|
MESH GALAFORM 3D OVL MED FR3D0
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
MESH GALAFORM 3D OVL MED FR3D0
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
MESH GALAFORM SCAFFLD 18*10.1C
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
MESH GALAFORM SCAFFLD 18*10.1C
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
MESH GALAFORM SCAFFOLD 10*20CM
|
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 SCAFFOLD 10*20CM
|
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 SCAFFOLD 15*20CM
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
MESH GALAFORM SCAFFOLD 15*20CM
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
MESH GORE BIO-A 7*10CM HH0710
|
Facility
|
OP
|
$4,036.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.88 |
| Max. Negotiated Rate |
$3,874.80 |
| Rate for Payer: Aetna Commercial |
$3,107.91
|
| Rate for Payer: Anthem Medicaid |
$1,388.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.28
|
| Rate for Payer: Cash Price |
$2,018.12
|
| Rate for Payer: Cigna Commercial |
$3,350.09
|
| Rate for Payer: First Health Commercial |
$3,834.44
|
| Rate for Payer: Humana Commercial |
$3,430.81
|
| Rate for Payer: Humana KY Medicaid |
$1,388.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,309.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,978.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,551.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,511.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.01
|
| Rate for Payer: PHCS Commercial |
$3,874.80
|
| Rate for Payer: United Healthcare All Payer |
$3,551.90
|
|
|
MESH GORE BIO-A 7*10CM HH0710
|
Facility
|
IP
|
$4,036.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.88 |
| Max. Negotiated Rate |
$3,874.80 |
| Rate for Payer: Aetna Commercial |
$3,107.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.28
|
| Rate for Payer: Cash Price |
$2,018.12
|
| Rate for Payer: Cigna Commercial |
$3,350.09
|
| Rate for Payer: First Health Commercial |
$3,834.44
|
| Rate for Payer: Humana Commercial |
$3,430.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,309.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,978.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,551.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,511.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.01
|
| Rate for Payer: PHCS Commercial |
$3,874.80
|
| Rate for Payer: United Healthcare All Payer |
$3,551.90
|
|
|
MESH PARIETEX PROGRIP 15*15CM
|
Facility
|
OP
|
$5,215.89
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.77 |
| Max. Negotiated Rate |
$5,007.25 |
| Rate for Payer: Aetna Commercial |
$4,016.24
|
| Rate for Payer: Anthem Medicaid |
$1,793.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,068.39
|
| Rate for Payer: Cash Price |
$2,607.94
|
| Rate for Payer: Cigna Commercial |
$4,329.19
|
| Rate for Payer: First Health Commercial |
$4,955.10
|
| Rate for Payer: Humana Commercial |
$4,433.51
|
| Rate for Payer: Humana KY Medicaid |
$1,793.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,812.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,277.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,849.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,829.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,589.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,911.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,172.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,537.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,598.96
|
| Rate for Payer: PHCS Commercial |
$5,007.25
|
| Rate for Payer: United Healthcare All Payer |
$4,589.98
|
|
|
MESH PARIETEX PROGRIP 15*15CM
|
Facility
|
IP
|
$5,215.89
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,564.77 |
| Max. Negotiated Rate |
$5,007.25 |
| Rate for Payer: Aetna Commercial |
$4,016.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,068.39
|
| Rate for Payer: Cash Price |
$2,607.94
|
| Rate for Payer: Cigna Commercial |
$4,329.19
|
| Rate for Payer: First Health Commercial |
$4,955.10
|
| Rate for Payer: Humana Commercial |
$4,433.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,277.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,849.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,564.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,589.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,911.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,172.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,537.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,598.96
|
| Rate for Payer: PHCS Commercial |
$5,007.25
|
| Rate for Payer: United Healthcare All Payer |
$4,589.98
|
|
|
MESH PARIETEX PROGRIP 30*15CM
|
Facility
|
IP
|
$6,993.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.09 |
| Max. Negotiated Rate |
$6,713.90 |
| Rate for Payer: Aetna Commercial |
$5,385.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,455.05
|
| Rate for Payer: Cash Price |
$3,496.82
|
| Rate for Payer: Cigna Commercial |
$5,804.73
|
| Rate for Payer: First Health Commercial |
$6,643.97
|
| Rate for Payer: Humana Commercial |
$5,944.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,734.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,161.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,154.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,594.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,084.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,825.62
|
| Rate for Payer: PHCS Commercial |
$6,713.90
|
| Rate for Payer: United Healthcare All Payer |
$6,154.41
|
|
|
MESH PARIETEX PROGRIP 30*15CM
