|
MESH PHASIX 12*12 30*30CM
|
Facility
|
OP
|
$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 Medicaid |
$28,234.58
|
| 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: Humana KY Medicaid |
$28,234.58
|
| Rate for Payer: Kentucky WC Medicaid |
$28,521.93
|
| 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: Molina Healthcare Medicaid |
$28,801.07
|
| 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
|
|
|
MESH PHASIX 15*20CM
|
Facility
|
IP
|
$21,931.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,579.38 |
| Max. Negotiated Rate |
$21,054.00 |
| Rate for Payer: Aetna Commercial |
$16,887.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,106.38
|
| Rate for Payer: Cash Price |
$10,965.62
|
| Rate for Payer: Cigna Commercial |
$18,202.94
|
| Rate for Payer: First Health Commercial |
$20,834.69
|
| Rate for Payer: Humana Commercial |
$18,641.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,983.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,185.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,579.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,299.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,448.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,080.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,132.56
|
| Rate for Payer: PHCS Commercial |
$21,054.00
|
| Rate for Payer: United Healthcare All Payer |
$19,299.50
|
|
|
MESH PHASIX 15*20CM
|
Facility
|
OP
|
$21,931.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,579.38 |
| Max. Negotiated Rate |
$21,054.00 |
| Rate for Payer: Aetna Commercial |
$16,887.06
|
| Rate for Payer: Anthem Medicaid |
$7,542.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,106.38
|
| Rate for Payer: Cash Price |
$10,965.62
|
| Rate for Payer: Cigna Commercial |
$18,202.94
|
| Rate for Payer: First Health Commercial |
$20,834.69
|
| Rate for Payer: Humana Commercial |
$18,641.56
|
| Rate for Payer: Humana KY Medicaid |
$7,542.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,618.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,983.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,185.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,579.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,693.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,299.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,448.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,080.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,132.56
|
| Rate for Payer: PHCS Commercial |
$21,054.00
|
| Rate for Payer: United Healthcare All Payer |
$19,299.50
|
|
|
MESH PHASIX 20*25CM
|
Facility
|
IP
|
$32,168.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,650.62 |
| Max. Negotiated Rate |
$30,882.00 |
| Rate for Payer: Aetna Commercial |
$24,769.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,091.62
|
| Rate for Payer: Cash Price |
$16,084.38
|
| Rate for Payer: Cigna Commercial |
$26,700.06
|
| Rate for Payer: First Health Commercial |
$30,560.31
|
| Rate for Payer: Humana Commercial |
$27,343.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,378.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,740.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,650.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,308.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,735.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,986.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,196.44
|
| Rate for Payer: PHCS Commercial |
$30,882.00
|
| Rate for Payer: United Healthcare All Payer |
$28,308.50
|
|
|
MESH PHASIX 20*25CM
|
Facility
|
OP
|
$32,168.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,650.62 |
| Max. Negotiated Rate |
$30,882.00 |
| Rate for Payer: Aetna Commercial |
$24,769.94
|
| Rate for Payer: Anthem Medicaid |
$11,062.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,091.62
|
| Rate for Payer: Cash Price |
$16,084.38
|
| Rate for Payer: Cigna Commercial |
$26,700.06
|
| Rate for Payer: First Health Commercial |
$30,560.31
|
| Rate for Payer: Humana Commercial |
$27,343.44
|
| Rate for Payer: Humana KY Medicaid |
$11,062.83
|
| Rate for Payer: Kentucky WC Medicaid |
$11,175.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,378.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,740.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,650.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,284.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,308.50
|
| Rate for Payer: Ohio Health Group HMO |
$24,126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,735.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,986.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,196.44
|
| Rate for Payer: PHCS Commercial |
$30,882.00
|
| Rate for Payer: United Healthcare All Payer |
$28,308.50
|
|
|
MESH PHASIX 25*30CM
|
Facility
|
OP
|
$71,794.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,538.20 |
| Max. Negotiated Rate |
$68,922.24 |
| Rate for Payer: Aetna Commercial |
$55,281.38
|
| Rate for Payer: Anthem Medicaid |
$24,689.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,999.32
|
| Rate for Payer: Cash Price |
$35,897.00
|
| Rate for Payer: Cigna Commercial |
$59,589.02
|
| Rate for Payer: First Health Commercial |
$68,204.30
|
| Rate for Payer: Humana Commercial |
$61,024.90
|
| Rate for Payer: Humana KY Medicaid |
$24,689.96
|
| Rate for Payer: Kentucky WC Medicaid |
$24,941.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,871.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,983.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,185.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,178.72
|
| Rate for Payer: Ohio Health Group HMO |
$53,845.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,460.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,537.86
|
| Rate for Payer: PHCS Commercial |
$68,922.24
|
| Rate for Payer: United Healthcare All Payer |
$63,178.72
