|
MESH VENTRALIGHT ECHO PS
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
MESH VENTRALIGHT ECHO PS 10*13
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
MESH VENTRALIGHT ECHO PS 10*13
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
MESH VENTRALIGHT ECHO PS 4*6
|
Facility
|
OP
|
$4,191.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.34 |
| Max. Negotiated Rate |
$4,023.48 |
| Rate for Payer: Aetna Commercial |
$3,227.16
|
| Rate for Payer: Anthem Medicaid |
$1,441.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,269.07
|
| Rate for Payer: Cash Price |
$2,095.56
|
| Rate for Payer: Cigna Commercial |
$3,478.63
|
| Rate for Payer: First Health Commercial |
$3,981.56
|
| Rate for Payer: Humana Commercial |
$3,562.45
|
| Rate for Payer: Humana KY Medicaid |
$1,441.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,456.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,093.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,470.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,688.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,646.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.87
|
| Rate for Payer: PHCS Commercial |
$4,023.48
|
| Rate for Payer: United Healthcare All Payer |
$3,688.19
|
|
|
MESH VENTRALIGHT ECHO PS 4*6
|
Facility
|
IP
|
$4,191.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.34 |
| Max. Negotiated Rate |
$4,023.48 |
| Rate for Payer: Aetna Commercial |
$3,227.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,269.07
|
| Rate for Payer: Cash Price |
$2,095.56
|
| Rate for Payer: Cigna Commercial |
$3,478.63
|
| Rate for Payer: First Health Commercial |
$3,981.56
|
| Rate for Payer: Humana Commercial |
$3,562.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,093.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,688.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,646.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.87
|
| Rate for Payer: PHCS Commercial |
$4,023.48
|
| Rate for Payer: United Healthcare All Payer |
$3,688.19
|
|
|
MESH VENTRALIGHT ECHO PS 6*10
|
Facility
|
IP
|
$11,281.87
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,384.56 |
| Max. Negotiated Rate |
$10,830.60 |
| Rate for Payer: Aetna Commercial |
$8,687.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,799.86
|
| Rate for Payer: Cash Price |
$5,640.93
|
| Rate for Payer: Cigna Commercial |
$9,363.95
|
| Rate for Payer: First Health Commercial |
$10,717.78
|
| Rate for Payer: Humana Commercial |
$9,589.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,251.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,326.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,384.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,928.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,461.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,025.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,815.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,784.49
|
| Rate for Payer: PHCS Commercial |
$10,830.60
|
| Rate for Payer: United Healthcare All Payer |
$9,928.05
|
|
|
MESH VENTRALIGHT ECHO PS 6*10
|
Facility
|
OP
|
$11,281.87
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,384.56 |
| Max. Negotiated Rate |
$10,830.60 |
| Rate for Payer: Aetna Commercial |
$8,687.04
|
| Rate for Payer: Anthem Medicaid |
$3,879.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,799.86
|
| Rate for Payer: Cash Price |
$5,640.93
|
| Rate for Payer: Cigna Commercial |
$9,363.95
|
| Rate for Payer: First Health Commercial |
$10,717.78
|
| Rate for Payer: Humana Commercial |
$9,589.59
|
| Rate for Payer: Humana KY Medicaid |
$3,879.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,919.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,251.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,326.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,384.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,957.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,928.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,461.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,025.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,815.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,784.49
|
| Rate for Payer: PHCS Commercial |
$10,830.60
|
| Rate for Payer: United Healthcare All Payer |
$9,928.05
|
|
|
MESH VENTRALIGHT ECHO PS 6*8
|
Facility
|
IP
|
$7,176.33
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,152.90 |
| Max. Negotiated Rate |
$6,889.28 |
| Rate for Payer: Aetna Commercial |
$5,525.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,597.54
|
| Rate for Payer: Cash Price |
$3,588.16
|
| Rate for Payer: Cigna Commercial |
$5,956.35
|
| Rate for Payer: First Health Commercial |
$6,817.51
|
| Rate for Payer: Humana Commercial |
$6,099.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,884.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,296.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,315.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,382.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,741.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,243.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.67
|
| Rate for Payer: PHCS Commercial |
$6,889.28
|
| Rate for Payer: United Healthcare All Payer |
$6,315.17
|
|
|
MESH VENTRALIGHT ECHO PS 6*8
|
Facility
|
OP
|
$7,176.33
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,152.90 |
| Max. Negotiated Rate |
$6,889.28 |
| Rate for Payer: Aetna Commercial |