|
Facility
|
OP
|
$6,993.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.09 |
| Max. Negotiated Rate |
$6,713.90 |
| Rate for Payer: Aetna Commercial |
$5,385.11
|
| Rate for Payer: Anthem Medicaid |
$2,405.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,455.05
|
| Rate for Payer: Cash Price |
$3,496.82
|
| Rate for Payer: Cigna Commercial |
$5,804.73
|
| Rate for Payer: First Health Commercial |
$6,643.97
|
| Rate for Payer: Humana Commercial |
$5,944.60
|
| Rate for Payer: Humana KY Medicaid |
$2,405.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,429.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,734.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,161.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,453.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,154.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,594.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,084.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,825.62
|
| Rate for Payer: PHCS Commercial |
$6,713.90
|
| Rate for Payer: United Healthcare All Payer |
$6,154.41
|
|
|
MESH PATCH PROCEED VENTRAL MED
|
Facility
|
IP
|
$4,054.59
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.38 |
| Max. Negotiated Rate |
$3,892.41 |
| Rate for Payer: Aetna Commercial |
$3,122.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.58
|
| Rate for Payer: Cash Price |
$2,027.29
|
| Rate for Payer: Cigna Commercial |
$3,365.31
|
| Rate for Payer: First Health Commercial |
$3,851.86
|
| Rate for Payer: Humana Commercial |
$3,446.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,992.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,568.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,040.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,243.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,527.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,797.67
|
| Rate for Payer: PHCS Commercial |
$3,892.41
|
| Rate for Payer: United Healthcare All Payer |
$3,568.04
|
|
|
MESH PATCH PROCEED VENTRAL MED
|
Facility
|
OP
|
$4,054.59
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.38 |
| Max. Negotiated Rate |
$3,892.41 |
| Rate for Payer: Aetna Commercial |
$3,122.03
|
| Rate for Payer: Anthem Medicaid |
$1,394.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.58
|
| Rate for Payer: Cash Price |
$2,027.29
|
| Rate for Payer: Cigna Commercial |
$3,365.31
|
| Rate for Payer: First Health Commercial |
$3,851.86
|
| Rate for Payer: Humana Commercial |
$3,446.40
|
| Rate for Payer: Humana KY Medicaid |
$1,394.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,408.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,324.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,992.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,422.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,568.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,040.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,243.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,527.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,797.67
|
| Rate for Payer: PHCS Commercial |
$3,892.41
|
| Rate for Payer: United Healthcare All Payer |
$3,568.04
|
|
|
MESH PATCH PROCEED VENTRAL SM
|
Facility
|
OP
|
$3,717.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.36 |
| Max. Negotiated Rate |
$3,569.16 |
| Rate for Payer: Aetna Commercial |
$2,862.77
|
| Rate for Payer: Anthem Medicaid |
$1,278.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.95
|
| Rate for Payer: Cash Price |
$1,858.94
|
| Rate for Payer: Cigna Commercial |
$3,085.84
|
| Rate for Payer: First Health Commercial |
$3,531.99
|
| Rate for Payer: Humana Commercial |
$3,160.20
|
| Rate for Payer: Humana KY Medicaid |
$1,278.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.34
|
| Rate for Payer: PHCS Commercial |
$3,569.16
|
| Rate for Payer: United Healthcare All Payer |
$3,271.73
|
|
|
MESH PATCH PROCEED VENTRAL SM
|
Facility
|
IP
|
$3,717.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.36 |
| Max. Negotiated Rate |
$3,569.16 |
| Rate for Payer: Aetna Commercial |
$2,862.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.95
|
| Rate for Payer: Cash Price |
$1,858.94
|
| Rate for Payer: Cigna Commercial |
$3,085.84
|
| Rate for Payer: First Health Commercial |
$3,531.99
|
| Rate for Payer: Humana Commercial |
$3,160.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.34
|
| Rate for Payer: PHCS Commercial |
$3,569.16
|
| Rate for Payer: United Healthcare All Payer |
$3,271.73
|
|
|
MESH PERFIX PLUGS LG
|
Facility
|
OP
|
$1,858.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.58 |
| Max. Negotiated Rate |
$1,784.26 |
| Rate for Payer: Aetna Commercial |
$1,431.12
|
| Rate for Payer: Anthem Medicaid |
$639.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.71
|
| Rate for Payer: Cash Price |
$929.30
|
| Rate for Payer: Cigna Commercial |
$1,542.64
|
| Rate for Payer: First Health Commercial |
$1,765.67
|
| Rate for Payer: Humana Commercial |
$1,579.81
|
| Rate for Payer: Humana KY Medicaid |
$639.17
|
| Rate for Payer: Kentucky WC Medicaid |
$645.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,635.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,486.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,616.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.43
|
| Rate for Payer: PHCS Commercial |
$1,784.26
|
| Rate for Payer: United Healthcare All Payer |
$1,635.57
|
|
|
MESH PERFIX PLUGS LG
|
Facility
|
IP
|
$1,858.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.58 |
| Max. Negotiated Rate |
$1,784.26 |
| Rate for Payer: Aetna Commercial |
