|
MESHED BILAYER WND MATRIX 4*5
|
Facility
|
IP
|
$13,287.89
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,986.37 |
| Max. Negotiated Rate |
$12,756.37 |
| Rate for Payer: Aetna Commercial |
$10,231.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,364.55
|
| Rate for Payer: Cash Price |
$6,643.94
|
| Rate for Payer: Cigna Commercial |
$11,028.95
|
| Rate for Payer: First Health Commercial |
$12,623.50
|
| Rate for Payer: Humana Commercial |
$11,294.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,896.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,806.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,986.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,693.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,965.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,630.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,560.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,168.64
|
| Rate for Payer: PHCS Commercial |
$12,756.37
|
| Rate for Payer: United Healthcare All Payer |
$11,693.34
|
|
|
MESH FLAT 10*14
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
MESH FLAT 10*14
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
MESH FLAT 3*6
|
Facility
|
OP
|
$1,732.06
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.62 |
| Max. Negotiated Rate |
$1,662.78 |
| Rate for Payer: Aetna Commercial |
$1,333.69
|
| Rate for Payer: Anthem Medicaid |
$595.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.01
|
| Rate for Payer: Cash Price |
$866.03
|
| Rate for Payer: Cigna Commercial |
$1,437.61
|
| Rate for Payer: First Health Commercial |
$1,645.46
|
| Rate for Payer: Humana Commercial |
$1,472.25
|
| Rate for Payer: Humana KY Medicaid |
$595.66
|
| Rate for Payer: Kentucky WC Medicaid |
$601.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,420.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,278.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,524.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,385.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.12
|
| Rate for Payer: PHCS Commercial |
$1,662.78
|
| Rate for Payer: United Healthcare All Payer |
$1,524.21
|
|
|
MESH FLAT 3*6
|
Facility
|
IP
|
$1,732.06
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.62 |
| Max. Negotiated Rate |
$1,662.78 |
| Rate for Payer: Aetna Commercial |
$1,333.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,351.01
|
| Rate for Payer: Cash Price |
$866.03
|
| Rate for Payer: Cigna Commercial |
$1,437.61
|
| Rate for Payer: First Health Commercial |
$1,645.46
|
| Rate for Payer: Humana Commercial |
$1,472.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,420.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,278.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,524.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,299.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,385.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.12
|
| Rate for Payer: PHCS Commercial |
$1,662.78
|
| Rate for Payer: United Healthcare All Payer |
$1,524.21
|
|
|
MESH FLEXHD PLIABLE PRE THCK L
|
Facility
|
OP
|
$81,368.40
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,410.52 |
| Max. Negotiated Rate |
$78,113.66 |
| Rate for Payer: Aetna Commercial |
$62,653.67
|
| Rate for Payer: Anthem Medicaid |
$27,982.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,467.35
|
| Rate for Payer: Cash Price |
$40,684.20
|
| Rate for Payer: Cigna Commercial |
$67,535.77
|
| Rate for Payer: First Health Commercial |
$77,299.98
|
| Rate for Payer: Humana Commercial |
$69,163.14
|
| Rate for Payer: Humana KY Medicaid |
$27,982.59
|
| Rate for Payer: Kentucky WC Medicaid |
$28,267.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,722.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,049.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,410.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,544.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,604.19
|
| Rate for Payer: Ohio Health Group HMO |
$61,026.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,094.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,790.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,144.20
|
| Rate for Payer: PHCS Commercial |
$78,113.66
|
| Rate for Payer: United Healthcare All Payer |
$71,604.19
|
|
|
MESH FLEXHD PLIABLE PRE THCK L
|
Facility
|
IP
|
$81,368.40
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,410.52 |
| Max. Negotiated Rate |
$78,113.66 |
| Rate for Payer: Aetna Commercial |
$62,653.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,467.35
|
| Rate for Payer: Cash Price |
$40,684.20
|
| Rate for Payer: Cigna Commercial |
$67,535.77
|
| Rate for Payer: First Health Commercial |
$77,299.98
|
| Rate for Payer: Humana Commercial |
