|
MESH PHYSIOMESH 15*20CM
|
Facility
|
OP
|
$7,462.67
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,238.80 |
| Max. Negotiated Rate |
$7,164.16 |
| Rate for Payer: Aetna Commercial |
$5,746.26
|
| Rate for Payer: Anthem Medicaid |
$2,566.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,820.88
|
| Rate for Payer: Cash Price |
$3,731.34
|
| Rate for Payer: Cigna Commercial |
$6,194.02
|
| Rate for Payer: First Health Commercial |
$7,089.54
|
| Rate for Payer: Humana Commercial |
$6,343.27
|
| Rate for Payer: Humana KY Medicaid |
$2,566.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,592.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,617.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,970.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,492.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,149.24
|
| Rate for Payer: PHCS Commercial |
$7,164.16
|
| Rate for Payer: United Healthcare All Payer |
$6,567.15
|
|
|
MESH PHYSIOMESH 15*20CM
|
Facility
|
IP
|
$7,462.67
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,238.80 |
| Max. Negotiated Rate |
$7,164.16 |
| Rate for Payer: Aetna Commercial |
$5,746.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,820.88
|
| Rate for Payer: Cash Price |
$3,731.34
|
| Rate for Payer: Cigna Commercial |
$6,194.02
|
| Rate for Payer: First Health Commercial |
$7,089.54
|
| Rate for Payer: Humana Commercial |
$6,343.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,119.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,507.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,238.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,567.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,970.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,492.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,149.24
|
| Rate for Payer: PHCS Commercial |
$7,164.16
|
| Rate for Payer: United Healthcare All Payer |
$6,567.15
|
|
|
MESH PHYSIOMESH 20*25CM
|
Facility
|
OP
|
$10,227.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.10 |
| Max. Negotiated Rate |
$9,817.92 |
| Rate for Payer: Aetna Commercial |
$7,874.79
|
| Rate for Payer: Anthem Medicaid |
$3,517.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,977.06
|
| Rate for Payer: Cash Price |
$5,113.50
|
| Rate for Payer: Cigna Commercial |
$8,488.41
|
| Rate for Payer: First Health Commercial |
$9,715.65
|
| Rate for Payer: Humana Commercial |
$8,692.95
|
| Rate for Payer: Humana KY Medicaid |
$3,517.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,552.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,547.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,587.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,999.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,670.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,897.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,056.63
|
| Rate for Payer: PHCS Commercial |
$9,817.92
|
| Rate for Payer: United Healthcare All Payer |
$8,999.76
|
|
|
MESH PHYSIOMESH 20*25CM
|
Facility
|
IP
|
$10,227.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,068.10 |
| Max. Negotiated Rate |
$9,817.92 |
| Rate for Payer: Aetna Commercial |
$7,874.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,977.06
|
| Rate for Payer: Cash Price |
$5,113.50
|
| Rate for Payer: Cigna Commercial |
$8,488.41
|
| Rate for Payer: First Health Commercial |
$9,715.65
|
| Rate for Payer: Humana Commercial |
$8,692.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,547.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,999.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,670.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,897.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,056.63
|
| Rate for Payer: PHCS Commercial |
$9,817.92
|
| Rate for Payer: United Healthcare All Payer |
$8,999.76
|
|
|
MESH PHYSIOMESH 30*35CM
|
Facility
|
OP
|
$14,399.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,319.97 |
| Max. Negotiated Rate |
$13,823.90 |
| Rate for Payer: Aetna Commercial |
$11,087.92
|
| Rate for Payer: Anthem Medicaid |
$4,952.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,231.92
|
| Rate for Payer: Cash Price |
$7,199.95
|
| Rate for Payer: Cigna Commercial |
$11,951.92
|
| Rate for Payer: First Health Commercial |
$13,679.91
|
| Rate for Payer: Humana Commercial |
$12,239.92
|
| Rate for Payer: Humana KY Medicaid |
$4,952.13
|
| Rate for Payer: Kentucky WC Medicaid |
$5,002.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,807.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,627.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,319.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,051.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,671.91
|
| Rate for Payer: Ohio Health Group HMO |
$10,799.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,519.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,527.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,935.93
|
