|
MESH SURGIMND MP 20CM*20CM*2MM
|
Facility
|
OP
|
$35,000.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,500.00 |
| Max. Negotiated Rate |
$33,600.00 |
| Rate for Payer: Aetna Commercial |
$26,950.00
|
| Rate for Payer: Anthem Medicaid |
$12,036.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,300.00
|
| Rate for Payer: Cash Price |
$17,500.00
|
| Rate for Payer: Cigna Commercial |
$29,050.00
|
| Rate for Payer: First Health Commercial |
$33,250.00
|
| Rate for Payer: Humana Commercial |
$29,750.00
|
| Rate for Payer: Humana KY Medicaid |
$12,036.50
|
| Rate for Payer: Kentucky WC Medicaid |
$12,159.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,700.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,830.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,800.00
|
| Rate for Payer: Ohio Health Group HMO |
$26,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,450.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,150.00
|
| Rate for Payer: PHCS Commercial |
$33,600.00
|
| Rate for Payer: United Healthcare All Payer |
$30,800.00
|
|
|
MESH SURGIMND MP 20CM*20CM*2MM
|
Facility
|
IP
|
$35,000.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,500.00 |
| Max. Negotiated Rate |
$33,600.00 |
| Rate for Payer: Aetna Commercial |
$26,950.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,300.00
|
| Rate for Payer: Cash Price |
$17,500.00
|
| Rate for Payer: Cigna Commercial |
$29,050.00
|
| Rate for Payer: First Health Commercial |
$33,250.00
|
| Rate for Payer: Humana Commercial |
$29,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28,700.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,830.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,800.00
|
| Rate for Payer: Ohio Health Group HMO |
$26,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,450.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,150.00
|
| Rate for Payer: PHCS Commercial |
$33,600.00
|
| Rate for Payer: United Healthcare All Payer |
$30,800.00
|
|
|
MESH SURGIMND MP 20CM*20CM*3MM
|
Facility
|
OP
|
$36,500.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,950.00 |
| Max. Negotiated Rate |
$35,040.00 |
| Rate for Payer: Aetna Commercial |
$28,105.00
|
| Rate for Payer: Anthem Medicaid |
$12,552.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,470.00
|
| Rate for Payer: Cash Price |
$18,250.00
|
| Rate for Payer: Cigna Commercial |
$30,295.00
|
| Rate for Payer: First Health Commercial |
$34,675.00
|
| Rate for Payer: Humana Commercial |
$31,025.00
|
| Rate for Payer: Humana KY Medicaid |
$12,552.35
|
| Rate for Payer: Kentucky WC Medicaid |
$12,680.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,930.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,937.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,950.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,804.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,120.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,755.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,185.00
|
| Rate for Payer: PHCS Commercial |
$35,040.00
|
| Rate for Payer: United Healthcare All Payer |
$32,120.00
|
|
|
MESH SURGIMND MP 20CM*20CM*3MM
|
Facility
|
IP
|
$36,500.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,950.00 |
| Max. Negotiated Rate |
$35,040.00 |
| Rate for Payer: Aetna Commercial |
$28,105.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,470.00
|
| Rate for Payer: Cash Price |
$18,250.00
|
| Rate for Payer: Cigna Commercial |
$30,295.00
|
| Rate for Payer: First Health Commercial |
$34,675.00
|
| Rate for Payer: Humana Commercial |
$31,025.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,930.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,937.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,950.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,120.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31,755.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,185.00
|
| Rate for Payer: PHCS Commercial |
$35,040.00
|
| Rate for Payer: United Healthcare All Payer |
$32,120.00
|
|
|
MESH SURGIMND MP 20CM*25CM*2M
|
Facility
|
OP
|
$33,500.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,050.00 |
| Max. Negotiated Rate |
$32,160.00 |
| Rate for Payer: Aetna Commercial |
$25,795.00
|
| Rate for Payer: Anthem Medicaid |
$11,520.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,130.00
|
| Rate for Payer: Cash Price |
$16,750.00
|
| Rate for Payer: Cigna Commercial |
$27,805.00
|
| Rate for Payer: First Health Commercial |
$31,825.00
|
| Rate for Payer: Humana Commercial |
$28,475.00
|
| Rate for Payer: Humana KY Medicaid |
$11,520.65
|
| Rate for Payer: Kentucky WC Medicaid |
$11,637.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,470.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,723.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,751.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,480.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,145.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,115.00
|
| Rate for Payer: PHCS Commercial |
$32,160.00
|
| Rate for Payer: United Healthcare All Payer |
$29,480.00
|
|
|
MESH SURGIMND MP 20CM*25CM*2M
|
Facility
|
IP
|
$33,500.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
