|
AMBI PLATE 2 SLOT 140*60MM
|
Facility
|
OP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem Medicaid |
$1,264.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Humana KY Medicaid |
$1,264.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
AMBI PLATE 2 SLOT 145*60MM
|
Facility
|
IP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
AMBI PLATE 2 SLOT 145*60MM
|
Facility
|
OP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem Medicaid |
$1,264.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Humana KY Medicaid |
$1,264.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
AMBI PLATE 2 SLOT 150*60MM
|
Facility
|
OP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem Medicaid |
$1,264.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Humana KY Medicaid |
$1,264.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
AMBI PLATE 2 SLOT 150*60MM
|
Facility
|
IP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
AMBI PLATE 3 SLOT 130*80MM
|
Facility
|
OP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem Medicaid |
$1,299.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Humana KY Medicaid |
$1,299.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,325.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
AMBI PLATE 3 SLOT 130*80MM
|
Facility
|
IP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
AMBI PLATE 3 SLOT 135*80MM
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
AMBI PLATE 3 SLOT 135*80MM
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
AMBI PLATE 3 SLOT 140*80MM
|
Facility
|
OP
|
$4,002.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.75 |
| Max. Negotiated Rate |
$3,842.40 |
| Rate for Payer: Aetna Commercial |
$3,081.93
|
| Rate for Payer: Anthem Medicaid |
$1,376.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.95
|
| Rate for Payer: Cash Price |
$2,001.25
|
| Rate for Payer: Cigna Commercial |
$3,322.07
|
| Rate for Payer: First Health Commercial |
$3,802.38
|
| Rate for Payer: Humana Commercial |
$3,402.12
|
| Rate for Payer: Humana KY Medicaid |
$1,376.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,282.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,404.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,522.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,202.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,482.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.72
|
| Rate for Payer: PHCS Commercial |
$3,842.40
|
| Rate for Payer: United Healthcare All Payer |
$3,522.20
|
|
|
AMBI PLATE 3 SLOT 140*80MM
|
Facility
|
IP
|
$4,002.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.75 |
| Max. Negotiated Rate |
$3,842.40 |
| Rate for Payer: Aetna Commercial |
$3,081.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.95
|
| Rate for Payer: Cash Price |
$2,001.25
|
| Rate for Payer: Cigna Commercial |
$3,322.07
|
| Rate for Payer: First Health Commercial |
$3,802.38
|
| Rate for Payer: Humana Commercial |
$3,402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,282.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,522.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,202.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,482.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.72
|
| Rate for Payer: PHCS Commercial |
$3,842.40
|
| Rate for Payer: United Healthcare All Payer |
$3,522.20
|
|
|
AMBI PLATE 3 SLOT 145*80MM
|
Facility
|
OP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem Medicaid |
$1,299.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Humana KY Medicaid |
$1,299.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,325.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
AMBI PLATE 3 SLOT 145*80MM
|
Facility
|
IP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
AMBI PLATE 3 SLOT 150*80MM
|
Facility
|
OP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem Medicaid |
$1,299.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Humana KY Medicaid |
$1,299.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,312.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,325.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
AMBI PLATE 3 SLOT 150*80MM
|
Facility
|
IP
|
$3,777.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.25 |
| Max. Negotiated Rate |
$3,626.40 |
| Rate for Payer: Aetna Commercial |
$2,908.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,946.45
|
| Rate for Payer: Cash Price |
$1,888.75
|
| Rate for Payer: Cigna Commercial |
$3,135.32
|
| Rate for Payer: First Health Commercial |