$5,525.77
|
| Rate for Payer: Anthem Medicaid |
$2,467.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,597.54
|
| Rate for Payer: Cash Price |
$3,588.16
|
| Rate for Payer: Cigna Commercial |
$5,956.35
|
| Rate for Payer: First Health Commercial |
$6,817.51
|
| Rate for Payer: Humana Commercial |
$6,099.88
|
| Rate for Payer: Humana KY Medicaid |
$2,467.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,493.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,884.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,296.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,517.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,315.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,382.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,741.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,243.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,951.67
|
| Rate for Payer: PHCS Commercial |
$6,889.28
|
| Rate for Payer: United Healthcare All Payer |
$6,315.17
|
|
|
MESH VENTRALIGHT ECHO PS 6 CIR
|
Facility
|
IP
|
$5,369.38
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.81 |
| Max. Negotiated Rate |
$5,154.60 |
| Rate for Payer: Aetna Commercial |
$4,134.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,188.12
|
| Rate for Payer: Cash Price |
$2,684.69
|
| Rate for Payer: Cigna Commercial |
$4,456.59
|
| Rate for Payer: First Health Commercial |
$5,100.91
|
| Rate for Payer: Humana Commercial |
$4,563.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,402.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,962.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,725.05
|
| Rate for Payer: Ohio Health Group HMO |
$4,027.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,295.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,671.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,704.87
|
| Rate for Payer: PHCS Commercial |
$5,154.60
|
| Rate for Payer: United Healthcare All Payer |
$4,725.05
|
|
|
MESH VENTRALIGHT ECHO PS 6 CIR
|
Facility
|
OP
|
$5,369.38
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.81 |
| Max. Negotiated Rate |
$5,154.60 |
| Rate for Payer: Aetna Commercial |
$4,134.42
|
| Rate for Payer: Anthem Medicaid |
$1,846.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,188.12
|
| Rate for Payer: Cash Price |
$2,684.69
|
| Rate for Payer: Cigna Commercial |
$4,456.59
|
| Rate for Payer: First Health Commercial |
$5,100.91
|
| Rate for Payer: Humana Commercial |
$4,563.97
|
| Rate for Payer: Humana KY Medicaid |
$1,846.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,865.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,402.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,962.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,883.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,725.05
|
| Rate for Payer: Ohio Health Group HMO |
$4,027.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,295.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,671.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,704.87
|
| Rate for Payer: PHCS Commercial |
$5,154.60
|
| Rate for Payer: United Healthcare All Payer |
$4,725.05
|
|
|
MESH VENTRALIGHT ECHO PS 7*9
|
Facility
|
IP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
MESH VENTRALIGHT ECHO PS 7*9
|
Facility
|
OP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem Medicaid |
$2,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Humana KY Medicaid |
$2,889.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,947.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
MESH VENTRALIGHT ECHO PS 8*10
|
Facility
|
IP
|
$9,474.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.42 |
| Max. Negotiated Rate |
$9,095.75 |
| Rate for Payer: Aetna Commercial |
$7,295.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,390.30
|
| Rate for Payer: Cash Price |
$4,737.37
|
| Rate for Payer: Cigna Commercial |
$7,864.03
|
| Rate for Payer: First Health Commercial |
$9,001.00
|
| Rate for Payer: Humana Commercial |
$8,053.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,769.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,992.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,842.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,337.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,106.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,579.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,243.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,537.57
|
| Rate for Payer: PHCS Commercial |
$9,095.75
|
| Rate for Payer: United Healthcare All Payer |
$8,337.77
|
|
|
MESH VENTRALIGHT ECHO PS 8*10
|
Facility
|
OP
|
$9,474.74
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,842.42 |
| Max. Negotiated Rate |
$9,095.75 |
| Rate for Payer: Aetna Commercial |
$7,295.55
|
| Rate for Payer: Anthem Medicaid |
$3,258.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,390.30
|
| Rate for Payer: Cash Price |
$4,737.37
|
| Rate for Payer: Cigna Commercial |
$7,864.03
|
| Rate for Payer: First Health Commercial |
$9,001.00
|
| Rate for Payer: Humana Commercial |
$8,053.53
|
| Rate for Payer: Humana KY Medicaid |
$3,258.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,291.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,769.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,992.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,842.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,323.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,337.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,106.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,579.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,243.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,537.57