| Rate for Payer: PHCS Commercial |
$13,823.90
|
| Rate for Payer: United Healthcare All Payer |
$12,671.91
|
|
|
MESH PHYSIOMESH 30*35CM
|
Facility
|
IP
|
$14,399.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,319.97 |
| Max. Negotiated Rate |
$13,823.90 |
| Rate for Payer: Aetna Commercial |
$11,087.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,231.92
|
| Rate for Payer: Cash Price |
$7,199.95
|
| Rate for Payer: Cigna Commercial |
$11,951.92
|
| Rate for Payer: First Health Commercial |
$13,679.91
|
| Rate for Payer: Humana Commercial |
$12,239.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,807.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,627.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,319.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,671.91
|
| Rate for Payer: Ohio Health Group HMO |
$10,799.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,519.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,527.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,935.93
|
| Rate for Payer: PHCS Commercial |
$13,823.90
|
| Rate for Payer: United Healthcare All Payer |
$12,671.91
|
|
|
MESH PHYSIOMESH 30*50CM
|
Facility
|
IP
|
$16,487.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,946.37 |
| Max. Negotiated Rate |
$15,828.38 |
| Rate for Payer: Aetna Commercial |
$12,695.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,860.56
|
| Rate for Payer: Cash Price |
$8,243.95
|
| Rate for Payer: Cigna Commercial |
$13,684.96
|
| Rate for Payer: First Health Commercial |
$15,663.50
|
| Rate for Payer: Humana Commercial |
$14,014.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,520.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,168.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,946.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,509.35
|
| Rate for Payer: Ohio Health Group HMO |
$12,365.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,190.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,344.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,376.65
|
| Rate for Payer: PHCS Commercial |
$15,828.38
|
| Rate for Payer: United Healthcare All Payer |
$14,509.35
|
|
|
MESH PHYSIOMESH 30*50CM
|
Facility
|
OP
|
$16,487.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,946.37 |
| Max. Negotiated Rate |
$15,828.38 |
| Rate for Payer: Aetna Commercial |
$12,695.68
|
| Rate for Payer: Anthem Medicaid |
$5,670.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,860.56
|
| Rate for Payer: Cash Price |
$8,243.95
|
| Rate for Payer: Cigna Commercial |
$13,684.96
|
| Rate for Payer: First Health Commercial |
$15,663.50
|
| Rate for Payer: Humana Commercial |
$14,014.72
|
| Rate for Payer: Humana KY Medicaid |
$5,670.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,727.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,520.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,168.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,946.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,783.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,509.35
|
| Rate for Payer: Ohio Health Group HMO |
$12,365.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,190.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,344.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,376.65
|
| Rate for Payer: PHCS Commercial |
$15,828.38
|
| Rate for Payer: United Healthcare All Payer |
$14,509.35
|
|
|
MESH PHYSIOMESH OPEN 10*10CM
|
Facility
|
OP
|
$3,522.69
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.81 |
| Max. Negotiated Rate |
$3,381.78 |
| Rate for Payer: Aetna Commercial |
$2,712.47
|
| Rate for Payer: Anthem Medicaid |
$1,211.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,747.70
|
| Rate for Payer: Cash Price |
$1,761.34
|
| Rate for Payer: Cigna Commercial |
$2,923.83
|
| Rate for Payer: First Health Commercial |
$3,346.56
|
| Rate for Payer: Humana Commercial |
$2,994.29
|
| Rate for Payer: Humana KY Medicaid |
$1,211.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,223.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,888.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,599.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,235.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,099.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,642.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,818.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,064.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,430.66
|
| Rate for Payer: PHCS Commercial |
$3,381.78
|
| Rate for Payer: United Healthcare All Payer |
$3,099.97
|
|
|
MESH PHYSIOMESH OPEN 10*10CM
|
Facility
|
IP
|
$3,522.69
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.81 |
| Max. Negotiated Rate |
$3,381.78 |
| Rate for Payer: Aetna Commercial |
$2,712.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,747.70
|
| Rate for Payer: Cash Price |
$1,761.34
|
| Rate for Payer: Cigna Commercial |
$2,923.83
|
| Rate for Payer: First Health Commercial |
