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.21
|
| Rate for Payer: PHCS Commercial |
$2,823.24
|
| Rate for Payer: United Healthcare All Payer |
$2,587.97
|
|
|
MESH 3D MAX MID XL RIGHT
|
Facility
|
IP
|
$3,038.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.40 |
| Max. Negotiated Rate |
$2,916.48 |
| Rate for Payer: Aetna Commercial |
$2,339.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.64
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cigna Commercial |
$2,521.54
|
| Rate for Payer: First Health Commercial |
$2,886.10
|
| Rate for Payer: Humana Commercial |
$2,582.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.22
|
| Rate for Payer: PHCS Commercial |
$2,916.48
|
| Rate for Payer: United Healthcare All Payer |
$2,673.44
|
|
|
MESH 3D MAX MID XL RIGHT
|
Facility
|
OP
|
$3,038.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.40 |
| Max. Negotiated Rate |
$2,916.48 |
| Rate for Payer: Aetna Commercial |
$2,339.26
|
| Rate for Payer: Anthem Medicaid |
$1,044.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,369.64
|
| Rate for Payer: Cash Price |
$1,519.00
|
| Rate for Payer: Cigna Commercial |
$2,521.54
|
| Rate for Payer: First Health Commercial |
$2,886.10
|
| Rate for Payer: Humana Commercial |
$2,582.30
|
| Rate for Payer: Humana KY Medicaid |
$1,044.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,673.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,278.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,430.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.22
|
| Rate for Payer: PHCS Commercial |
$2,916.48
|
| Rate for Payer: United Healthcare All Payer |
$2,673.44
|
|
|
MESH 4.5 COMPOSIX L/P
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
MESH 4.5 COMPOSIX L/P
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem Medicaid |
$1,409.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Humana KY Medicaid |
$1,409.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
MESH 6*8 COMPOSIX L/P
|
Facility
|
IP
|
$4,955.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,486.50 |
| Max. Negotiated Rate |
$4,756.80 |
| Rate for Payer: Aetna Commercial |
$3,815.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,864.90
|
| Rate for Payer: Cash Price |
$2,477.50
|
| Rate for Payer: Cigna Commercial |
$4,112.65
|
| Rate for Payer: First Health Commercial |
$4,707.25
|
| Rate for Payer: Humana Commercial |
$4,211.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,063.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,656.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,486.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,360.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,310.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,418.95
|
| Rate for Payer: PHCS Commercial |
$4,756.80
|
| Rate for Payer: United Healthcare All Payer |
$4,360.40
|
|
|
MESH 6*8 COMPOSIX L/P
|
Facility
|
OP
|
$4,955.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,486.50 |
| Max. Negotiated Rate |
$4,756.80 |
| Rate for Payer: Aetna Commercial |
$3,815.35
|
| Rate for Payer: Anthem Medicaid |
$1,704.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,864.90
|
| Rate for Payer: Cash Price |
$2,477.50
|
| Rate for Payer: Cigna Commercial |
$4,112.65
|
| Rate for Payer: First Health Commercial |
$4,707.25
|
| Rate for Payer: Humana Commercial |
$4,211.75
|
| Rate for Payer: Humana KY Medicaid |
$1,704.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,721.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,063.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,656.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,486.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,738.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,360.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,310.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,418.95
|
| Rate for Payer: PHCS Commercial |
$4,756.80
|
| Rate for Payer: United Healthcare All Payer |
$4,360.40
|
|
|
MESHAGRAPH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESHAGRAPH
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESH ALLODERM CONTOUR 9.6*19.3
|
Facility
|
IP
|
$18,175.10
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,452.53 |
| Max. Negotiated Rate |
$17,448.10 |
| Rate for Payer: Aetna Commercial |
$13,994.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,176.58
|
| Rate for Payer: Cash Price |
$9,087.55
|
| Rate for Payer: Cigna Commercial |
$15,085.33
|
| Rate for Payer: First Health Commercial |
$17,266.35
|
| Rate for Payer: Humana Commercial |
$15,448.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,903.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,413.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,994.09
|
| Rate for Payer: Ohio Health Group HMO |
$13,631.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,812.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,540.82
|
| Rate for Payer: PHCS Commercial |
$17,448.10
|
| Rate for Payer: United Healthcare All Payer |
$15,994.09
|
|
|
MESH ALLODERM CONTOUR 9.6*19.3
|
Facility
|
OP
|
$18,175.10
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
27000077
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,452.53 |
| Max. Negotiated Rate |
$17,448.10 |
| Rate for Payer: Aetna Commercial |
$13,994.83
|
| Rate for Payer: Anthem Medicaid |
$6,250.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,176.58
|
| Rate for Payer: Cash Price |
$9,087.55
|
| Rate for Payer: Cigna Commercial |
$15,085.33
|
| Rate for Payer: First Health Commercial |
$17,266.35
|
| Rate for Payer: Humana Commercial |
$15,448.83
|
| Rate for Payer: Humana KY Medicaid |
$6,250.42
|
| Rate for Payer: Kentucky WC Medicaid |
$6,314.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,903.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,413.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,452.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,375.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,994.09
|
| Rate for Payer: Ohio Health Group HMO |
$13,631.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,540.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,812.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,540.82
|
| Rate for Payer: PHCS Commercial |
$17,448.10
|
| Rate for Payer: United Healthcare All Payer |
$15,994.09
|
|
