|
AMBI PLATE 6 SLOT 150*140MM
|
Facility
|
IP
|
$3,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.19 |
| Max. Negotiated Rate |
$3,834.00 |
| Rate for Payer: Aetna Commercial |
$3,075.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,115.12
|
| Rate for Payer: Cash Price |
$1,996.88
|
| Rate for Payer: Cigna Commercial |
$3,314.81
|
| Rate for Payer: First Health Commercial |
$3,794.06
|
| Rate for Payer: Humana Commercial |
$3,394.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,274.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,947.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,198.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,514.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,995.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$798.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,238.06
|
| Rate for Payer: PHCS Commercial |
$3,834.00
|
| Rate for Payer: United Healthcare All Payer |
$3,514.50
|
|
|
AMBI PLATE 6 SLOT 150*140MM
|
Facility
|
OP
|
$3,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.19 |
| Max. Negotiated Rate |
$3,834.00 |
| Rate for Payer: Aetna Commercial |
$3,075.19
|
| Rate for Payer: Anthem Medicaid |
$1,373.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,115.12
|
| Rate for Payer: Cash Price |
$1,996.88
|
| Rate for Payer: Cigna Commercial |
$3,314.81
|
| Rate for Payer: First Health Commercial |
$3,794.06
|
| Rate for Payer: Humana Commercial |
$3,394.69
|
| Rate for Payer: Humana KY Medicaid |
$1,373.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,387.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,274.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,947.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,198.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,401.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,514.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,995.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$798.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,238.06
|
| Rate for Payer: PHCS Commercial |
$3,834.00
|
| Rate for Payer: United Healthcare All Payer |
$3,514.50
|
|
|
AMBI PLATE 6 SLOT 90*124MM
|
Facility
|
IP
|
$4,363.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.19 |
| Max. Negotiated Rate |
$4,188.48 |
| Rate for Payer: Aetna Commercial |
$3,359.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.14
|
| Rate for Payer: Cash Price |
$2,181.50
|
| Rate for Payer: Cigna Commercial |
$3,621.29
|
| Rate for Payer: First Health Commercial |
$4,144.85
|
| Rate for Payer: Humana Commercial |
$3,708.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,577.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,219.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,839.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,352.53
|
| Rate for Payer: PHCS Commercial |
$4,188.48
|
| Rate for Payer: United Healthcare All Payer |
$3,839.44
|
|
|
AMBI PLATE 6 SLOT 90*124MM
|
Facility
|
OP
|
$4,363.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.19 |
| Max. Negotiated Rate |
$4,188.48 |
| Rate for Payer: Humana Commercial |
$3,708.55
|
| Rate for Payer: Humana KY Medicaid |
$1,500.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,577.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,219.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,530.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,839.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,352.53
|
| Rate for Payer: PHCS Commercial |
$4,188.48
|
| Rate for Payer: United Healthcare All Payer |
$3,839.44
|
| Rate for Payer: Aetna Commercial |
$3,359.51
|
| Rate for Payer: Anthem Medicaid |
$1,500.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.14
|
| Rate for Payer: Cash Price |
$2,181.50
|
| Rate for Payer: Cigna Commercial |
$3,621.29
|
| Rate for Payer: First Health Commercial |
$4,144.85
|
|
|
AMBI PLATE 6 SLOT 95*124MM
|
Facility
|
OP
|
$4,481.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$4,302.38 |
| Rate for Payer: Aetna Commercial |
$3,450.87
|
| Rate for Payer: Anthem Medicaid |
$1,541.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.69
|
| Rate for Payer: Cash Price |
$2,240.82
|
| Rate for Payer: Cigna Commercial |
$3,719.77
|
| Rate for Payer: First Health Commercial |
$4,257.57
|
| Rate for Payer: Humana Commercial |
$3,809.40
