|
MESH PROGRIP FLATSHEET 10*15CM
|
Facility
|
OP
|
$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 Medicaid |
$1,247.47
|
| 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: Humana KY Medicaid |
$1,247.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.16
|
| 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: Molina Healthcare Medicaid |
$1,272.50
|
| 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
|
|
|
MESH PROLENE (2.5*10CM)1*4 PMX
|
Facility
|
OP
|
$1,575.26
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.58 |
| Max. Negotiated Rate |
$1,512.25 |
| Rate for Payer: Aetna Commercial |
$1,212.95
|
| Rate for Payer: Anthem Medicaid |
$541.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.70
|
| Rate for Payer: Cash Price |
$787.63
|
| Rate for Payer: Cigna Commercial |
$1,307.47
|
| Rate for Payer: First Health Commercial |
$1,496.50
|
| Rate for Payer: Humana Commercial |
$1,338.97
|
| Rate for Payer: Humana KY Medicaid |
$541.73
|
| Rate for Payer: Kentucky WC Medicaid |
$547.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,370.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.93
|
| Rate for Payer: PHCS Commercial |
$1,512.25
|
| Rate for Payer: United Healthcare All Payer |
$1,386.23
|
|
|
MESH PROLENE (2.5*10CM)1*4 PMX
|
Facility
|
IP
|
$1,575.26
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.58 |
| Max. Negotiated Rate |
$1,512.25 |
| Rate for Payer: Aetna Commercial |
$1,212.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.70
|
| Rate for Payer: Cash Price |
$787.63
|
| Rate for Payer: Cigna Commercial |
$1,307.47
|
| Rate for Payer: First Health Commercial |
$1,496.50
|
| Rate for Payer: Humana Commercial |
$1,338.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,370.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.93
|
| Rate for Payer: PHCS Commercial |
$1,512.25
|
| Rate for Payer: United Healthcare All Payer |
$1,386.23
|
|
|
MESH PROLENE(30*30CM)12*12 PML
|
Facility
|
IP
|
$3,046.91
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.07 |
| Max. Negotiated Rate |
$2,925.03 |
| Rate for Payer: Aetna Commercial |
$2,346.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,376.59
|
| Rate for Payer: Cash Price |
$1,523.46
|
| Rate for Payer: Cigna Commercial |
$2,528.94
|
| Rate for Payer: First Health Commercial |
$2,894.56
|
| Rate for Payer: Humana Commercial |
$2,589.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,498.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,248.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,681.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,285.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,437.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,650.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,102.37
|
| Rate for Payer: PHCS Commercial |
$2,925.03
|
| Rate for Payer: United Healthcare All Payer |
$2,681.28
|
|
|
MESH PROLENE(30*30CM)12*12 PML
|
Facility
|
OP
|
$3,046.91
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.07 |
| Max. Negotiated Rate |
$2,925.03 |
| Rate for Payer: Aetna Commercial |
$2,346.12
|
| Rate for Payer: Anthem Medicaid |
$1,047.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,376.59
|
| Rate for Payer: Cash Price |
$1,523.46
|
| Rate for Payer: Cigna Commercial |
$2,528.94
|
| Rate for Payer: First Health Commercial |
$2,894.56
|
| Rate for Payer: Humana Commercial |
$2,589.87
|
| Rate for Payer: Humana KY Medicaid |
$1,047.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,058.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,498.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,248.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,068.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,681.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,285.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,437.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,650.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,102.37
|
| Rate for Payer: PHCS Commercial |
$2,925.03
|
| Rate for Payer: United Healthcare All Payer |
$2,681.28
|
|
|
MESH PROLENE (4.6*10.2CM)1.8*4
|
Facility
|
OP
|
$1,839.95
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.99 |
| Max. Negotiated Rate |
$1,766.35 |
| Rate for Payer: Aetna Commercial |
$1,416.76
|
| Rate for Payer: Anthem Medicaid |
$632.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.16
|