|
|
|
MESH PHASIX 25*30CM
|
Facility
|
IP
|
$71,794.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,538.20 |
| Max. Negotiated Rate |
$68,922.24 |
| Rate for Payer: Aetna Commercial |
$55,281.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,999.32
|
| Rate for Payer: Cash Price |
$35,897.00
|
| Rate for Payer: Cigna Commercial |
$59,589.02
|
| Rate for Payer: First Health Commercial |
$68,204.30
|
| Rate for Payer: Humana Commercial |
$61,024.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,871.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,983.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,178.72
|
| Rate for Payer: Ohio Health Group HMO |
$53,845.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62,460.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,537.86
|
| Rate for Payer: PHCS Commercial |
$68,922.24
|
| Rate for Payer: United Healthcare All Payer |
$63,178.72
|
|
|
MESH PHASIX 4*6 1190200
|
Facility
|
OP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem Medicaid |
$3,980.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Humana KY Medicaid |
$3,980.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,020.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,060.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
MESH PHASIX 4*6 1190200
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
|
MESH PHASIX ST 15*20CM
|
Facility
|
OP
|
$26,650.62
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,995.19 |
| Max. Negotiated Rate |
$25,584.60 |
| Rate for Payer: Aetna Commercial |
$20,520.98
|
| Rate for Payer: Anthem Medicaid |
$9,165.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,787.48
|
| Rate for Payer: Cash Price |
$13,325.31
|
| Rate for Payer: Cigna Commercial |
$22,120.01
|
| Rate for Payer: First Health Commercial |
$25,318.09
|
| Rate for Payer: Humana Commercial |
$22,653.03
|
| Rate for Payer: Humana KY Medicaid |
$9,165.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,258.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,853.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,668.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,995.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,349.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,452.55
|
| Rate for Payer: Ohio Health Group HMO |
$19,987.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,320.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,186.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,388.93
|
| Rate for Payer: PHCS Commercial |
$25,584.60
|
| Rate for Payer: United Healthcare All Payer |
$23,452.55
|
|
|
MESH PHASIX ST 15*20CM
|
Facility
|
IP
|
$26,650.62
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,995.19 |
| Max. Negotiated Rate |
$25,584.60 |
| Rate for Payer: Aetna Commercial |
$20,520.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,787.48
|
| Rate for Payer: Cash Price |
$13,325.31
|
| Rate for Payer: Cigna Commercial |
$22,120.01
|
| Rate for Payer: First Health Commercial |
$25,318.09
|
| Rate for Payer: Humana Commercial |
$22,653.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,853.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,668.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,995.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,452.55
|
| Rate for Payer: Ohio Health Group HMO |
$19,987.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,320.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,186.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,388.93
|
| Rate for Payer: PHCS Commercial |
$25,584.60
|
| Rate for Payer: United Healthcare All Payer |
$23,452.55
|
|
|
MESH PHASIX ST 20*25CM
|
Facility
|
OP
|
$40,132.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,039.67 |
| Max. Negotiated Rate |
$38,526.96 |
| Rate for Payer: Aetna Commercial |
$30,901.83
|
| Rate for Payer: Anthem Medicaid |
$13,801.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,303.15
|
| Rate for Payer: Cash Price |
$20,066.12
|
| Rate for Payer: Cigna Commercial |
$33,309.77
|
| Rate for Payer: First Health Commercial |
$38,125.64
|
| Rate for Payer: Humana Commercial |
$34,112.41
|
| Rate for Payer: Humana KY Medicaid |
$13,801.48
|
| Rate for Payer: Kentucky WC Medicaid |
$13,941.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,908.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,617.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,039.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,078.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,316.38
|
| Rate for Payer: Ohio Health Group HMO |
$30,099.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,105.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,915.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,691.25
|
| Rate for Payer: PHCS Commercial |
$38,526.96
|
| Rate for Payer: United Healthcare All Payer |
$35,316.38
|
|
|
MESH PHASIX ST 20*25CM
|
Facility
|
IP
|
$40,132.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,039.67 |
| Max. Negotiated Rate |
$38,526.96 |
| Rate for Payer: Aetna Commercial |
$30,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,303.15
|
| Rate for Payer: Cash Price |
$20,066.12
|
| Rate for Payer: Cigna Commercial |
$33,309.77
|
| Rate for Payer: First Health Commercial |
$38,125.64
|
| Rate for Payer: Humana Commercial |
$34,112.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,908.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,617.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,039.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,316.38
|
| Rate for Payer: Ohio Health Group HMO |
$30,099.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,105.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34,915.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,691.25
|
| Rate for Payer: PHCS Commercial |
$38,526.96
|
| Rate for Payer: United Healthcare All Payer |
$35,316.38
|
|
|