|
| Rate for Payer: Humana KY Medicaid |
$1,541.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,556.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.31
|
| Rate for Payer: PHCS Commercial |
$4,302.38
|
| Rate for Payer: United Healthcare All Payer |
$3,943.85
|
|
|
AMBI PLATE 6 SLOT 95*124MM
|
Facility
|
IP
|
$4,481.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$4,302.38 |
| Rate for Payer: Aetna Commercial |
$3,450.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.69
|
| Rate for Payer: Cash Price |
$2,240.82
|
| Rate for Payer: Cigna Commercial |
$3,719.77
|
| Rate for Payer: First Health Commercial |
$4,257.57
|
| Rate for Payer: Humana Commercial |
$3,809.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.31
|
| Rate for Payer: PHCS Commercial |
$4,302.38
|
| Rate for Payer: United Healthcare All Payer |
$3,943.85
|
|
|
AMBI PLATE 8 SLOT 130*180MM
|
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 8 SLOT 130*180MM
|
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 8 SLOT 135*180MM
|
Facility
|
OP
|
$4,381.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.56 |
| Max. Negotiated Rate |
$4,205.95 |
| Rate for Payer: Aetna Commercial |
$3,373.52
|
| Rate for Payer: Anthem Medicaid |
$1,506.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.34
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,636.40
|
| Rate for Payer: First Health Commercial |
$4,162.14
|
| Rate for Payer: Humana Commercial |
$3,724.02
|
| Rate for Payer: Humana KY Medicaid |
$1,506.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,592.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,536.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,855.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.17
|
| Rate for Payer: PHCS Commercial |
$4,205.95
|
| Rate for Payer: United Healthcare All Payer |
$3,855.46
|
|
|
AMBI PLATE 8 SLOT 135*180MM
|
Facility
|
IP
|
$4,381.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.56 |
| Max. Negotiated Rate |
$4,205.95 |
| Rate for Payer: Aetna Commercial |
$3,373.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.34
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,636.40
|
| Rate for Payer: First Health Commercial |
$4,162.14
|
| Rate for Payer: Humana Commercial |
$3,724.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,592.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,855.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.17
|
| Rate for Payer: PHCS Commercial |
$4,205.95
|
| Rate for Payer: United Healthcare All Payer |
$3,855.46
|
|
|
AMBI PLATE 8 SLOT 140*180MM
|
Facility
|
IP
|
$4,381.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.56 |
| Max. Negotiated Rate |
$4,205.95 |
| Rate for Payer: Aetna Commercial |
$3,373.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.34
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,636.40
|
| Rate for Payer: First Health Commercial |
$4,162.14
|
| Rate for Payer: Humana Commercial |
$3,724.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,592.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,855.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.17
|
| Rate for Payer: PHCS Commercial |
$4,205.95
|
| Rate for Payer: United Healthcare All Payer |
$3,855.46
|
|
|
AMBI PLATE 8 SLOT 140*180MM
|
Facility
|
OP
|
$4,381.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.56 |
| Max. Negotiated Rate |
$4,205.95 |
| Rate for Payer: Aetna Commercial |
$3,373.52
|
| Rate for Payer: Anthem Medicaid |
$1,506.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.34
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,636.40
|
| Rate for Payer: First Health Commercial |
$4,162.14
|
| Rate for Payer: Humana Commercial |
$3,724.02
|
| Rate for Payer: Humana KY Medicaid |
$1,506.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,592.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,536.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,855.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.17
|
| Rate for Payer: PHCS Commercial |
$4,205.95
|
| Rate for Payer: United Healthcare All Payer |
$3,855.46
|
|
|
AMBI PLATE 8 SLOT 145*180MM
|
Facility
|
OP
|
$4,381.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.56 |
| Max. Negotiated Rate |
$4,205.95 |
| Rate for Payer: Aetna Commercial |
$3,373.52
|
| Rate for Payer: Anthem Medicaid |