27000075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,050.00 |
| Max. Negotiated Rate |
$32,160.00 |
| Rate for Payer: Aetna Commercial |
$25,795.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,130.00
|
| Rate for Payer: Cash Price |
$16,750.00
|
| Rate for Payer: Cigna Commercial |
$27,805.00
|
| Rate for Payer: First Health Commercial |
$31,825.00
|
| Rate for Payer: Humana Commercial |
$28,475.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,470.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,723.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,480.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,145.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,115.00
|
| Rate for Payer: PHCS Commercial |
$32,160.00
|
| Rate for Payer: United Healthcare All Payer |
$29,480.00
|
|
|
MESH SURGIMND MP 20CM*30CM*2MM
|
Facility
|
IP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
MESH SURGIMND MP 20CM*30CM*2MM
|
Facility
|
OP
|
$75,100.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,530.00 |
| Max. Negotiated Rate |
$72,096.00 |
| Rate for Payer: Aetna Commercial |
$57,827.00
|
| Rate for Payer: Anthem Medicaid |
$25,826.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,578.00
|
| Rate for Payer: Cash Price |
$37,550.00
|
| Rate for Payer: Cigna Commercial |
$62,333.00
|
| Rate for Payer: First Health Commercial |
$71,345.00
|
| Rate for Payer: Humana Commercial |
$63,835.00
|
| Rate for Payer: Humana KY Medicaid |
$25,826.89
|
| Rate for Payer: Kentucky WC Medicaid |
$26,089.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,582.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,423.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,530.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,345.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,088.00
|
| Rate for Payer: Ohio Health Group HMO |
$56,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,337.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,819.00
|
| Rate for Payer: PHCS Commercial |
$72,096.00
|
| Rate for Payer: United Healthcare All Payer |
$66,088.00
|
|
|
MESH SURGIMND MP 20CM*30CM*3MM
|
Facility
|
IP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
MESH SURGIMND MP 20CM*30CM*3MM
|
Facility
|
OP
|
$72,820.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,846.00 |
| Max. Negotiated Rate |
$69,907.20 |
| Rate for Payer: Aetna Commercial |
$56,071.40
|
| Rate for Payer: Anthem Medicaid |
$25,042.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,799.60
|
| Rate for Payer: Cash Price |
$36,410.00
|
| Rate for Payer: Cigna Commercial |
$60,440.60
|
| Rate for Payer: First Health Commercial |
$69,179.00
|
| Rate for Payer: Humana Commercial |
$61,897.00
|
| Rate for Payer: Humana KY Medicaid |
$25,042.80
|
| Rate for Payer: Kentucky WC Medicaid |
$25,297.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,712.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,741.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,846.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,545.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,081.60
|
| Rate for Payer: Ohio Health Group HMO |
$54,615.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,353.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50,245.80
|
| Rate for Payer: PHCS Commercial |
$69,907.20
|
| Rate for Payer: United Healthcare All Payer |
$64,081.60
|
|
|
MESH ULTRA PRO 3*6
|
Facility
|
IP
|
$2,072.96
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.89 |
| Max. Negotiated Rate |
$1,990.04 |
| Rate for Payer: Aetna Commercial |
$1,596.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,616.91
|
| Rate for Payer: Cash Price |
$1,036.48
|
| Rate for Payer: Cigna Commercial |
$1,720.56
|
| Rate for Payer: First Health Commercial |
$1,969.31
|
| Rate for Payer: Humana Commercial |
$1,762.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,699.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,529.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,824.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,554.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,803.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.34
|
| Rate for Payer: PHCS Commercial |
$1,990.04
|
| Rate for Payer: United Healthcare All Payer |
$1,824.20
|
|
|
MESH ULTRA PRO 3*6
|
Facility
|
OP
|
$2,072.96
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.89 |
| Max. Negotiated Rate |
$1,990.04 |
| Rate for Payer: Aetna Commercial |
$1,596.18
|
| Rate for Payer: Anthem Medicaid |
$712.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,616.91
|
| Rate for Payer: Cash Price |
$1,036.48
|
| Rate for Payer: Cigna Commercial |
$1,720.56
|
| Rate for Payer: First Health Commercial |
$1,969.31
|
| Rate for Payer: Humana Commercial |
$1,762.02
|
| Rate for Payer: Humana KY Medicaid |
$712.89
|
| Rate for Payer: Kentucky WC Medicaid |
$720.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,699.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,529.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,824.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,554.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,658.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,803.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.34