MESH PHASIX ST 25*30CM
|
Facility
|
OP
|
$82,365.22
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,709.57 |
| Max. Negotiated Rate |
$79,070.61 |
| Rate for Payer: Aetna Commercial |
$63,421.22
|
| Rate for Payer: Anthem Medicaid |
$28,325.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,244.87
|
| Rate for Payer: Cash Price |
$41,182.61
|
| Rate for Payer: Cigna Commercial |
$68,363.13
|
| Rate for Payer: First Health Commercial |
$78,246.96
|
| Rate for Payer: Humana Commercial |
$70,010.44
|
| Rate for Payer: Humana KY Medicaid |
$28,325.40
|
| Rate for Payer: Kentucky WC Medicaid |
$28,613.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,539.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,785.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,709.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,893.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,481.39
|
| Rate for Payer: Ohio Health Group HMO |
$61,773.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,892.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,657.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,832.00
|
| Rate for Payer: PHCS Commercial |
$79,070.61
|
| Rate for Payer: United Healthcare All Payer |
$72,481.39
|
|
|
MESH PHASIX ST 25*30CM
|
Facility
|
IP
|
$82,365.22
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,709.57 |
| Max. Negotiated Rate |
$79,070.61 |
| Rate for Payer: Aetna Commercial |
$63,421.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64,244.87
|
| Rate for Payer: Cash Price |
$41,182.61
|
| Rate for Payer: Cigna Commercial |
$68,363.13
|
| Rate for Payer: First Health Commercial |
$78,246.96
|
| Rate for Payer: Humana Commercial |
$70,010.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,539.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,785.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,709.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,481.39
|
| Rate for Payer: Ohio Health Group HMO |
$61,773.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,892.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,657.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,832.00
|
| Rate for Payer: PHCS Commercial |
$79,070.61
|
| Rate for Payer: United Healthcare All Payer |
$72,481.39
|
|
|
MESH PHASIX ST 7*10CM
|
Facility
|
OP
|
$8,549.09
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.73 |
| Max. Negotiated Rate |
$8,207.13 |
| Rate for Payer: Aetna Commercial |
$6,582.80
|
| Rate for Payer: Anthem Medicaid |
$2,940.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.29
|
| Rate for Payer: Cash Price |
$4,274.55
|
| Rate for Payer: Cigna Commercial |
$7,095.74
|
| Rate for Payer: First Health Commercial |
$8,121.64
|
| Rate for Payer: Humana Commercial |
$7,266.73
|
| Rate for Payer: Humana KY Medicaid |
$2,940.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,010.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,309.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,999.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,839.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,437.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.87
|
| Rate for Payer: PHCS Commercial |
$8,207.13
|
| Rate for Payer: United Healthcare All Payer |
$7,523.20
|
|
|
MESH PHASIX ST 7*10CM
|
Facility
|
IP
|
$8,549.09
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.73 |
| Max. Negotiated Rate |
$8,207.13 |
| Rate for Payer: Aetna Commercial |
$6,582.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,668.29
|
| Rate for Payer: Cash Price |
$4,274.55
|
| Rate for Payer: Cigna Commercial |
$7,095.74
|
| Rate for Payer: First Health Commercial |
$8,121.64
|
| Rate for Payer: Humana Commercial |
$7,266.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,010.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,309.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,839.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,437.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.87
|
| Rate for Payer: PHCS Commercial |
$8,207.13
|
| Rate for Payer: United Healthcare All Payer |
$7,523.20
|
|
|
MESH PHASIX W/ECHO 11CM
|
Facility
|
OP
|
$12,825.47
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.64 |
| Max. Negotiated Rate |
$12,312.45 |
| Rate for Payer: Aetna Commercial |
$9,875.61
|
| Rate for Payer: Anthem Medicaid |
$4,410.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,003.87
|
| Rate for Payer: Cash Price |
$6,412.74
|
| Rate for Payer: Cigna Commercial |
$10,645.14
|
| Rate for Payer: First Health Commercial |
$12,184.20
|
| Rate for Payer: Humana Commercial |
$10,901.65
|
| Rate for Payer: Humana KY Medicaid |
$4,410.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,455.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,516.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,499.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,286.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,260.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,158.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,849.57
|
| Rate for Payer: PHCS Commercial |
$12,312.45
|
| Rate for Payer: United Healthcare All Payer |
$11,286.41
|
|
|
MESH PHASIX W/ECHO 11CM
|
Facility
|
IP
|
$12,825.47
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,847.64 |
| Max. Negotiated Rate |
$12,312.45 |
| Rate for Payer: Aetna Commercial |
$9,875.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,003.87
|
| Rate for Payer: Cash Price |
$6,412.74
|
| Rate for Payer: Cigna Commercial |
$10,645.14
|
| Rate for Payer: First Health Commercial |
$12,184.20
|
| Rate for Payer: Humana Commercial |
$10,901.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,516.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,465.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,847.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,286.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,619.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,260.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,158.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,849.57