$1,506.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.34
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,636.40
|
| Rate for Payer: First Health Commercial |
$4,162.14
|
| Rate for Payer: Humana Commercial |
$3,724.02
|
| Rate for Payer: Humana KY Medicaid |
$1,506.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,592.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,536.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,855.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.17
|
| Rate for Payer: PHCS Commercial |
$4,205.95
|
| Rate for Payer: United Healthcare All Payer |
$3,855.46
|
|
|
AMBI PLATE 8 SLOT 145*180MM
|
Facility
|
IP
|
$4,381.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.56 |
| Max. Negotiated Rate |
$4,205.95 |
| Rate for Payer: Aetna Commercial |
$3,373.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.34
|
| Rate for Payer: Cash Price |
$2,190.60
|
| Rate for Payer: Cigna Commercial |
$3,636.40
|
| Rate for Payer: First Health Commercial |
$4,162.14
|
| Rate for Payer: Humana Commercial |
$3,724.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,592.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,855.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,285.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.17
|
| Rate for Payer: PHCS Commercial |
$4,205.95
|
| Rate for Payer: United Healthcare All Payer |
$3,855.46
|
|
|
AMBI PLATE 8 SLOT 150*180MM
|
Facility
|
OP
|
$4,423.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.02 |
| Max. Negotiated Rate |
$4,246.27 |
| Rate for Payer: Aetna Commercial |
$3,405.86
|
| Rate for Payer: Anthem Medicaid |
$1,521.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,450.10
|
| Rate for Payer: Cash Price |
$2,211.60
|
| Rate for Payer: Cigna Commercial |
$3,671.26
|
| Rate for Payer: First Health Commercial |
$4,202.04
|
| Rate for Payer: Humana Commercial |
$3,759.72
|
| Rate for Payer: Humana KY Medicaid |
$1,521.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,536.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,627.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,264.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,326.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,551.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,892.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,317.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$884.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,371.19
|
| Rate for Payer: PHCS Commercial |
$4,246.27
|
| Rate for Payer: United Healthcare All Payer |
$3,892.42
|
|
|
AMBI PLATE 8 SLOT 150*180MM
|
Facility
|
IP
|
$4,423.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.02 |
| Max. Negotiated Rate |
$4,246.27 |
| Rate for Payer: Aetna Commercial |
$3,405.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,450.10
|
| Rate for Payer: Cash Price |
$2,211.60
|
| Rate for Payer: Cigna Commercial |
$3,671.26
|
| Rate for Payer: First Health Commercial |
$4,202.04
|
| Rate for Payer: Humana Commercial |
$3,759.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,627.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,264.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,326.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,892.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,317.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$884.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,371.19
|
| Rate for Payer: PHCS Commercial |
$4,246.27
|
| Rate for Payer: United Healthcare All Payer |
$3,892.42
|
|
|
AMBI PLATE 8 SLOT 90*164MM
|
Facility
|
IP
|
$4,363.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.19 |
| Max. Negotiated Rate |
$4,188.48 |
| Rate for Payer: Aetna Commercial |
$3,359.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.14
|
| Rate for Payer: Cash Price |
$2,181.50
|
| Rate for Payer: Cigna Commercial |
$3,621.29
|
| Rate for Payer: First Health Commercial |
$4,144.85
|
| Rate for Payer: Humana Commercial |
$3,708.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,577.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,219.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,839.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,352.53
|
| Rate for Payer: PHCS Commercial |
$4,188.48
|
| Rate for Payer: United Healthcare All Payer |
$3,839.44
|