$69,163.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,722.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,049.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,410.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,604.19
|
| Rate for Payer: Ohio Health Group HMO |
$61,026.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,094.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,790.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,144.20
|
| Rate for Payer: PHCS Commercial |
$78,113.66
|
| Rate for Payer: United Healthcare All Payer |
$71,604.19
|
|
|
MESH FLEXHD PLIABLE PRE THIN L
|
Facility
|
IP
|
$81,368.40
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,410.52 |
| Max. Negotiated Rate |
$78,113.66 |
| Rate for Payer: Aetna Commercial |
$62,653.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,467.35
|
| Rate for Payer: Cash Price |
$40,684.20
|
| Rate for Payer: Cigna Commercial |
$67,535.77
|
| Rate for Payer: First Health Commercial |
$77,299.98
|
| Rate for Payer: Humana Commercial |
$69,163.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,722.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,049.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,410.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,604.19
|
| Rate for Payer: Ohio Health Group HMO |
$61,026.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,094.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,790.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,144.20
|
| Rate for Payer: PHCS Commercial |
$78,113.66
|
| Rate for Payer: United Healthcare All Payer |
$71,604.19
|
|
|
MESH FLEXHD PLIABLE PRE THIN L
|
Facility
|
OP
|
$81,368.40
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,410.52 |
| Max. Negotiated Rate |
$78,113.66 |
| Rate for Payer: Aetna Commercial |
$62,653.67
|
| Rate for Payer: Anthem Medicaid |
$27,982.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,467.35
|
| Rate for Payer: Cash Price |
$40,684.20
|
| Rate for Payer: Cigna Commercial |
$67,535.77
|
| Rate for Payer: First Health Commercial |
$77,299.98
|
| Rate for Payer: Humana Commercial |
$69,163.14
|
| Rate for Payer: Humana KY Medicaid |
$27,982.59
|
| Rate for Payer: Kentucky WC Medicaid |
$28,267.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,722.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,049.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,410.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,544.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,604.19
|
| Rate for Payer: Ohio Health Group HMO |
$61,026.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,094.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70,790.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,144.20
|
| Rate for Payer: PHCS Commercial |
$78,113.66
|
| Rate for Payer: United Healthcare All Payer |
$71,604.19
|
|
|
MESH FLEXHD PLIABLE PRE THIN M
|
Facility
|
IP
|
$77,380.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,214.00 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,320.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,392.20
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
MESH FLEXHD PLIABLE PRE THIN M
|
Facility
|
OP
|
$77,380.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,214.00 |
| Max. Negotiated Rate |
$74,284.80 |
| Rate for Payer: Aetna Commercial |
$59,582.60
|
| Rate for Payer: Anthem Medicaid |
$26,610.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,356.40
|
| Rate for Payer: Cash Price |
$38,690.00
|
| Rate for Payer: Cigna Commercial |
$64,225.40
|
| Rate for Payer: First Health Commercial |
$73,511.00
|
| Rate for Payer: Humana Commercial |
$65,773.00
|
| Rate for Payer: Humana KY Medicaid |
$26,610.98
|
| Rate for Payer: Kentucky WC Medicaid |
$26,881.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,451.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,106.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$68,094.40
|
| Rate for Payer: Ohio Health Group HMO |
$58,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,320.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,392.20
|
| Rate for Payer: PHCS Commercial |
$74,284.80
|
| Rate for Payer: United Healthcare All Payer |
$68,094.40
|
|
|
MESH FLEXHD PLIABLE PRE THIN S
|
Facility
|
OP
|
$70,977.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,293.10 |
| Max. Negotiated Rate |
$68,137.92 |
| Rate for Payer: Aetna Commercial |
$54,652.29
|
| Rate for Payer: Anthem Medicaid |
$24,408.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,362.06
|
| Rate for Payer: Cash Price |
$35,488.50
|
| Rate for Payer: Cigna Commercial |
$58,910.91
|
| Rate for Payer: First Health Commercial |
$67,428.15
|
| Rate for Payer: Humana Commercial |
$60,330.45
|
| Rate for Payer: Humana KY Medicaid |
$24,408.99
|
| Rate for Payer: Kentucky WC Medicaid |