$3,346.56
|
| Rate for Payer: Humana Commercial |
$2,994.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,888.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,599.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,099.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,642.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,818.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,064.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,430.66
|
| Rate for Payer: PHCS Commercial |
$3,381.78
|
| Rate for Payer: United Healthcare All Payer |
$3,099.97
|
|
|
MESH PHYSIOMESH OPEN 15*20CM
|
Facility
|
IP
|
$7,237.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.30 |
| Max. Negotiated Rate |
$6,948.14 |
| Rate for Payer: Aetna Commercial |
$5,572.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,645.37
|
| Rate for Payer: Cash Price |
$3,618.82
|
| Rate for Payer: Cigna Commercial |
$6,007.25
|
| Rate for Payer: First Health Commercial |
$6,875.77
|
| Rate for Payer: Humana Commercial |
$6,152.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,934.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,341.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,369.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,428.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,790.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,296.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,993.98
|
| Rate for Payer: PHCS Commercial |
$6,948.14
|
| Rate for Payer: United Healthcare All Payer |
$6,369.13
|
|
|
MESH PHYSIOMESH OPEN 15*20CM
|
Facility
|
OP
|
$7,237.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.30 |
| Max. Negotiated Rate |
$6,948.14 |
| Rate for Payer: Aetna Commercial |
$5,572.99
|
| Rate for Payer: Anthem Medicaid |
$2,489.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,645.37
|
| Rate for Payer: Cash Price |
$3,618.82
|
| Rate for Payer: Cigna Commercial |
$6,007.25
|
| Rate for Payer: First Health Commercial |
$6,875.77
|
| Rate for Payer: Humana Commercial |
$6,152.00
|
| Rate for Payer: Humana KY Medicaid |
$2,489.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,514.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,934.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,341.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,538.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,369.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,428.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,790.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,296.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,993.98
|
| Rate for Payer: PHCS Commercial |
$6,948.14
|
| Rate for Payer: United Healthcare All Payer |
$6,369.13
|
|
|
MESH PHYSIOMESH OPEN 15*25CM
|
Facility
|
IP
|
$9,948.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.51 |
| Max. Negotiated Rate |
$9,550.43 |
| Rate for Payer: Aetna Commercial |
$7,660.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,759.72
|
| Rate for Payer: Cash Price |
$4,974.18
|
| Rate for Payer: Cigna Commercial |
$8,257.14
|
| Rate for Payer: First Health Commercial |
$9,450.94
|
| Rate for Payer: Humana Commercial |
$8,456.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,157.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,341.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,984.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,754.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,461.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,958.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,655.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,864.37
|
| Rate for Payer: PHCS Commercial |
$9,550.43
|
| Rate for Payer: United Healthcare All Payer |
$8,754.56
|
|
|
MESH PHYSIOMESH OPEN 15*25CM
|
Facility
|
OP
|
$9,948.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.51 |
| Max. Negotiated Rate |
$9,550.43 |
| Rate for Payer: Aetna Commercial |
$7,660.24
|
| Rate for Payer: Anthem Medicaid |
$3,421.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,759.72
|
| Rate for Payer: Cash Price |
$4,974.18
|
| Rate for Payer: Cigna Commercial |
$8,257.14
|
| Rate for Payer: First Health Commercial |
$9,450.94
|
| Rate for Payer: Humana Commercial |
$8,456.11
|
| Rate for Payer: Humana KY Medicaid |
$3,421.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,456.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,157.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,341.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,984.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,489.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,754.56
|
| Rate for Payer: Ohio Health Group HMO |
$7,461.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,958.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,655.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,864.37
|
| Rate for Payer: PHCS Commercial |
$9,550.43
|
| Rate for Payer: United Healthcare All Payer |