$3,588.62
|
| Rate for Payer: Humana Commercial |
$3,210.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,097.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,787.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,133.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,324.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,833.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,022.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,606.47
|
| Rate for Payer: PHCS Commercial |
$3,626.40
|
| Rate for Payer: United Healthcare All Payer |
$3,324.20
|
|
|
AMBI PLATE 4 SLOT 130*100MM
|
Facility
|
IP
|
$3,729.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.91 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Aetna Commercial |
$2,871.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.16
|
| Rate for Payer: Cash Price |
$1,864.84
|
| Rate for Payer: Cigna Commercial |
$3,095.64
|
| Rate for Payer: First Health Commercial |
$3,543.21
|
| Rate for Payer: Humana Commercial |
$3,170.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.49
|
| Rate for Payer: PHCS Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Payer |
$3,282.13
|
|
|
AMBI PLATE 4 SLOT 130*100MM
|
Facility
|
OP
|
$3,729.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.91 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Aetna Commercial |
$2,871.86
|
| Rate for Payer: Anthem Medicaid |
$1,282.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.16
|
| Rate for Payer: Cash Price |
$1,864.84
|
| Rate for Payer: Cigna Commercial |
$3,095.64
|
| Rate for Payer: First Health Commercial |
$3,543.21
|
| Rate for Payer: Humana Commercial |
$3,170.24
|
| Rate for Payer: Humana KY Medicaid |
$1,282.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.49
|
| Rate for Payer: PHCS Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Payer |
$3,282.13
|
|
|
AMBI PLATE 4 SLOT 135*100MM
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
AMBI PLATE 4 SLOT 135*100MM
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
AMBI PLATE 4 SLOT 140*100MM
|
Facility
|
OP
|
$3,237.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$2,492.88
|
| Rate for Payer: Anthem Medicaid |
$1,113.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.25
|
| Rate for Payer: Cash Price |
$1,618.75
|
| Rate for Payer: Cigna Commercial |
$2,687.12
|
| Rate for Payer: First Health Commercial |
$3,075.62
|
| Rate for Payer: Humana Commercial |
$2,751.88
|
| Rate for Payer: Humana KY Medicaid |
$1,113.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,124.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,135.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,816.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.88
|
| Rate for Payer: PHCS Commercial |
$3,108.00
|
| Rate for Payer: United Healthcare All Payer |
$2,849.00
|
|
|
AMBI PLATE 4 SLOT 140*100MM
|
Facility
|
IP
|
$3,237.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.25 |
| Max. Negotiated Rate |
$3,108.00 |
| Rate for Payer: Aetna Commercial |
$2,492.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.25
|
| Rate for Payer: Cash Price |
$1,618.75
|
| Rate for Payer: Cigna Commercial |
$2,687.12
|
| Rate for Payer: First Health Commercial |
$3,075.62
|
| Rate for Payer: Humana Commercial |
$2,751.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,654.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,816.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.88
|
| Rate for Payer: PHCS Commercial |
$3,108.00
|
| Rate for Payer: United Healthcare All Payer |
$2,849.00
|
|
|
AMBI PLATE 4 SLOT 145*100MM
|
Facility
|
IP
|
$3,729.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.91 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Aetna Commercial |
$2,871.86
|
| Rate for Payer: Aetna Commercial |
$2,936.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.11
|
| Rate for Payer: Cash Price |
$1,864.84
|
| Rate for Payer: Cash Price |
$1,907.12
|
| Rate for Payer: Cigna Commercial |
$3,095.64
|
| Rate for Payer: Cigna Commercial |
$3,165.83
|
| Rate for Payer: First Health Commercial |
$3,623.54
|
| Rate for Payer: First Health Commercial |
$3,543.21
|
| Rate for Payer: Humana Commercial |
$3,242.11
|
| Rate for Payer: Humana Commercial |
$3,170.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,356.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,051.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,318.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,631.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.49
