|
MESH VENTRALIGHT W/ECHO 15CM
|
Facility
|
OP
|
$5,688.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,706.66 |
| Max. Negotiated Rate |
$5,461.32 |
| Rate for Payer: Aetna Commercial |
$4,380.44
|
| Rate for Payer: Anthem Medicaid |
$1,956.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.33
|
| Rate for Payer: Cash Price |
$2,844.44
|
| Rate for Payer: Cigna Commercial |
$4,721.77
|
| Rate for Payer: First Health Commercial |
$5,404.44
|
| Rate for Payer: Humana Commercial |
$4,835.55
|
| Rate for Payer: Humana KY Medicaid |
$1,956.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,976.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,664.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,198.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,995.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,006.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,266.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,551.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,949.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.33
|
| Rate for Payer: PHCS Commercial |
$5,461.32
|
| Rate for Payer: United Healthcare All Payer |
$5,006.21
|
|
|
MESH VENTRALIGHT W/ECHO 15CM
|
Facility
|
IP
|
$5,688.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,706.66 |
| Max. Negotiated Rate |
$5,461.32 |
| Rate for Payer: Aetna Commercial |
$4,380.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.33
|
| Rate for Payer: Cash Price |
$2,844.44
|
| Rate for Payer: Cigna Commercial |
$4,721.77
|
| Rate for Payer: First Health Commercial |
$5,404.44
|
| Rate for Payer: Humana Commercial |
$4,835.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,664.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,198.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,006.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,266.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,551.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,949.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.33
|
| Rate for Payer: PHCS Commercial |
$5,461.32
|
| Rate for Payer: United Healthcare All Payer |
$5,006.21
|
|
|
MESH VENTRIO ST HERNIA 3.1*4.7
|
Facility
|
IP
|
$4,364.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.42 |
| Max. Negotiated Rate |
$4,190.16 |
| Rate for Payer: Aetna Commercial |
$3,360.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,404.51
|
| Rate for Payer: Cash Price |
$2,182.38
|
| Rate for Payer: Cigna Commercial |
$3,622.74
|
| Rate for Payer: First Health Commercial |
$4,146.51
|
| Rate for Payer: Humana Commercial |
$3,710.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,840.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,491.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,797.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,011.68
|
| Rate for Payer: PHCS Commercial |
$4,190.16
|
| Rate for Payer: United Healthcare All Payer |
$3,840.98
|
|
|
MESH VENTRIO ST HERNIA 3.1*4.7
|
Facility
|
OP
|
$4,364.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.42 |
| Max. Negotiated Rate |
$4,190.16 |
| Rate for Payer: Aetna Commercial |
$3,360.86
|
| Rate for Payer: Anthem Medicaid |
$1,501.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,404.51
|
| Rate for Payer: Cash Price |
$2,182.38
|
| Rate for Payer: Cigna Commercial |
$3,622.74
|
| Rate for Payer: First Health Commercial |
$4,146.51
|
| Rate for Payer: Humana Commercial |
$3,710.04
|
| Rate for Payer: Humana KY Medicaid |
$1,501.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,516.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,531.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,840.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,273.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,491.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,797.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,011.68
|
| Rate for Payer: PHCS Commercial |
$4,190.16
|
| Rate for Payer: United Healthcare All Payer |
$3,840.98
|
|
|
MESH VENTRIO ST HERNIA 5.4*7.0
|
Facility
|
OP
|
$7,433.66
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.10 |
| Max. Negotiated Rate |
$7,136.31 |
| Rate for Payer: Aetna Commercial |
$5,723.92
|
| Rate for Payer: Anthem Medicaid |
$2,556.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,798.25
|
| Rate for Payer: Cash Price |
$3,716.83
|
| Rate for Payer: Cigna Commercial |
$6,169.94
|
| Rate for Payer: First Health Commercial |
$7,061.98
|
| Rate for Payer: Humana Commercial |
$6,318.61
|
| Rate for Payer: Humana KY Medicaid |
$2,556.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,582.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,095.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,486.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,230.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,607.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,541.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,575.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,946.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,467.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,129.23
|
| Rate for Payer: PHCS Commercial |
$7,136.31
|
| Rate for Payer: United Healthcare All Payer |
$6,541.62
|
|
|
MESH VENTRIO ST HERNIA 5.4*7.0
|
Facility
|
IP
|
$7,433.66
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.10 |
| Max. Negotiated Rate |
$7,136.31 |
| Rate for Payer: Aetna Commercial |
$5,723.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,798.25
|
| Rate for Payer: Cash Price |
$3,716.83
|
| Rate for Payer: Cigna Commercial |
$6,169.94
|
| Rate for Payer: First Health Commercial |
$7,061.98
|
| Rate for Payer: Humana Commercial |
$6,318.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,095.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,486.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,230.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,541.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,575.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,946.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,467.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,129.23
|
| Rate for Payer: PHCS Commercial |
$7,136.31
|
| Rate for Payer: United Healthcare All Payer |
$6,541.62
|
|
|
MESH VENTRIO ST HERNIA 6.1*10.
