|
AMBI PLATE 10 SLOT 130*220MM
|
Facility
|
IP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
AMBI PLATE 10 SLOT 135*220MM
|
Facility
|
OP
|
$4,746.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.01 |
| Max. Negotiated Rate |
$4,556.40 |
| Rate for Payer: Aetna Commercial |
$3,654.61
|
| Rate for Payer: Anthem Medicaid |
$1,632.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,702.08
|
| Rate for Payer: Cash Price |
$2,373.12
|
| Rate for Payer: Cigna Commercial |
$3,939.39
|
| Rate for Payer: First Health Commercial |
$4,508.94
|
| Rate for Payer: Humana Commercial |
$4,034.31
|
| Rate for Payer: Humana KY Medicaid |
$1,632.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,648.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,891.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,502.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,664.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,176.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.34
|
| Rate for Payer: PHCS Commercial |
$4,556.40
|
| Rate for Payer: United Healthcare All Payer |
$4,176.70
|
|
|
AMBI PLATE 10 SLOT 135*220MM
|
Facility
|
IP
|
$4,746.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.01 |
| Max. Negotiated Rate |
$4,556.40 |
| Rate for Payer: Aetna Commercial |
$3,654.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,702.08
|
| Rate for Payer: Cash Price |
$2,373.12
|
| Rate for Payer: Cigna Commercial |
$3,939.39
|
| Rate for Payer: First Health Commercial |
$4,508.94
|
| Rate for Payer: Humana Commercial |
$4,034.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,891.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,502.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,176.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.34
|
| Rate for Payer: PHCS Commercial |
$4,556.40
|
| Rate for Payer: United Healthcare All Payer |
$4,176.70
|
|
|
AMBI PLATE 10 SLOT 140*220MM
|
Facility
|
OP
|
$4,747.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.13 |
| Max. Negotiated Rate |
$4,557.24 |
| Rate for Payer: Aetna Commercial |
$3,655.28
|
| Rate for Payer: Anthem Medicaid |
$1,632.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,702.75
|
| Rate for Payer: Cash Price |
$2,373.56
|
| Rate for Payer: Cigna Commercial |
$3,940.11
|
| Rate for Payer: First Health Commercial |
$4,509.76
|
| Rate for Payer: Humana Commercial |
$4,035.05
|
| Rate for Payer: Humana KY Medicaid |
$1,632.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,892.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,503.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,177.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,560.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.61
|
| Rate for Payer: PHCS Commercial |
$4,557.24
|
| Rate for Payer: United Healthcare All Payer |
$4,177.47
|
|
|
AMBI PLATE 10 SLOT 140*220MM
|
Facility
|
IP
|
$4,747.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.13 |
| Max. Negotiated Rate |
$4,557.24 |
| Rate for Payer: Aetna Commercial |
$3,655.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,702.75
|
| Rate for Payer: Cash Price |
$2,373.56
|
| Rate for Payer: Cigna Commercial |
$3,940.11
|
| Rate for Payer: First Health Commercial |
$4,509.76
|
| Rate for Payer: Humana Commercial |
$4,035.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,892.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,503.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,177.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,560.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.61
|
| Rate for Payer: PHCS Commercial |
$4,557.24
|
| Rate for Payer: United Healthcare All Payer |
$4,177.47
|
|
|
AMBI PLATE 10 SLOT 145*220MM
|
Facility
|
OP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem Medicaid |
$1,294.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Humana KY Medicaid |
$1,294.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,307.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,320.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
AMBI PLATE 10 SLOT 145*220MM
|
Facility
|
IP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
AMBI PLATE 10 SLOT 150*220M
|
Facility
|
OP
|
$4,745.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.85 |
| Max. Negotiated Rate |
$4,555.22 |
| Rate for Payer: Aetna Commercial |
$3,653.67
|
| Rate for Payer: Anthem Medicaid |
$1,631.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,701.12
|
| Rate for Payer: Cash Price |
$2,372.51
|
| Rate for Payer: Cigna Commercial |
$3,938.37
|
| Rate for Payer: First Health Commercial |
$4,507.77
|
| Rate for Payer: Humana Commercial |
$4,033.27
|
| Rate for Payer: Humana KY Medicaid |
$1,631.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,648.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,890.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,664.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,175.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,558.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$616.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,470.96
|