| Rate for Payer: Cash Price |
$919.98
|
| Rate for Payer: Cigna Commercial |
$1,527.16
|
| Rate for Payer: First Health Commercial |
$1,747.95
|
| Rate for Payer: Humana Commercial |
$1,563.96
|
| Rate for Payer: Humana KY Medicaid |
$632.76
|
| Rate for Payer: Kentucky WC Medicaid |
$639.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.57
|
| Rate for Payer: PHCS Commercial |
$1,766.35
|
| Rate for Payer: United Healthcare All Payer |
$1,619.16
|
|
|
MESH PROLENE (4.6*10.2CM)1.8*4
|
Facility
|
IP
|
$1,839.95
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.99 |
| Max. Negotiated Rate |
$1,766.35 |
| Rate for Payer: Aetna Commercial |
$1,416.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.16
|
| Rate for Payer: Cash Price |
$919.98
|
| Rate for Payer: Cigna Commercial |
$1,527.16
|
| Rate for Payer: First Health Commercial |
$1,747.95
|
| Rate for Payer: Humana Commercial |
$1,563.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.57
|
| Rate for Payer: PHCS Commercial |
$1,766.35
|
| Rate for Payer: United Healthcare All Payer |
$1,619.16
|
|
|
MESH PROLENE(6.1*13.7C)2.4*5.4
|
Facility
|
IP
|
$1,965.32
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.60 |
| Max. Negotiated Rate |
$1,886.71 |
| Rate for Payer: Aetna Commercial |
$1,513.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.95
|
| Rate for Payer: Cash Price |
$982.66
|
| Rate for Payer: Cigna Commercial |
$1,631.22
|
| Rate for Payer: First Health Commercial |
$1,867.05
|
| Rate for Payer: Humana Commercial |
$1,670.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.07
|
| Rate for Payer: PHCS Commercial |
$1,886.71
|
| Rate for Payer: United Healthcare All Payer |
$1,729.48
|
|
|
MESH PROLENE(6.1*13.7C)2.4*5.4
|
Facility
|
OP
|
$1,965.32
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.60 |
| Max. Negotiated Rate |
$1,886.71 |
| Rate for Payer: Aetna Commercial |
$1,513.30
|
| Rate for Payer: Anthem Medicaid |
$675.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.95
|
| Rate for Payer: Cash Price |
$982.66
|
| Rate for Payer: Cigna Commercial |
$1,631.22
|
| Rate for Payer: First Health Commercial |
$1,867.05
|
| Rate for Payer: Humana Commercial |
$1,670.52
|
| Rate for Payer: Humana KY Medicaid |
$675.87
|
| Rate for Payer: Kentucky WC Medicaid |
$682.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.07
|
| Rate for Payer: PHCS Commercial |
$1,886.71
|
| Rate for Payer: United Healthcare All Payer |
$1,729.48
|
|
|
MESH PROLENE (7.6X15CM) 3*6
|
Facility
|
IP
|
$1,756.68
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.00 |
| Max. Negotiated Rate |
$1,686.41 |
| Rate for Payer: Aetna Commercial |
$1,352.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,370.21
|
| Rate for Payer: Cash Price |
$878.34
|
| Rate for Payer: Cigna Commercial |
$1,458.04
|
| Rate for Payer: First Health Commercial |
$1,668.85
|
| Rate for Payer: Humana Commercial |
$1,493.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,440.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,296.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.11
|
| Rate for Payer: PHCS Commercial |
$1,686.41
|
| Rate for Payer: United Healthcare All Payer |
$1,545.88
|
|
|
MESH PROLENE (7.6X15CM) 3*6
|
Facility
|
OP
|
$1,756.68
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.00 |
| Max. Negotiated Rate |
$1,686.41 |
| Rate for Payer: Aetna Commercial |
$1,352.64
|
| Rate for Payer: Anthem Medicaid |
$604.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,370.21
|
| Rate for Payer: Cash Price |
$878.34
|
| Rate for Payer: Cigna Commercial |
$1,458.04
|
| Rate for Payer: First Health Commercial |
$1,668.85
|
| Rate for Payer: Humana Commercial |
$1,493.18
|
| Rate for Payer: Humana KY Medicaid |
$604.12
|
| Rate for Payer: Kentucky WC Medicaid |
$610.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,440.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,296.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,405.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.11
|
| Rate for Payer: PHCS Commercial |
$1,686.41
|
| Rate for Payer: United Healthcare All Payer |
$1,545.88
|
|
|
MESH PROLITE ULTRA 6*6
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
MESH PROLITE ULTRA 6*6
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
MESH REVIZE COLLAGEN 4CM*16CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESH REVIZE COLLAGEN 4CM*16CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