|
Facility
|
IP
|
$9,885.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.61 |
| Max. Negotiated Rate |
$9,489.95 |
| Rate for Payer: Aetna Commercial |
$7,611.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.58
|
| Rate for Payer: Cash Price |
$4,942.68
|
| Rate for Payer: Cigna Commercial |
$8,204.85
|
| Rate for Payer: First Health Commercial |
$9,391.09
|
| Rate for Payer: Humana Commercial |
$8,402.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.12
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,820.90
|
| Rate for Payer: PHCS Commercial |
$9,489.95
|
| Rate for Payer: United Healthcare All Payer |
$8,699.12
|
|
|
MESH VENTRIO ST HERNIA 6.1*10.
|
Facility
|
OP
|
$9,885.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.61 |
| Max. Negotiated Rate |
$9,489.95 |
| Rate for Payer: Aetna Commercial |
$7,611.73
|
| Rate for Payer: Anthem Medicaid |
$3,399.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.58
|
| Rate for Payer: Cash Price |
$4,942.68
|
| Rate for Payer: Cigna Commercial |
$8,204.85
|
| Rate for Payer: First Health Commercial |
$9,391.09
|
| Rate for Payer: Humana Commercial |
$8,402.56
|
| Rate for Payer: Humana KY Medicaid |
$3,399.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.12
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,820.90
|
| Rate for Payer: PHCS Commercial |
$9,489.95
|
| Rate for Payer: United Healthcare All Payer |
$8,699.12
|
|
|
MESH VENTRIO ST HRNIA 8.7*10.7
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
MESH VENTRIO ST HRNIA 8.7*10.7
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
MESH VENTRO ST HRNIA 10.8*13.7
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
MESH VENTRO ST HRNIA 10.8*13.7
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
MESH VICRYL KNITTED 12*12
|
Facility
|
OP
|
$7,043.99
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,113.20 |
| Max. Negotiated Rate |
$6,762.23 |
| Rate for Payer: Aetna Commercial |
$5,423.87
|
| Rate for Payer: Anthem Medicaid |
$2,422.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,494.31
|
| Rate for Payer: Cash Price |
$3,522.00
|
| Rate for Payer: Cigna Commercial |
$5,846.51
|
| Rate for Payer: First Health Commercial |
$6,691.79
|
| Rate for Payer: Humana Commercial |
$5,987.39
|
| Rate for Payer: Humana KY Medicaid |
$2,422.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,447.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,776.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,198.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,471.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,198.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,635.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,128.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,860.35
|
| Rate for Payer: PHCS Commercial |
$6,762.23
|
| Rate for Payer: United Healthcare All Payer |
$6,198.71
|
|
|
MESH VICRYL KNITTED 12*12
|
Facility
|
IP
|
$7,043.99
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,113.20 |
| Max. Negotiated Rate |
$6,762.23 |
| Rate for Payer: Aetna Commercial |
$5,423.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,494.31
|
| Rate for Payer: Cash Price |
$3,522.00
|
| Rate for Payer: Cigna Commercial |
$5,846.51
|
| Rate for Payer: First Health Commercial |
$6,691.79
|
| Rate for Payer: Humana Commercial |
$5,987.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,776.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,198.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,198.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,635.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,128.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,860.35
|
| Rate for Payer: PHCS Commercial |
$6,762.23
|
| Rate for Payer: United Healthcare All Payer |
$6,198.71
|
|
|
MESH VICRYL KNITTED 6*6
|
Facility
|
OP
|
$3,787.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.21 |
| Max. Negotiated Rate |
$3,635.87 |
| Rate for Payer: Aetna Commercial |
$2,916.27
|
| Rate for Payer: Anthem Medicaid |
$1,302.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,954.14
|
| Rate for Payer: Cash Price |
$1,893.68
|
| Rate for Payer: Cigna Commercial |
$3,143.51
|
| Rate for Payer: First Health Commercial |
$3,597.99
|
| Rate for Payer: Humana Commercial |
$3,219.26
|
| Rate for Payer: Humana KY Medicaid |
$1,302.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,315.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,105.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,795.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,328.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,332.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,840.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,295.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,613.28
|
| Rate for Payer: PHCS Commercial |
$3,635.87
|
| Rate for Payer: United Healthcare All Payer |
$3,332.88
|
|
|
MESH VICRYL KNITTED 6*6
|
Facility
|
IP
|
$3,787.36
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.21 |
| Max. Negotiated Rate |
$3,635.87 |
| Rate for Payer: Aetna Commercial |
$2,916.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,954.14
|
| Rate for Payer: Cash Price |
$1,893.68
|
| Rate for Payer: Cigna Commercial |