| Rate for Payer: PHCS Commercial |
$4,555.22
|
| Rate for Payer: United Healthcare All Payer |
$4,175.62
|
|
|
AMBI PLATE 10 SLOT 150*220M
|
Facility
|
IP
|
$4,745.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$616.85 |
| Max. Negotiated Rate |
$4,555.22 |
| Rate for Payer: Aetna Commercial |
$3,653.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,701.12
|
| Rate for Payer: Cash Price |
$2,372.51
|
| Rate for Payer: Cigna Commercial |
$3,938.37
|
| Rate for Payer: First Health Commercial |
$4,507.77
|
| Rate for Payer: Humana Commercial |
$4,033.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,890.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,175.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,558.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$616.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,470.96
|
| Rate for Payer: PHCS Commercial |
$4,555.22
|
| Rate for Payer: United Healthcare All Payer |
$4,175.62
|
|
|
AMBI PLATE 10 SLOT 90*204MM
|
Facility
|
OP
|
$4,639.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.14 |
| Max. Negotiated Rate |
$4,453.92 |
| Rate for Payer: Aetna Commercial |
$3,572.42
|
| Rate for Payer: Anthem Medicaid |
$1,595.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,618.81
|
| Rate for Payer: Cash Price |
$2,319.75
|
| Rate for Payer: Cigna Commercial |
$3,850.78
|
| Rate for Payer: First Health Commercial |
$4,407.52
|
| Rate for Payer: Humana Commercial |
$3,943.58
|
| Rate for Payer: Humana KY Medicaid |
$1,595.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,611.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,804.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,423.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,391.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,627.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,082.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,479.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$603.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,438.24
|
| Rate for Payer: PHCS Commercial |
$4,453.92
|
| Rate for Payer: United Healthcare All Payer |
$4,082.76
|
|
|
AMBI PLATE 10 SLOT 90*204MM
|
Facility
|
IP
|
$4,639.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$603.14 |
| Max. Negotiated Rate |
$4,453.92 |
| Rate for Payer: Aetna Commercial |
$3,572.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,618.81
|
| Rate for Payer: Cash Price |
$2,319.75
|
| Rate for Payer: Cigna Commercial |
$3,850.78
|
| Rate for Payer: First Health Commercial |
$4,407.52
|
| Rate for Payer: Humana Commercial |
$3,943.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,804.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,423.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,391.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,082.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,479.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$603.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,438.24
|
| Rate for Payer: PHCS Commercial |
$4,453.92
|
| Rate for Payer: United Healthcare All Payer |
$4,082.76
|
|
|
AMBI PLATE 10 SLOT 95*204MM
|
Facility
|
IP
|
$4,646.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.07 |
| Max. Negotiated Rate |
$4,460.81 |
| Rate for Payer: Aetna Commercial |
$3,577.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,624.41
|
| Rate for Payer: Cash Price |
$2,323.34
|
| Rate for Payer: Cigna Commercial |
$3,856.74
|
| Rate for Payer: First Health Commercial |
$4,414.35
|
| Rate for Payer: Humana Commercial |
$3,949.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,810.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,429.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,394.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,089.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,485.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.47
|
| Rate for Payer: PHCS Commercial |
$4,460.81
|
| Rate for Payer: United Healthcare All Payer |
$4,089.08
|
|
|
AMBI PLATE 10 SLOT 95*204MM
|
Facility
|
OP
|
$4,646.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.07 |
| Max. Negotiated Rate |
$4,460.81 |
| Rate for Payer: Aetna Commercial |
$3,577.94
|
| Rate for Payer: Anthem Medicaid |
$1,597.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,624.41
|
| Rate for Payer: Cash Price |
$2,323.34
|
| Rate for Payer: Cigna Commercial |
$3,856.74
|
| Rate for Payer: First Health Commercial |
$4,414.35
|
| Rate for Payer: Humana Commercial |
$3,949.68
|
| Rate for Payer: Humana KY Medicaid |
$1,597.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,614.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,810.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,429.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,394.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,630.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,089.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,485.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.47
|
| Rate for Payer: PHCS Commercial |
$4,460.81
|
| Rate for Payer: United Healthcare All Payer |