MESH STRATTICE CONTUR 9*18.5CM
|
Facility
|
IP
|
$13,519.10
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,055.73 |
| Max. Negotiated Rate |
$12,978.34 |
| Rate for Payer: Aetna Commercial |
$10,409.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,544.90
|
| Rate for Payer: Cash Price |
$6,759.55
|
| Rate for Payer: Cigna Commercial |
$11,220.85
|
| Rate for Payer: First Health Commercial |
$12,843.15
|
| Rate for Payer: Humana Commercial |
$11,491.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,085.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,055.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,896.81
|
| Rate for Payer: Ohio Health Group HMO |
$10,139.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,815.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,761.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,328.18
|
| Rate for Payer: PHCS Commercial |
$12,978.34
|
| Rate for Payer: United Healthcare All Payer |
$11,896.81
|
|
|
MESH STRATTICE CONTUR 9*18.5CM
|
Facility
|
OP
|
$13,519.10
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,055.73 |
| Max. Negotiated Rate |
$12,978.34 |
| Rate for Payer: Aetna Commercial |
$10,409.71
|
| Rate for Payer: Anthem Medicaid |
$4,649.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,544.90
|
| Rate for Payer: Cash Price |
$6,759.55
|
| Rate for Payer: Cigna Commercial |
$11,220.85
|
| Rate for Payer: First Health Commercial |
$12,843.15
|
| Rate for Payer: Humana Commercial |
$11,491.24
|
| Rate for Payer: Humana KY Medicaid |
$4,649.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,085.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,055.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,896.81
|
| Rate for Payer: Ohio Health Group HMO |
$10,139.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,815.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,761.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,328.18
|
| Rate for Payer: PHCS Commercial |
$12,978.34
|
| Rate for Payer: United Healthcare All Payer |
$11,896.81
|
|
|
MESH STRATTICE FIRM 20*30CM
|
Facility
|
OP
|
$84,003.40
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25,201.02 |
| Max. Negotiated Rate |
$80,643.26 |
| Rate for Payer: Aetna Commercial |
$64,682.62
|
| Rate for Payer: Anthem Medicaid |
$28,888.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,522.65
|
| Rate for Payer: Cash Price |
$42,001.70
|
| Rate for Payer: Cigna Commercial |
$69,722.82
|
| Rate for Payer: First Health Commercial |
$79,803.23
|
| Rate for Payer: Humana Commercial |
$71,402.89
|
| Rate for Payer: Humana KY Medicaid |
$28,888.77
|
| Rate for Payer: Kentucky WC Medicaid |
$29,182.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,882.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,994.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,201.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,468.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,922.99
|
| Rate for Payer: Ohio Health Group HMO |
$63,002.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,202.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,082.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,962.35
|
| Rate for Payer: PHCS Commercial |
$80,643.26
|
| Rate for Payer: United Healthcare All Payer |
$73,922.99
|
|
|
MESH STRATTICE FIRM 20*30CM
|
Facility
|
IP
|
$84,003.40
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25,201.02 |
| Max. Negotiated Rate |
$80,643.26 |
| Rate for Payer: Aetna Commercial |
$64,682.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,522.65
|
| Rate for Payer: Cash Price |
$42,001.70
|
| Rate for Payer: Cigna Commercial |
$69,722.82
|
| Rate for Payer: First Health Commercial |
$79,803.23
|
| Rate for Payer: Humana Commercial |
$71,402.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,882.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,994.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,201.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,922.99
|
| Rate for Payer: Ohio Health Group HMO |
$63,002.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67,202.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73,082.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57,962.35
|
| Rate for Payer: PHCS Commercial |
$80,643.26
|
| Rate for Payer: United Healthcare All Payer |