$8,754.56
|
|
|
MESH PHYSIOMESH OPEN 20*30CM
|
Facility
|
OP
|
$10,942.83
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,282.85 |
| Max. Negotiated Rate |
$10,505.12 |
| Rate for Payer: Aetna Commercial |
$8,425.98
|
| Rate for Payer: Anthem Medicaid |
$3,763.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,535.41
|
| Rate for Payer: Cash Price |
$5,471.42
|
| Rate for Payer: Cigna Commercial |
$9,082.55
|
| Rate for Payer: First Health Commercial |
$10,395.69
|
| Rate for Payer: Humana Commercial |
$9,301.41
|
| Rate for Payer: Humana KY Medicaid |
$3,763.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,801.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,973.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,075.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,282.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,838.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,629.69
|
| Rate for Payer: Ohio Health Group HMO |
$8,207.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,754.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,550.55
|
| Rate for Payer: PHCS Commercial |
$10,505.12
|
| Rate for Payer: United Healthcare All Payer |
$9,629.69
|
|
|
MESH PHYSIOMESH OPEN 20*30CM
|
Facility
|
IP
|
$10,942.83
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,282.85 |
| Max. Negotiated Rate |
$10,505.12 |
| Rate for Payer: Aetna Commercial |
$8,425.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,535.41
|
| Rate for Payer: Cash Price |
$5,471.42
|
| Rate for Payer: Cigna Commercial |
$9,082.55
|
| Rate for Payer: First Health Commercial |
$10,395.69
|
| Rate for Payer: Humana Commercial |
$9,301.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,973.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,075.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,282.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,629.69
|
| Rate for Payer: Ohio Health Group HMO |
$8,207.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,754.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,550.55
|
| Rate for Payer: PHCS Commercial |
$10,505.12
|
| Rate for Payer: United Healthcare All Payer |
$9,629.69
|
|
|
MESH PLUG ULTRAPRO COMFRT 40MM
|
Facility
|
OP
|
$2,014.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.38 |
| Max. Negotiated Rate |
$1,934.02 |
| Rate for Payer: Aetna Commercial |
$1,551.24
|
| Rate for Payer: Anthem Medicaid |
$692.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.39
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: Cigna Commercial |
$1,672.12
|
| Rate for Payer: First Health Commercial |
$1,913.87
|
| Rate for Payer: Humana Commercial |
$1,712.41
|
| Rate for Payer: Humana KY Medicaid |
$692.82
|
| Rate for Payer: Kentucky WC Medicaid |
$699.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.07
|
| Rate for Payer: PHCS Commercial |
$1,934.02
|
| Rate for Payer: United Healthcare All Payer |
$1,772.85
|
|
|
MESH PLUG ULTRAPRO COMFRT 40MM
|
Facility
|
IP
|
$2,014.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.38 |
| Max. Negotiated Rate |
$1,934.02 |
| Rate for Payer: Aetna Commercial |
$1,551.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.39
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: Cigna Commercial |
$1,672.12
|
| Rate for Payer: First Health Commercial |
$1,913.87
|
| Rate for Payer: Humana Commercial |
$1,712.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.07
|
| Rate for Payer: PHCS Commercial |
$1,934.02
|
| Rate for Payer: United Healthcare All Payer |
$1,772.85
|
|
|
MESH PLUG ULTRAPRO COMFRT 55MM
|
Facility
|
OP
|
$2,014.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.38 |
| Max. Negotiated Rate |
$1,934.02 |
| Rate for Payer: Aetna Commercial |
$1,551.24
|
| Rate for Payer: Anthem Medicaid |
$692.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.39
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: Cigna Commercial |
$1,672.12
|
| Rate for Payer: First Health Commercial |
$1,913.87
|
| Rate for Payer: Humana Commercial |
$1,712.41
|
| Rate for Payer: Humana KY Medicaid |
$692.82
|
| Rate for Payer: Kentucky WC Medicaid |
$699.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.07
|
| Rate for Payer: PHCS Commercial |
$1,934.02
|
| Rate for Payer: United Healthcare All Payer |
$1,772.85
|
|
|
MESH PLUG ULTRAPRO COMFRT 55MM
|
Facility
|
IP
|
$2,014.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.38 |
| Max. Negotiated Rate |
$1,934.02 |
| Rate for Payer: Aetna Commercial |
$1,551.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.39
|
| Rate for Payer: Cash Price |
$1,007.30
|
| Rate for Payer: Cigna Commercial |
$1,672.12
|
| Rate for Payer: First Health Commercial |
$1,913.87
|
| Rate for Payer: Humana Commercial |
$1,712.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.07
|
| Rate for Payer: PHCS Commercial |
$1,934.02
|
| Rate for Payer: United Healthcare All Payer |
$1,772.85
|
|
|
MESH PROCEED SURG 15*15CM
|
Facility
|
IP
|
$4,191.91