|
| Rate for Payer: PHCS Commercial |
$1,990.04
|
| Rate for Payer: United Healthcare All Payer |
$1,824.20
|
|
|
MESH ULTRA PRO 6*6
|
Facility
|
OP
|
$2,990.44
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.13 |
| Max. Negotiated Rate |
$2,870.82 |
| Rate for Payer: Aetna Commercial |
$2,302.64
|
| Rate for Payer: Anthem Medicaid |
$1,028.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.54
|
| Rate for Payer: Cash Price |
$1,495.22
|
| Rate for Payer: Cigna Commercial |
$2,482.07
|
| Rate for Payer: First Health Commercial |
$2,840.92
|
| Rate for Payer: Humana Commercial |
$2,541.87
|
| Rate for Payer: Humana KY Medicaid |
$1,028.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,049.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.40
|
| Rate for Payer: PHCS Commercial |
$2,870.82
|
| Rate for Payer: United Healthcare All Payer |
$2,631.59
|
|
|
MESH ULTRA PRO 6*6
|
Facility
|
IP
|
$2,990.44
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.13 |
| Max. Negotiated Rate |
$2,870.82 |
| Rate for Payer: Aetna Commercial |
$2,302.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,332.54
|
| Rate for Payer: Cash Price |
$1,495.22
|
| Rate for Payer: Cigna Commercial |
$2,482.07
|
| Rate for Payer: First Health Commercial |
$2,840.92
|
| Rate for Payer: Humana Commercial |
$2,541.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,631.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,601.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,063.40
|
| Rate for Payer: PHCS Commercial |
$2,870.82
|
| Rate for Payer: United Healthcare All Payer |
$2,631.59
|
|
|
MESH ULTRAPRO ADVANCED 10*15CM
|
Facility
|
OP
|
$1,744.55
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.37 |
| Max. Negotiated Rate |
$1,674.77 |
| Rate for Payer: Aetna Commercial |
$1,343.30
|
| Rate for Payer: Anthem Medicaid |
$599.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.75
|
| Rate for Payer: Cash Price |
$872.27
|
| Rate for Payer: Cigna Commercial |
$1,447.98
|
| Rate for Payer: First Health Commercial |
$1,657.32
|
| Rate for Payer: Humana Commercial |
$1,482.87
|
| Rate for Payer: Humana KY Medicaid |
$599.95
|
| Rate for Payer: Kentucky WC Medicaid |
$606.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,535.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.74
|
| Rate for Payer: PHCS Commercial |
$1,674.77
|
| Rate for Payer: United Healthcare All Payer |
$1,535.20
|
|
|
MESH ULTRAPRO ADVANCED 10*15CM
|
Facility
|
IP
|
$1,744.55
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.37 |
| Max. Negotiated Rate |
$1,674.77 |
| Rate for Payer: Aetna Commercial |
$1,343.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.75
|
| Rate for Payer: Cash Price |
$872.27
|
| Rate for Payer: Cigna Commercial |
$1,447.98
|
| Rate for Payer: First Health Commercial |
$1,657.32
|
| Rate for Payer: Humana Commercial |
$1,482.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,535.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.74
|
| Rate for Payer: PHCS Commercial |
$1,674.77
|
| Rate for Payer: United Healthcare All Payer |
$1,535.20
|
|
|
MESH ULTRAPRO ADVANCED 15*15CM
|
Facility
|
IP
|
$1,787.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.28 |
| Max. Negotiated Rate |
$1,716.10 |
| Rate for Payer: Aetna Commercial |
$1,376.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.33
|
| Rate for Payer: Cash Price |
$893.80
|
| Rate for Payer: Cigna Commercial |
$1,483.71
|
| Rate for Payer: First Health Commercial |
$1,698.22
|
| Rate for Payer: Humana Commercial |
$1,519.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.44
|
| Rate for Payer: PHCS Commercial |
$1,716.10
|
| Rate for Payer: United Healthcare All Payer |
$1,573.09
|
|
|
MESH ULTRAPRO ADVANCED 15*15CM
|
Facility
|
OP
|
$1,787.60
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.28 |
| Max. Negotiated Rate |
$1,716.10 |
| Rate for Payer: Aetna Commercial |
$1,376.45
|
| Rate for Payer: Anthem Medicaid |
$614.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.33
|
| Rate for Payer: Cash Price |
$893.80
|
| Rate for Payer: Cigna Commercial |
$1,483.71
|
| Rate for Payer: First Health Commercial |
$1,698.22
|
| Rate for Payer: Humana Commercial |
$1,519.46
|
| Rate for Payer: Humana KY Medicaid |
$614.76
|
| Rate for Payer: Kentucky WC Medicaid |
$621.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.44
|
| Rate for Payer: PHCS Commercial |
$1,716.10
|
| Rate for Payer: United Healthcare All Payer |
$1,573.09
|
|
|
MESH VENTRALEX ST HERNIA LRG C
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.00 |
| Max. Negotiated Rate |
$4,224.00 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem Medicaid |
$1,513.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Humana KY Medicaid |
$1,513.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,528.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,320.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,543.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,828.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,036.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
|
MESH VENTRALEX ST HERNIA LRG C
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.00 |
| Max. Negotiated Rate |