$73,922.99
|
|
|
MESH STRATTICE PREFORATD 20*25
|
Facility
|
OP
|
$76,278.00
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,883.40 |
| Max. Negotiated Rate |
$73,226.88 |
| Rate for Payer: Aetna Commercial |
$58,734.06
|
| Rate for Payer: Anthem Medicaid |
$26,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,496.84
|
| Rate for Payer: Cash Price |
$38,139.00
|
| Rate for Payer: Cigna Commercial |
$63,310.74
|
| Rate for Payer: First Health Commercial |
$72,464.10
|
| Rate for Payer: Humana Commercial |
$64,836.30
|
| Rate for Payer: Humana KY Medicaid |
$26,232.00
|
| Rate for Payer: Kentucky WC Medicaid |
$26,498.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,547.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,293.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,883.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,758.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$57,208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,361.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,631.82
|
| Rate for Payer: PHCS Commercial |
$73,226.88
|
| Rate for Payer: United Healthcare All Payer |
$67,124.64
|
|
|
MESH STRATTICE PREFORATD 20*25
|
Facility
|
IP
|
$76,278.00
|
|
|
Service Code
|
HCPCS Q4130
|
| Hospital Charge Code |
27000079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22,883.40 |
| Max. Negotiated Rate |
$73,226.88 |
| Rate for Payer: Aetna Commercial |
$58,734.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,496.84
|
| Rate for Payer: Cash Price |
$38,139.00
|
| Rate for Payer: Cigna Commercial |
$63,310.74
|
| Rate for Payer: First Health Commercial |
$72,464.10
|
| Rate for Payer: Humana Commercial |
$64,836.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,547.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,293.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,883.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,124.64
|
| Rate for Payer: Ohio Health Group HMO |
$57,208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,022.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,361.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,631.82
|
| Rate for Payer: PHCS Commercial |
$73,226.88
|
| Rate for Payer: United Healthcare All Payer |
$67,124.64
|
|
|
MESH SURGIMND MP 16CM*20CM*3MM
|
Facility
|
IP
|
$27,800.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,340.00 |
| Max. Negotiated Rate |
$26,688.00 |
| Rate for Payer: Aetna Commercial |
$21,406.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,684.00
|
| Rate for Payer: Cash Price |
$13,900.00
|
| Rate for Payer: Cigna Commercial |
$23,074.00
|
| Rate for Payer: First Health Commercial |
$26,410.00
|
| Rate for Payer: Humana Commercial |
$23,630.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,796.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,516.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,340.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,186.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,182.00
|
| Rate for Payer: PHCS Commercial |
$26,688.00
|
| Rate for Payer: United Healthcare All Payer |
$24,464.00
|
|
|
MESH SURGIMND MP 16CM*20CM*3MM
|
Facility
|
OP
|
$27,800.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,340.00 |
| Max. Negotiated Rate |
$26,688.00 |
| Rate for Payer: Aetna Commercial |
$21,406.00
|
| Rate for Payer: Anthem Medicaid |
$9,560.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,684.00
|
| Rate for Payer: Cash Price |
$13,900.00
|
| Rate for Payer: Cigna Commercial |
$23,074.00
|
| Rate for Payer: First Health Commercial |
$26,410.00
|
| Rate for Payer: Humana Commercial |
$23,630.00
|
| Rate for Payer: Humana KY Medicaid |
$9,560.42
|
| Rate for Payer: Kentucky WC Medicaid |
$9,657.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,796.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,516.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,340.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,752.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,186.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,182.00
|
| Rate for Payer: PHCS Commercial |
$26,688.00
|
| Rate for Payer: United Healthcare All Payer |
$24,464.00
|
|
|
MESH SURGIMND MP 20CM*10CM*1MM
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
MESH SURGIMND MP 20CM*10CM*1MM
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