$24,657.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,201.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,381.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,293.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,898.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,459.76
|
| Rate for Payer: Ohio Health Group HMO |
$53,232.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,781.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,749.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,974.13
|
| Rate for Payer: PHCS Commercial |
$68,137.92
|
| Rate for Payer: United Healthcare All Payer |
$62,459.76
|
|
|
MESH FLEXHD PLIABLE PRE THIN S
|
Facility
|
IP
|
$70,977.00
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,293.10 |
| Max. Negotiated Rate |
$68,137.92 |
| Rate for Payer: Aetna Commercial |
$54,652.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,362.06
|
| Rate for Payer: Cash Price |
$35,488.50
|
| Rate for Payer: Cigna Commercial |
$58,910.91
|
| Rate for Payer: First Health Commercial |
$67,428.15
|
| Rate for Payer: Humana Commercial |
$60,330.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,201.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,381.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,293.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,459.76
|
| Rate for Payer: Ohio Health Group HMO |
$53,232.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,781.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,749.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,974.13
|
| Rate for Payer: PHCS Commercial |
$68,137.92
|
| Rate for Payer: United Healthcare All Payer |
$62,459.76
|
|
|
MESH FLEXHD PLIABLE PRE THN XL
|
Facility
|
IP
|
$82,699.47
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,809.84 |
| Max. Negotiated Rate |
$79,391.49 |
| Rate for Payer: Aetna Commercial |
$63,678.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,505.59
|
| Rate for Payer: Cash Price |
$41,349.73
|
| Rate for Payer: Cigna Commercial |
$68,640.56
|
| Rate for Payer: First Health Commercial |
$78,564.50
|
| Rate for Payer: Humana Commercial |
$70,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,813.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,809.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,775.53
|
| Rate for Payer: Ohio Health Group HMO |
$62,024.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,159.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,948.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,062.63
|
| Rate for Payer: PHCS Commercial |
$79,391.49
|
| Rate for Payer: United Healthcare All Payer |
$72,775.53
|
|
|
MESH FLEXHD PLIABLE PRE THN XL
|
Facility
|
OP
|
$82,699.47
|
|
|
Service Code
|
HCPCS Q4128
|
| Hospital Charge Code |
27000124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,809.84 |
| Max. Negotiated Rate |
$79,391.49 |
| Rate for Payer: Aetna Commercial |
$63,678.59
|
| Rate for Payer: Anthem Medicaid |
$28,440.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,505.59
|
| Rate for Payer: Cash Price |
$41,349.73
|
| Rate for Payer: Cigna Commercial |
$68,640.56
|
| Rate for Payer: First Health Commercial |
$78,564.50
|
| Rate for Payer: Humana Commercial |
$70,294.55
|
| Rate for Payer: Humana KY Medicaid |
$28,440.35
|
| Rate for Payer: Kentucky WC Medicaid |
$28,729.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,813.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,032.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,809.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,010.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,775.53
|
| Rate for Payer: Ohio Health Group HMO |
$62,024.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66,159.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,948.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,062.63
|
| Rate for Payer: PHCS Commercial |
$79,391.49
|
| Rate for Payer: United Healthcare All Payer |
$72,775.53
|
|
|
MESH GALAFLEX 3D
|
Facility
|
IP
|
$16,980.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,094.00 |
| Max. Negotiated Rate |
$16,300.80 |
| Rate for Payer: Aetna Commercial |
$13,074.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,244.40
|
| Rate for Payer: Cash Price |
$8,490.00
|
| Rate for Payer: Cigna Commercial |
$14,093.40
|
| Rate for Payer: First Health Commercial |
$16,131.00
|
| Rate for Payer: Humana Commercial |
$14,433.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,923.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,531.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,094.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,772.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,716.20
|
| Rate for Payer: PHCS Commercial |
$16,300.80
|