$4,089.08
|
|
|
AMBI PLATE 12 SLOT 135*260MM
|
Facility
|
IP
|
$4,926.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.44 |
| Max. Negotiated Rate |
$4,729.44 |
| Rate for Payer: Aetna Commercial |
$3,793.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.67
|
| Rate for Payer: Cash Price |
$2,463.25
|
| Rate for Payer: Cigna Commercial |
$4,089.00
|
| Rate for Payer: First Health Commercial |
$4,680.18
|
| Rate for Payer: Humana Commercial |
$4,187.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,335.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,527.22
|
| Rate for Payer: PHCS Commercial |
$4,729.44
|
| Rate for Payer: United Healthcare All Payer |
$4,335.32
|
|
|
AMBI PLATE 12 SLOT 135*260MM
|
Facility
|
OP
|
$4,926.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.44 |
| Max. Negotiated Rate |
$4,729.44 |
| Rate for Payer: Aetna Commercial |
$3,793.40
|
| Rate for Payer: Anthem Medicaid |
$1,694.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.67
|
| Rate for Payer: Cash Price |
$2,463.25
|
| Rate for Payer: Cigna Commercial |
$4,089.00
|
| Rate for Payer: First Health Commercial |
$4,680.18
|
| Rate for Payer: Humana Commercial |
$4,187.52
|
| Rate for Payer: Humana KY Medicaid |
$1,694.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,711.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,728.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,335.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,527.22
|
| Rate for Payer: PHCS Commercial |
$4,729.44
|
| Rate for Payer: United Healthcare All Payer |
$4,335.32
|
|
|
AMBI PLATE 12 SLOT 140*260MM
|
Facility
|
OP
|
$4,118.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.39 |
| Max. Negotiated Rate |
$3,953.62 |
| Rate for Payer: Aetna Commercial |
$3,171.13
|
| Rate for Payer: Anthem Medicaid |
$1,416.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,212.31
|
| Rate for Payer: Cash Price |
$2,059.18
|
| Rate for Payer: Cigna Commercial |
$3,418.23
|
| Rate for Payer: First Health Commercial |
$3,912.43
|
| Rate for Payer: Humana Commercial |
$3,500.60
|
| Rate for Payer: Humana KY Medicaid |
$1,416.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,430.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,039.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,444.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,624.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,088.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.69
|
| Rate for Payer: PHCS Commercial |
$3,953.62
|
| Rate for Payer: United Healthcare All Payer |
$3,624.15
|
|
|
AMBI PLATE 12 SLOT 140*260MM
|
Facility
|
IP
|
$4,118.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.39 |
| Max. Negotiated Rate |
$3,953.62 |
| Rate for Payer: Aetna Commercial |
$3,171.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,212.31
|
| Rate for Payer: Cash Price |
$2,059.18
|
| Rate for Payer: Cigna Commercial |
$3,418.23
|
| Rate for Payer: First Health Commercial |
$3,912.43
|
| Rate for Payer: Humana Commercial |
$3,500.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,039.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,624.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,088.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.69
|
| Rate for Payer: PHCS Commercial |
$3,953.62
|
| Rate for Payer: United Healthcare All Payer |
$3,624.15
|
|
|
AMBI PLATE 12 SLOT 145*260MM
|
Facility
|
IP
|
$4,926.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.44 |
| Max. Negotiated Rate |
$4,729.44 |
| Rate for Payer: Aetna Commercial |
$3,793.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.67
|
| Rate for Payer: Cash Price |
$2,463.25
|
| Rate for Payer: Cigna Commercial |
$4,089.00
|
| Rate for Payer: First Health Commercial |
$4,680.18
|
| Rate for Payer: Humana Commercial |
$4,187.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,335.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,527.22
|
| Rate for Payer: PHCS Commercial |
$4,729.44
|
| Rate for Payer: United Healthcare All Payer |
$4,335.32
|
|
|
AMBI PLATE 12 SLOT 145*260MM
|
Facility
|
OP
|
$4,926.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.44 |
| Max. Negotiated Rate |
$4,729.44 |
| Rate for Payer: Aetna Commercial |
$3,793.40
|
| Rate for Payer: Anthem Medicaid |
$1,694.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,842.67
|
| Rate for Payer: Cash Price |
$2,463.25
|
| Rate for Payer: Cigna Commercial |
$4,089.00
|
| Rate for Payer: First Health Commercial |
$4,680.18
|
| Rate for Payer: Humana Commercial |
$4,187.52
|
| Rate for Payer: Humana KY Medicaid |
$1,694.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,711.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,039.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,635.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,728.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,335.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,694.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$985.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,527.22
|
| Rate for Payer: PHCS Commercial |