$4,224.00 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,828.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,036.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
|
MESH VENTRALEX ST HERNIA MED C
|
Facility
|
OP
|
$3,794.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$3,642.24 |
| Rate for Payer: Aetna Commercial |
$2,921.38
|
| Rate for Payer: Anthem Medicaid |
$1,304.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,959.32
|
| Rate for Payer: Cash Price |
$1,897.00
|
| Rate for Payer: Cigna Commercial |
$3,149.02
|
| Rate for Payer: First Health Commercial |
$3,604.30
|
| Rate for Payer: Humana Commercial |
$3,224.90
|
| Rate for Payer: Humana KY Medicaid |
$1,304.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,318.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,111.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,799.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,138.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,330.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,338.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,845.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,035.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,300.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,617.86
|
| Rate for Payer: PHCS Commercial |
$3,642.24
|
| Rate for Payer: United Healthcare All Payer |
$3,338.72
|
|
|
MESH VENTRALEX ST HERNIA MED C
|
Facility
|
IP
|
$3,794.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.20 |
| Max. Negotiated Rate |
$3,642.24 |
| Rate for Payer: Aetna Commercial |
$2,921.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,959.32
|
| Rate for Payer: Cash Price |
$1,897.00
|
| Rate for Payer: Cigna Commercial |
$3,149.02
|
| Rate for Payer: First Health Commercial |
$3,604.30
|
| Rate for Payer: Humana Commercial |
$3,224.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,111.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,799.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,138.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,338.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,845.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,035.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,300.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,617.86
|
| Rate for Payer: PHCS Commercial |
$3,642.24
|
| Rate for Payer: United Healthcare All Payer |
$3,338.72
|
|
|
MESH VENTRALEX ST HERNIA SM CI
|
Facility
|
IP
|
$3,482.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.60 |
| Max. Negotiated Rate |
$3,342.72 |
| Rate for Payer: Aetna Commercial |
$2,681.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.96
|
| Rate for Payer: Cash Price |
$1,741.00
|
| Rate for Payer: Cigna Commercial |
$2,890.06
|
| Rate for Payer: First Health Commercial |
$3,307.90
|
| Rate for Payer: Humana Commercial |
$2,959.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,855.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,064.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,611.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,029.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.58
|
| Rate for Payer: PHCS Commercial |
$3,342.72
|
| Rate for Payer: United Healthcare All Payer |
$3,064.16
|
|
|
MESH VENTRALEX ST HERNIA SM CI
|
Facility
|
OP
|
$3,482.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.60 |
| Max. Negotiated Rate |
$3,342.72 |
| Rate for Payer: Aetna Commercial |
$2,681.14
|
| Rate for Payer: Anthem Medicaid |
$1,197.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.96
|
| Rate for Payer: Cash Price |
$1,741.00
|
| Rate for Payer: Cigna Commercial |
$2,890.06
|
| Rate for Payer: First Health Commercial |
$3,307.90
|
| Rate for Payer: Humana Commercial |
$2,959.70
|
| Rate for Payer: Humana KY Medicaid |
$1,197.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,855.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,064.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,611.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,029.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.58
|
| Rate for Payer: PHCS Commercial |
$3,342.72
|
| Rate for Payer: United Healthcare All Payer |
$3,064.16
|
|
|
MESH VENTRALIGHT ECHO PS
|
Facility
|
OP
|
$4,445.38
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.61 |
| Max. Negotiated Rate |
$4,267.56 |
| Rate for Payer: Aetna Commercial |
$3,422.94
|
| Rate for Payer: Anthem Medicaid |
$1,528.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.40
|
| Rate for Payer: Cash Price |
$2,222.69
|
| Rate for Payer: Cigna Commercial |
$3,689.67
|
| Rate for Payer: First Health Commercial |
$4,223.11
|
| Rate for Payer: Humana Commercial |
$3,778.57
|
| Rate for Payer: Humana KY Medicaid |
$1,528.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,544.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,645.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,559.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,334.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,556.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,867.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.31
|
| Rate for Payer: PHCS Commercial |
$4,267.56
|
| Rate for Payer: United Healthcare All Payer |
$3,911.93
|
|