|
| Rate for Payer: PHCS Commercial |
$12,312.45
|
| Rate for Payer: United Healthcare All Payer |
$11,286.41
|
|
|
MESH PHASIX W/ ECHO 15*20CM
|
Facility
|
OP
|
$27,275.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,182.50 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$21,001.75
|
| Rate for Payer: Anthem Medicaid |
$9,379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,274.50
|
| Rate for Payer: Cash Price |
$13,637.50
|
| Rate for Payer: Cigna Commercial |
$22,638.25
|
| Rate for Payer: First Health Commercial |
$25,911.25
|
| Rate for Payer: Humana Commercial |
$23,183.75
|
| Rate for Payer: Humana KY Medicaid |
$9,379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$9,475.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,128.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,182.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,568.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,002.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,729.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,819.75
|
| Rate for Payer: PHCS Commercial |
$26,184.00
|
| Rate for Payer: United Healthcare All Payer |
$24,002.00
|
|
|
MESH PHASIX W/ ECHO 15*20CM
|
Facility
|
IP
|
$27,275.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,182.50 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$21,001.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,274.50
|
| Rate for Payer: Cash Price |
$13,637.50
|
| Rate for Payer: Cigna Commercial |
$22,638.25
|
| Rate for Payer: First Health Commercial |
$25,911.25
|
| Rate for Payer: Humana Commercial |
$23,183.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,128.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,182.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,002.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,729.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,819.75
|
| Rate for Payer: PHCS Commercial |
$26,184.00
|
| Rate for Payer: United Healthcare All Payer |
$24,002.00
|
|
|
MESH PHASIX W/ECHO 15CM
|
Facility
|
IP
|
$27,275.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,182.50 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$21,001.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,274.50
|
| Rate for Payer: Cash Price |
$13,637.50
|
| Rate for Payer: Cigna Commercial |
$22,638.25
|
| Rate for Payer: First Health Commercial |
$25,911.25
|
| Rate for Payer: Humana Commercial |
$23,183.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,128.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,182.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,002.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,729.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,819.75
|
| Rate for Payer: PHCS Commercial |
$26,184.00
|
| Rate for Payer: United Healthcare All Payer |
$24,002.00
|
|
|
MESH PHASIX W/ECHO 15CM
|
Facility
|
OP
|
$27,275.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,182.50 |
| Max. Negotiated Rate |
$26,184.00 |
| Rate for Payer: Aetna Commercial |
$21,001.75
|
| Rate for Payer: Anthem Medicaid |
$9,379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,274.50
|
| Rate for Payer: Cash Price |
$13,637.50
|
| Rate for Payer: Cigna Commercial |
$22,638.25
|
| Rate for Payer: First Health Commercial |
$25,911.25
|
| Rate for Payer: Humana Commercial |
$23,183.75
|
| Rate for Payer: Humana KY Medicaid |
$9,379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$9,475.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,128.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,182.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,568.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,002.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,729.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,819.75
|
| Rate for Payer: PHCS Commercial |
$26,184.00
|
| Rate for Payer: United Healthcare All Payer |
$24,002.00
|
|
|
MESH PHYSIOMESH 10*15CM
|
Facility
|
IP
|
$4,524.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,357.35 |
| Max. Negotiated Rate |
$4,343.52 |
| Rate for Payer: Aetna Commercial |
$3,483.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,529.11
|
| Rate for Payer: Cash Price |
$2,262.25
|
| Rate for Payer: Cigna Commercial |
$3,755.34
|
| Rate for Payer: First Health Commercial |
$4,298.27
|
| Rate for Payer: Humana Commercial |
$3,845.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,710.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,339.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,936.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.91
|
| Rate for Payer: PHCS Commercial |
$4,343.52
|
| Rate for Payer: United Healthcare All Payer |
$3,981.56
|
|
|
MESH PHYSIOMESH 10*15CM
|
Facility
|
OP
|
$4,524.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,357.35 |
| Max. Negotiated Rate |
$4,343.52 |
| Rate for Payer: Aetna Commercial |
$3,483.86
|
| Rate for Payer: Anthem Medicaid |
$1,555.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,529.11
|
| Rate for Payer: Cash Price |
$2,262.25
|
| Rate for Payer: Cigna Commercial |
$3,755.34
|
| Rate for Payer: First Health Commercial |
$4,298.27
|
| Rate for Payer: Humana Commercial |
$3,845.82
|
| Rate for Payer: Humana KY Medicaid |
$1,555.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,571.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,710.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,339.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,587.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,936.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.91
|
| Rate for Payer: PHCS Commercial |
$4,343.52
|
| Rate for Payer: United Healthcare All Payer |
$3,981.56
|
|