$3,143.51
|
| Rate for Payer: First Health Commercial |
$3,597.99
|
| Rate for Payer: Humana Commercial |
$3,219.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,105.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,795.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,332.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,840.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,295.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,613.28
|
| Rate for Payer: PHCS Commercial |
$3,635.87
|
| Rate for Payer: United Healthcare All Payer |
$3,332.88
|
|
|
MESH XENMATRIX 10*15CM
|
Facility
|
IP
|
$22,293.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,688.16 |
| Max. Negotiated Rate |
$21,402.12 |
| Rate for Payer: Aetna Commercial |
$17,166.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,389.23
|
| Rate for Payer: Cash Price |
$11,146.94
|
| Rate for Payer: Cigna Commercial |
$18,503.92
|
| Rate for Payer: First Health Commercial |
$21,179.19
|
| Rate for Payer: Humana Commercial |
$18,949.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,280.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,452.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,688.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,618.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,720.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,835.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,395.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,382.78
|
| Rate for Payer: PHCS Commercial |
$21,402.12
|
| Rate for Payer: United Healthcare All Payer |
$19,618.61
|
|
|
MESH XENMATRIX 10*15CM
|
Facility
|
OP
|
$22,293.88
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,688.16 |
| Max. Negotiated Rate |
$21,402.12 |
| Rate for Payer: Aetna Commercial |
$17,166.29
|
| Rate for Payer: Anthem Medicaid |
$7,666.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,389.23
|
| Rate for Payer: Cash Price |
$11,146.94
|
| Rate for Payer: Cigna Commercial |
$18,503.92
|
| Rate for Payer: First Health Commercial |
$21,179.19
|
| Rate for Payer: Humana Commercial |
$18,949.80
|
| Rate for Payer: Humana KY Medicaid |
$7,666.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7,744.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,280.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,452.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,688.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,820.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,618.61
|
| Rate for Payer: Ohio Health Group HMO |
$16,720.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,835.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,395.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,382.78
|
| Rate for Payer: PHCS Commercial |
$21,402.12
|
| Rate for Payer: United Healthcare All Payer |
$19,618.61
|
|
|
MESH XENMATRIX 15*20CM
|
Facility
|
OP
|
$35,510.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,653.00 |
| Max. Negotiated Rate |
$34,089.60 |
| Rate for Payer: Aetna Commercial |
$27,342.70
|
| Rate for Payer: Anthem Medicaid |
$12,211.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,697.80
|
| Rate for Payer: Cash Price |
$17,755.00
|
| Rate for Payer: Cigna Commercial |
$29,473.30
|
| Rate for Payer: First Health Commercial |
$33,734.50
|
| Rate for Payer: Humana Commercial |
$30,183.50
|
| Rate for Payer: Humana KY Medicaid |
$12,211.89
|
| Rate for Payer: Kentucky WC Medicaid |
$12,336.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,118.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,206.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,653.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,456.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,248.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,632.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,893.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,501.90
|
| Rate for Payer: PHCS Commercial |
$34,089.60
|
| Rate for Payer: United Healthcare All Payer |
$31,248.80
|
|
|
MESH XENMATRIX 15*20CM
|
Facility
|
IP
|
$35,510.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,653.00 |
| Max. Negotiated Rate |
$34,089.60 |
| Rate for Payer: Aetna Commercial |
$27,342.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,697.80
|
| Rate for Payer: Cash Price |
$17,755.00
|
| Rate for Payer: Cigna Commercial |
$29,473.30
|
| Rate for Payer: First Health Commercial |
$33,734.50
|
| Rate for Payer: Humana Commercial |
$30,183.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,118.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,206.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,653.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,248.80
|
| Rate for Payer: Ohio Health Group HMO |
$26,632.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30,893.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,501.90
|
| Rate for Payer: PHCS Commercial |
$34,089.60
|
| Rate for Payer: United Healthcare All Payer |
$31,248.80
|
|
|
MESH XENMATRIX 19*35CM
|
Facility
|
IP
|
$97,729.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,318.70 |
| Max. Negotiated Rate |
$93,819.84 |
| Rate for Payer: Aetna Commercial |