|
| Rate for Payer: PHCS Commercial |
$3,580.50
|
| Rate for Payer: PHCS Commercial |
$3,661.68
|
| Rate for Payer: United Healthcare All Payer |
$3,282.13
|
| Rate for Payer: United Healthcare All Payer |
$3,356.54
|
|
|
AMBI PLATE 4 SLOT 145*100MM
|
Facility
|
OP
|
$3,729.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.91 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Aetna Commercial |
$2,871.86
|
| Rate for Payer: Aetna Commercial |
$2,936.97
|
| Rate for Payer: Anthem Medicaid |
$1,282.64
|
| Rate for Payer: Anthem Medicaid |
$1,311.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.11
|
| Rate for Payer: Cash Price |
$1,864.84
|
| Rate for Payer: Cash Price |
$1,907.12
|
| Rate for Payer: Cigna Commercial |
$3,165.83
|
| Rate for Payer: Cigna Commercial |
$3,095.64
|
| Rate for Payer: First Health Commercial |
$3,623.54
|
| Rate for Payer: First Health Commercial |
$3,543.21
|
| Rate for Payer: Humana Commercial |
$3,170.24
|
| Rate for Payer: Humana Commercial |
$3,242.11
|
| Rate for Payer: Humana KY Medicaid |
$1,282.64
|
| Rate for Payer: Humana KY Medicaid |
$1,311.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,325.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,338.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,356.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,051.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,318.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,631.83
|
| Rate for Payer: PHCS Commercial |
$3,661.68
|
| Rate for Payer: PHCS Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Payer |
$3,356.54
|
| Rate for Payer: United Healthcare All Payer |
$3,282.13
|
|
|
AMBI PLATE 4 SLOT 150*100MM
|
Facility
|
OP
|
$3,729.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.91 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Aetna Commercial |
$2,871.86
|
| Rate for Payer: Aetna Commercial |
$2,936.97
|
| Rate for Payer: Anthem Medicaid |
$1,282.64
|
| Rate for Payer: Anthem Medicaid |
$1,311.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.11
|
| Rate for Payer: Cash Price |
$1,864.84
|
| Rate for Payer: Cash Price |
$1,907.12
|
| Rate for Payer: Cigna Commercial |
$3,165.83
|
| Rate for Payer: Cigna Commercial |
$3,095.64
|
| Rate for Payer: First Health Commercial |
$3,623.54
|
| Rate for Payer: First Health Commercial |
$3,543.21
|
| Rate for Payer: Humana Commercial |
$3,170.24
|
| Rate for Payer: Humana Commercial |
$3,242.11
|
| Rate for Payer: Humana KY Medicaid |
$1,282.64
|
| Rate for Payer: Humana KY Medicaid |
$1,311.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,325.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,338.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,356.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,051.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,318.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,631.83
|
| Rate for Payer: PHCS Commercial |
$3,661.68
|
| Rate for Payer: PHCS Commercial |
$3,580.50
|
| Rate for Payer: United Healthcare All Payer |
$3,356.54
|
| Rate for Payer: United Healthcare All Payer |
$3,282.13
|
|
|
AMBI PLATE 4 SLOT 150*100MM
|
Facility
|
IP
|
$3,729.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.91 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Aetna Commercial |
$2,871.86
|
| Rate for Payer: Aetna Commercial |
$2,936.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.11
|
| Rate for Payer: Cash Price |
$1,864.84
|
| Rate for Payer: Cash Price |
$1,907.12
|
| Rate for Payer: Cigna Commercial |
$3,095.64
|
| Rate for Payer: Cigna Commercial |
$3,165.83
|
| Rate for Payer: First Health Commercial |
$3,623.54
|
| Rate for Payer: First Health Commercial |
$3,543.21
|
| Rate for Payer: Humana Commercial |
$3,242.11
|
| Rate for Payer: Humana Commercial |
$3,170.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,127.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,814.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,356.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,051.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,244.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,318.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,631.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.49
|
| Rate for Payer: PHCS Commercial |
$3,580.50
|
| Rate for Payer: PHCS Commercial |
$3,661.68
|
| Rate for Payer: United Healthcare All Payer |
$3,282.13
|
| Rate for Payer: United Healthcare All Payer |
$3,356.54
|
|