|
| Rate for Payer: PHCS Commercial |
$9,095.75
|
| Rate for Payer: United Healthcare All Payer |
$8,337.77
|
|
|
MESH VENTRALIGHT ECHO PS 8 CIR
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
MESH VENTRALIGHT ECHO PS 8 CIR
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
MESH VENTRALIGHT ST 10*13
|
Facility
|
IP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
MESH VENTRALIGHT ST 10*13
|
Facility
|
OP
|
$13,592.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,077.75 |
| Max. Negotiated Rate |
$13,048.80 |
| Rate for Payer: Aetna Commercial |
$10,466.23
|
| Rate for Payer: Anthem Medicaid |
$4,674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,602.15
|
| Rate for Payer: Cash Price |
$6,796.25
|
| Rate for Payer: Cigna Commercial |
$11,281.77
|
| Rate for Payer: First Health Commercial |
$12,912.88
|
| Rate for Payer: Humana Commercial |
$11,553.62
|
| Rate for Payer: Humana KY Medicaid |
$4,674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,722.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,145.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,031.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,077.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,961.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,194.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,825.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,378.83
|
| Rate for Payer: PHCS Commercial |
$13,048.80
|
| Rate for Payer: United Healthcare All Payer |
$11,961.40
|
|
|
MESH VENTRALIGHT ST 4.5 CIR
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
MESH VENTRALIGHT ST 4.5 CIR
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
MESH VENTRALIGHT ST 4*6
|
Facility
|
IP
|
$3,912.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.75 |
| Max. Negotiated Rate |
$3,756.00 |
| Rate for Payer: Aetna Commercial |
$3,012.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.75
|
| Rate for Payer: Cash Price |
$1,956.25
|
| Rate for Payer: Cigna Commercial |
$3,247.38
|
| Rate for Payer: First Health Commercial |
$3,716.88
|
| Rate for Payer: Humana Commercial |
$3,325.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,208.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,443.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.62
|
| Rate for Payer: PHCS Commercial |
$3,756.00
|
| Rate for Payer: United Healthcare All Payer |
$3,443.00
|
|
|
MESH VENTRALIGHT ST 4*6
|
Facility
|
OP
|
$3,912.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.75 |
| Max. Negotiated Rate |
$3,756.00 |
| Rate for Payer: Aetna Commercial |
$3,012.62
|
| Rate for Payer: Anthem Medicaid |
$1,345.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.75
|
| Rate for Payer: Cash Price |
$1,956.25
|
| Rate for Payer: Cigna Commercial |
$3,247.38
|
| Rate for Payer: First Health Commercial |
$3,716.88
|
| Rate for Payer: Humana Commercial |
$3,325.62
|
| Rate for Payer: Humana KY Medicaid |
$1,345.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,208.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,443.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.62
|
| Rate for Payer: PHCS Commercial |
$3,756.00
|
| Rate for Payer: United Healthcare All Payer |
$3,443.00
|
|
|
MESH VENTRALIGHT ST 6*8
|
Facility
|
IP
|
$7,695.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,308.50 |
| Max. Negotiated Rate |
$7,387.20 |
| Rate for Payer: Aetna Commercial |
$5,925.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,002.10
|
| Rate for Payer: Cash Price |
$3,847.50
|
| Rate for Payer: Cigna Commercial |
$6,386.85
|
| Rate for Payer: First Health Commercial |
$7,310.25
|
| Rate for Payer: Humana Commercial |
$6,540.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,309.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,678.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,308.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,771.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,694.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,309.55
|
| Rate for Payer: PHCS Commercial |
$7,387.20
|
| Rate for Payer: United Healthcare All Payer |
$6,771.60
|
|
|
MESH VENTRALIGHT ST 6*8
|
Facility
|
OP
|
$7,695.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,308.50 |
| Max. Negotiated Rate |
$7,387.20 |
| Rate for Payer: Aetna Commercial |
$5,925.15
|
| Rate for Payer: Anthem Medicaid |
$2,646.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,002.10
|
| Rate for Payer: Cash Price |
$3,847.50
|
| Rate for Payer: Cigna Commercial |
$6,386.85
|
| Rate for Payer: First Health Commercial |
$7,310.25
|
| Rate for Payer: Humana Commercial |
$6,540.75
|
| Rate for Payer: Humana KY Medicaid |
$2,646.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,673.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,309.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,678.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,308.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,699.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,771.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,694.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,309.55
|
| Rate for Payer: PHCS Commercial |
$7,387.20
|
| Rate for Payer: United Healthcare All Payer |
$6,771.60
|
|