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.57 |
| Max. Negotiated Rate |
$4,024.23 |
| Rate for Payer: Aetna Commercial |
$3,227.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,269.69
|
| Rate for Payer: Cash Price |
$2,095.96
|
| Rate for Payer: Cigna Commercial |
$3,479.29
|
| Rate for Payer: First Health Commercial |
$3,982.31
|
| Rate for Payer: Humana Commercial |
$3,563.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,437.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,093.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,688.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,353.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,646.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.42
|
| Rate for Payer: PHCS Commercial |
$4,024.23
|
| Rate for Payer: United Healthcare All Payer |
$3,688.88
|
|
|
MESH PROCEED SURG 15*15CM
|
Facility
|
OP
|
$4,191.91
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.57 |
| Max. Negotiated Rate |
$4,024.23 |
| Rate for Payer: Aetna Commercial |
$3,227.77
|
| Rate for Payer: Anthem Medicaid |
$1,441.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,269.69
|
| Rate for Payer: Cash Price |
$2,095.96
|
| Rate for Payer: Cigna Commercial |
$3,479.29
|
| Rate for Payer: First Health Commercial |
$3,982.31
|
| Rate for Payer: Humana Commercial |
$3,563.12
|
| Rate for Payer: Humana KY Medicaid |
$1,441.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,456.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,437.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,093.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,470.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,688.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,353.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,646.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.42
|
| Rate for Payer: PHCS Commercial |
$4,024.23
|
| Rate for Payer: United Healthcare All Payer |
$3,688.88
|
|
|
MESH PROCEED SURG 26*34CM
|
Facility
|
IP
|
$12,848.92
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,854.68 |
| Max. Negotiated Rate |
$12,334.96 |
| Rate for Payer: Aetna Commercial |
$9,893.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,022.16
|
| Rate for Payer: Cash Price |
$6,424.46
|
| Rate for Payer: Cigna Commercial |
$10,664.60
|
| Rate for Payer: First Health Commercial |
$12,206.47
|
| Rate for Payer: Humana Commercial |
$10,921.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,536.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,482.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,854.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,307.05
|
| Rate for Payer: Ohio Health Group HMO |
$9,636.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,279.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,178.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,865.75
|
| Rate for Payer: PHCS Commercial |
$12,334.96
|
| Rate for Payer: United Healthcare All Payer |
$11,307.05
|
|
|
MESH PROCEED SURG 26*34CM
|
Facility
|
OP
|
$12,848.92
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,854.68 |
| Max. Negotiated Rate |
$12,334.96 |
| Rate for Payer: Aetna Commercial |
$9,893.67
|
| Rate for Payer: Anthem Medicaid |
$4,418.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,022.16
|
| Rate for Payer: Cash Price |
$6,424.46
|
| Rate for Payer: Cigna Commercial |
$10,664.60
|
| Rate for Payer: First Health Commercial |
$12,206.47
|
| Rate for Payer: Humana Commercial |
$10,921.58
|
| Rate for Payer: Humana KY Medicaid |
$4,418.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,463.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,536.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,482.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,854.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,507.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,307.05
|
| Rate for Payer: Ohio Health Group HMO |
$9,636.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,279.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,178.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,865.75
|
| Rate for Payer: PHCS Commercial |
$12,334.96
|
| Rate for Payer: United Healthcare All Payer |
$11,307.05
|
|
|
MESH PROGRIP FLATSHEET 10*15CM
|
Facility
|
IP
|
$3,627.41
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.22 |
| Max. Negotiated Rate |
$3,482.31 |
| Rate for Payer: Aetna Commercial |
$2,793.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.38
|
| Rate for Payer: Cash Price |
$1,813.70
|
| Rate for Payer: Cigna Commercial |
$3,010.75
|
| Rate for Payer: First Health Commercial |
$3,446.04
|
| Rate for Payer: Humana Commercial |
$3,083.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,901.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,155.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,502.91
|
| Rate for Payer: PHCS Commercial |
$3,482.31
|
| Rate for Payer: United Healthcare All Payer |
$3,192.12
|
|