$75,251.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,228.62
|
| Rate for Payer: Cash Price |
$48,864.50
|
| Rate for Payer: Cigna Commercial |
$81,115.07
|
| Rate for Payer: First Health Commercial |
$92,842.55
|
| Rate for Payer: Humana Commercial |
$83,069.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,137.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,124.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,318.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,001.52
|
| Rate for Payer: Ohio Health Group HMO |
$73,296.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,024.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,433.01
|
| Rate for Payer: PHCS Commercial |
$93,819.84
|
| Rate for Payer: United Healthcare All Payer |
$86,001.52
|
|
|
MESH XENMATRIX 19*35CM
|
Facility
|
OP
|
$97,729.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,318.70 |
| Max. Negotiated Rate |
$93,819.84 |
| Rate for Payer: Aetna Commercial |
$75,251.33
|
| Rate for Payer: Anthem Medicaid |
$33,609.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,228.62
|
| Rate for Payer: Cash Price |
$48,864.50
|
| Rate for Payer: Cigna Commercial |
$81,115.07
|
| Rate for Payer: First Health Commercial |
$92,842.55
|
| Rate for Payer: Humana Commercial |
$83,069.65
|
| Rate for Payer: Humana KY Medicaid |
$33,609.00
|
| Rate for Payer: Kentucky WC Medicaid |
$33,951.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,137.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,124.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,318.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,283.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,001.52
|
| Rate for Payer: Ohio Health Group HMO |
$73,296.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,024.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,433.01
|
| Rate for Payer: PHCS Commercial |
$93,819.84
|
| Rate for Payer: United Healthcare All Payer |
$86,001.52
|
|
|
MESH XENMATRIX 20*20CM
|
Facility
|
OP
|
$41,296.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,388.88 |
| Max. Negotiated Rate |
$39,644.40 |
| Rate for Payer: Aetna Commercial |
$31,798.11
|
| Rate for Payer: Anthem Medicaid |
$14,201.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,211.08
|
| Rate for Payer: Cash Price |
$20,648.12
|
| Rate for Payer: Cigna Commercial |
$34,275.89
|
| Rate for Payer: First Health Commercial |
$39,231.44
|
| Rate for Payer: Humana Commercial |
$35,101.81
|
| Rate for Payer: Humana KY Medicaid |
$14,201.78
|
| Rate for Payer: Kentucky WC Medicaid |
$14,346.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,476.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,388.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,486.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,340.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,972.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,927.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,494.41
|
| Rate for Payer: PHCS Commercial |
$39,644.40
|
| Rate for Payer: United Healthcare All Payer |
$36,340.70
|
|
|
MESH XENMATRIX 20*20CM
|
Facility
|
IP
|
$41,296.25
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,388.88 |
| Max. Negotiated Rate |
$39,644.40 |
| Rate for Payer: Aetna Commercial |
$31,798.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,211.08
|
| Rate for Payer: Cash Price |
$20,648.12
|
| Rate for Payer: Cigna Commercial |
$34,275.89
|
| Rate for Payer: First Health Commercial |
$39,231.44
|
| Rate for Payer: Humana Commercial |
$35,101.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,476.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,388.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,340.70
|
| Rate for Payer: Ohio Health Group HMO |
$30,972.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,927.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,494.41
|
| Rate for Payer: PHCS Commercial |
$39,644.40
|
| Rate for Payer: United Healthcare All Payer |
$36,340.70
|
|
|
MESH XENMATRIX 20*25CM
|
Facility
|
OP
|
$81,860.20
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,558.06 |
| Max. Negotiated Rate |
$78,585.79 |
| Rate for Payer: Aetna Commercial |
$63,032.35
|
| Rate for Payer: Anthem Medicaid |
$28,151.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,850.96
|
| Rate for Payer: Cash Price |
$40,930.10
|
| Rate for Payer: Cigna Commercial |
$67,943.97
|
| Rate for Payer: First Health Commercial |
$77,767.19
|
| Rate for Payer: Humana Commercial |
$69,581.17
|
| Rate for Payer: Humana KY Medicaid |
$28,151.72
|
| Rate for Payer: Kentucky WC Medicaid |
$28,438.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67,125.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,412.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,558.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,716.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$72,036.98
|
| Rate for Payer: Ohio Health Group HMO |
$61,395.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65,488.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71,218.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56,483.54
|
| Rate for Payer: PHCS Commercial |
$78,585.79
|
| Rate for Payer: United Healthcare All Payer |
$72,036.98
|
|