| Rate for Payer: United Healthcare All Payer |
$14,942.40
|
|
|
MESH GALAFLEX 3D
|
Facility
|
OP
|
$16,980.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,094.00 |
| Max. Negotiated Rate |
$16,300.80 |
| Rate for Payer: Aetna Commercial |
$13,074.60
|
| Rate for Payer: Anthem Medicaid |
$5,839.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,244.40
|
| Rate for Payer: Cash Price |
$8,490.00
|
| Rate for Payer: Cigna Commercial |
$14,093.40
|
| Rate for Payer: First Health Commercial |
$16,131.00
|
| Rate for Payer: Humana Commercial |
$14,433.00
|
| Rate for Payer: Humana KY Medicaid |
$5,839.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,898.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,923.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,531.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,094.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,956.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$12,735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,772.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,716.20
|
| Rate for Payer: PHCS Commercial |
$16,300.80
|
| Rate for Payer: United Healthcare All Payer |
$14,942.40
|
|
|
MESH GALAFORM 3D OVL 5.3*15.5C
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
MESH GALAFORM 3D OVL 5.3*15.5C
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
MESH GALAFORM 3D OVL 6.4*18.5C
|
Facility
|
IP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
MESH GALAFORM 3D OVL 6.4*18.5C
|
Facility
|
OP
|
$13,776.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,132.80 |
| Max. Negotiated Rate |
$13,224.96 |
| Rate for Payer: Aetna Commercial |
$10,607.52
|
| Rate for Payer: Anthem Medicaid |
$4,737.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,745.28
|
| Rate for Payer: Cash Price |
$6,888.00
|
| Rate for Payer: Cigna Commercial |
$11,434.08
|
| Rate for Payer: First Health Commercial |
$13,087.20
|
| Rate for Payer: Humana Commercial |
$11,709.60
|
| Rate for Payer: Humana KY Medicaid |
$4,737.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,785.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,296.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,166.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,505.44
|
| Rate for Payer: PHCS Commercial |
$13,224.96
|
| Rate for Payer: United Healthcare All Payer |
$12,122.88
|
|
|
MESH GALAFORM 3D OVL 7.5*21.0C
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
MESH GALAFORM 3D OVL 7.5*21.0C
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
MESH GALAFORM 3D OVL LG FR3D05
|
Facility
|
IP
|
$11,390.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,417.15 |
| Max. Negotiated Rate |
$10,934.88 |
| Rate for Payer: Aetna Commercial |
$8,770.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,884.59
|
| Rate for Payer: Cash Price |
$5,695.25
|
| Rate for Payer: Cigna Commercial |
$9,454.11
|
| Rate for Payer: First Health Commercial |
$10,820.98
|
| Rate for Payer: Humana Commercial |
$9,681.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,340.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,406.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,417.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,023.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,542.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,112.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,909.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,859.44
|
| Rate for Payer: PHCS Commercial |
$10,934.88
|
| Rate for Payer: United Healthcare All Payer |
$10,023.64
|
|
|
MESH GALAFORM 3D OVL LG FR3D05
|
Facility
|
OP
|
$11,390.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,417.15 |
| Max. Negotiated Rate |
$10,934.88 |
| Rate for Payer: Aetna Commercial |
$8,770.68
|
| Rate for Payer: Anthem Medicaid |
$3,917.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,884.59
|
| Rate for Payer: Cash Price |
$5,695.25
|
| Rate for Payer: Cigna Commercial |
$9,454.11
|
| Rate for Payer: First Health Commercial |
$10,820.98
|
| Rate for Payer: Humana Commercial |
$9,681.92
|
| Rate for Payer: Humana KY Medicaid |
$3,917.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,957.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,340.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,406.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,417.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,995.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,023.64
|
| Rate for Payer: Ohio Health Group HMO |
$8,542.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,112.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,909.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,859.44
|
| Rate for Payer: PHCS Commercial |
$10,934.88
|
| Rate for Payer: United Healthcare All Payer |
$10,023.64
|
|