$1,431.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.71
|
| Rate for Payer: Cash Price |
$929.30
|
| Rate for Payer: Cigna Commercial |
$1,542.64
|
| Rate for Payer: First Health Commercial |
$1,765.67
|
| Rate for Payer: Humana Commercial |
$1,579.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,635.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,486.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,616.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.43
|
| Rate for Payer: PHCS Commercial |
$1,784.26
|
| Rate for Payer: United Healthcare All Payer |
$1,635.57
|
|
|
MESH PERFIX PLUGS MED
|
Facility
|
IP
|
$1,858.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.58 |
| Max. Negotiated Rate |
$1,784.26 |
| Rate for Payer: Aetna Commercial |
$1,431.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.71
|
| Rate for Payer: Cash Price |
$929.30
|
| Rate for Payer: Cigna Commercial |
$1,542.64
|
| Rate for Payer: First Health Commercial |
$1,765.67
|
| Rate for Payer: Humana Commercial |
$1,579.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,635.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,486.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,616.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.43
|
| Rate for Payer: PHCS Commercial |
$1,784.26
|
| Rate for Payer: United Healthcare All Payer |
$1,635.57
|
|
|
MESH PERFIX PLUGS MED
|
Facility
|
OP
|
$1,858.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.58 |
| Max. Negotiated Rate |
$1,784.26 |
| Rate for Payer: Aetna Commercial |
$1,431.12
|
| Rate for Payer: Anthem Medicaid |
$639.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.71
|
| Rate for Payer: Cash Price |
$929.30
|
| Rate for Payer: Cigna Commercial |
$1,542.64
|
| Rate for Payer: First Health Commercial |
$1,765.67
|
| Rate for Payer: Humana Commercial |
$1,579.81
|
| Rate for Payer: Humana KY Medicaid |
$639.17
|
| Rate for Payer: Kentucky WC Medicaid |
$645.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,635.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,486.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,616.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.43
|
| Rate for Payer: PHCS Commercial |
$1,784.26
|
| Rate for Payer: United Healthcare All Payer |
$1,635.57
|
|
|
MESH PERFIX PLUG X-LG
|
Facility
|
OP
|
$6,744.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,023.47 |
| Max. Negotiated Rate |
$6,475.10 |
| Rate for Payer: Aetna Commercial |
$5,193.57
|
| Rate for Payer: Anthem Medicaid |
$2,319.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,261.02
|
| Rate for Payer: Cash Price |
$3,372.45
|
| Rate for Payer: Cigna Commercial |
$5,598.27
|
| Rate for Payer: First Health Commercial |
$6,407.65
|
| Rate for Payer: Humana Commercial |
$5,733.16
|
| Rate for Payer: Humana KY Medicaid |
$2,319.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,343.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,530.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,977.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,023.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,366.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,935.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,058.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,395.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,868.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,653.98
|
| Rate for Payer: PHCS Commercial |
$6,475.10
|
| Rate for Payer: United Healthcare All Payer |
$5,935.51
|
|
|
MESH PERFIX PLUG X-LG
|
Facility
|
IP
|
$6,744.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,023.47 |
| Max. Negotiated Rate |
$6,475.10 |
| Rate for Payer: Aetna Commercial |
$5,193.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,261.02
|
| Rate for Payer: Cash Price |
$3,372.45
|
| Rate for Payer: Cigna Commercial |
$5,598.27
|
| Rate for Payer: First Health Commercial |
$6,407.65
|
| Rate for Payer: Humana Commercial |
$5,733.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,530.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,977.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,023.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,935.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,058.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,395.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,868.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,653.98
|
| Rate for Payer: PHCS Commercial |
$6,475.10
|
| Rate for Payer: United Healthcare All Payer |
$5,935.51
|
|
|
MESH PHASIX 12*12 30*30CM
|
Facility
|
IP
|
$82,101.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,630.34 |
| Max. Negotiated Rate |
$78,817.08 |
| Rate for Payer: Aetna Commercial |
$63,217.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,038.87
|
| Rate for Payer: Cash Price |
$41,050.56
|
| Rate for Payer: Cigna Commercial |
$68,143.93
|
| Rate for Payer: First Health Commercial |
$77,996.06
|
| Rate for Payer: Humana Commercial |
$69,785.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,322.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,590.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,630.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,248.99
|
| Rate for Payer: Ohio Health Group HMO |
$61,575.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,680.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,427.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,649.77
|
| Rate for Payer: PHCS Commercial |
$78,817.08
|
| Rate for Payer: United Healthcare All Payer |
$72,248.99
|
|