$4,729.44
|
| Rate for Payer: United Healthcare All Payer |
$4,335.32
|
|
|
AMBI PLATE 12 SLOT 90*244MM
|
Facility
|
OP
|
$4,962.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.11 |
| Max. Negotiated Rate |
$4,763.88 |
| Rate for Payer: Humana Commercial |
$4,218.02
|
| Rate for Payer: Humana KY Medicaid |
$1,706.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,723.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,069.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,740.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.34
|
| Rate for Payer: PHCS Commercial |
$4,763.88
|
| Rate for Payer: United Healthcare All Payer |
$4,366.89
|
| Rate for Payer: Aetna Commercial |
$3,821.03
|
| Rate for Payer: Anthem Medicaid |
$1,706.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,870.66
|
| Rate for Payer: Cash Price |
$2,481.19
|
| Rate for Payer: Cigna Commercial |
$4,118.78
|
| Rate for Payer: First Health Commercial |
$4,714.26
|
|
|
AMBI PLATE 12 SLOT 90*244MM
|
Facility
|
IP
|
$4,962.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.11 |
| Max. Negotiated Rate |
$4,763.88 |
| Rate for Payer: Aetna Commercial |
$3,821.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,870.66
|
| Rate for Payer: Cash Price |
$2,481.19
|
| Rate for Payer: Cigna Commercial |
$4,118.78
|
| Rate for Payer: First Health Commercial |
$4,714.26
|
| Rate for Payer: Humana Commercial |
$4,218.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,069.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.34
|
| Rate for Payer: PHCS Commercial |
$4,763.88
|
| Rate for Payer: United Healthcare All Payer |
$4,366.89
|
|
|
AMBI PLATE 12 SLOT 95*244MM
|
Facility
|
IP
|
$4,962.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.11 |
| Max. Negotiated Rate |
$4,763.88 |
| Rate for Payer: Aetna Commercial |
$3,821.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,870.66
|
| Rate for Payer: Cash Price |
$2,481.19
|
| Rate for Payer: Cigna Commercial |
$4,118.78
|
| Rate for Payer: First Health Commercial |
$4,714.26
|
| Rate for Payer: Humana Commercial |
$4,218.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,069.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.34
|
| Rate for Payer: PHCS Commercial |
$4,763.88
|
| Rate for Payer: United Healthcare All Payer |
$4,366.89
|
|
|
AMBI PLATE 12 SLOT 95*244MM
|
Facility
|
OP
|
$4,962.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.11 |
| Max. Negotiated Rate |
$4,763.88 |
| Rate for Payer: Aetna Commercial |
$3,821.03
|
| Rate for Payer: Anthem Medicaid |
$1,706.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,870.66
|
| Rate for Payer: Cash Price |
$2,481.19
|
| Rate for Payer: Cigna Commercial |
$4,118.78
|
| Rate for Payer: First Health Commercial |
$4,714.26
|
| Rate for Payer: Humana Commercial |
$4,218.02
|
| Rate for Payer: Humana KY Medicaid |
$1,706.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,723.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,069.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,740.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.34
|
| Rate for Payer: PHCS Commercial |
$4,763.88
|
| Rate for Payer: United Healthcare All Payer |
$4,366.89
|
|
|
AMBI PLATE 14 SLOT 135*300MM
|
Facility
|
OP
|
$5,608.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.06 |
| Max. Negotiated Rate |
$5,383.80 |
| Rate for Payer: Aetna Commercial |
$4,318.25
|
| Rate for Payer: Anthem Medicaid |
$1,928.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,374.33
|
| Rate for Payer: Cash Price |
$2,804.06
|
| Rate for Payer: Cigna Commercial |
$4,654.74
|
| Rate for Payer: First Health Commercial |
$5,327.71
|
| Rate for Payer: Humana Commercial |
$4,766.90
|
| Rate for Payer: Humana KY Medicaid |
$1,928.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,948.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,967.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,935.15
|
| Rate for Payer: Ohio Health Group HMO |
$4,206.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,121.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.52
|
| Rate for Payer: PHCS Commercial |
$5,383.80
|
| Rate for Payer: United Healthcare All Payer |
$4,935.15
|
|
|
AMBI PLATE 14 SLOT 135*300MM
|
Facility
|
IP
|
$5,608.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.06 |
| Max. Negotiated Rate |
$5,383.80 |
| Rate for Payer: Aetna Commercial |
$4,318.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,374.33
|
| Rate for Payer: Cash Price |
$2,804.06
|
| Rate for Payer: Cigna Commercial |
$4,654.74
|
| Rate for Payer: First Health Commercial |
$5,327.71
|
| Rate for Payer: Humana Commercial |
$4,766.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,598.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,138.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,935.15
|
| Rate for Payer: Ohio Health Group HMO |
$4,206.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,121.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,738.52
|
| Rate for Payer: PHCS Commercial |
$5,383.80
|
| Rate for Payer: United Healthcare All Payer |
$4,935.15
|
|