|
|
AMBI PLATE 8 SLOT 90*164MM
|
Facility
|
OP
|
$4,363.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.19 |
| Max. Negotiated Rate |
$4,188.48 |
| Rate for Payer: Aetna Commercial |
$3,359.51
|
| Rate for Payer: Anthem Medicaid |
$1,500.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.14
|
| Rate for Payer: Cash Price |
$2,181.50
|
| Rate for Payer: Cigna Commercial |
$3,621.29
|
| Rate for Payer: First Health Commercial |
$4,144.85
|
| Rate for Payer: Humana Commercial |
$3,708.55
|
| Rate for Payer: Humana KY Medicaid |
$1,500.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,577.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,219.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,530.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,839.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,352.53
|
| Rate for Payer: PHCS Commercial |
$4,188.48
|
| Rate for Payer: United Healthcare All Payer |
$3,839.44
|
|
|
AMBI PLATE 8 SLOT 95*164MM
|
Facility
|
OP
|
$3,957.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.52 |
| Max. Negotiated Rate |
$3,799.56 |
| Rate for Payer: Aetna Commercial |
$3,047.57
|
| Rate for Payer: Anthem Medicaid |
$1,361.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,087.15
|
| Rate for Payer: Cash Price |
$1,978.94
|
| Rate for Payer: Cigna Commercial |
$3,285.04
|
| Rate for Payer: First Health Commercial |
$3,759.99
|
| Rate for Payer: Humana Commercial |
$3,364.20
|
| Rate for Payer: Humana KY Medicaid |
$1,361.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.94
|
| Rate for Payer: PHCS Commercial |
$3,799.56
|
| Rate for Payer: United Healthcare All Payer |
$3,482.93
|
|
|
AMBI PLATE 8 SLOT 95*164MM
|
Facility
|
IP
|
$3,957.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.52 |
| Max. Negotiated Rate |
$3,799.56 |
| Rate for Payer: Aetna Commercial |
$3,047.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,087.15
|
| Rate for Payer: Cash Price |
$1,978.94
|
| Rate for Payer: Cigna Commercial |
$3,285.04
|
| Rate for Payer: First Health Commercial |
$3,759.99
|
| Rate for Payer: Humana Commercial |
$3,364.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.94
|
| Rate for Payer: PHCS Commercial |
$3,799.56
|
| Rate for Payer: United Healthcare All Payer |
$3,482.93
|
|
|
AMBI PLATEI 4 SLOT 130*100MM
|
Facility
|
OP
|
$3,893.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.13 |
| Max. Negotiated Rate |
$3,737.57 |
| Rate for Payer: Anthem Medicaid |
$1,338.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,036.77
|
| Rate for Payer: Cash Price |
$1,946.65
|
| Rate for Payer: Cigna Commercial |
$3,231.44
|
| Rate for Payer: First Health Commercial |
$3,698.64
|
| Rate for Payer: Humana Commercial |
$3,309.30
|
| Rate for Payer: Humana KY Medicaid |
$1,338.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,352.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,192.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,873.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,365.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,426.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.92
|
| Rate for Payer: PHCS Commercial |
$3,737.57
|
| Rate for Payer: United Healthcare All Payer |
$3,426.10
|
| Rate for Payer: Aetna Commercial |
$2,997.84
|
|
|
AMBI PLATEI 4 SLOT 130*100MM
|
Facility
|
IP
|
$3,893.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.13 |
| Max. Negotiated Rate |
$3,737.57 |
| Rate for Payer: Aetna Commercial |
$2,997.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,036.77
|
| Rate for Payer: Cash Price |
$1,946.65
|
| Rate for Payer: Cigna Commercial |
$3,231.44
|
| Rate for Payer: First Health Commercial |
$3,698.64
|
| Rate for Payer: Humana Commercial |
$3,309.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,192.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,873.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,426.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.92
|
| Rate for Payer: PHCS Commercial |
$3,737.57
|
| Rate for Payer: United Healthcare All Payer |
$3,426.10
|
|
|
AMBI PLATE SHORT BARREL 4H 140
|
Facility
|
IP
|
$3,477.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.08 |
| Max. Negotiated Rate |
$3,338.40 |
| Rate for Payer: Aetna Commercial |
$2,677.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.45
|
| Rate for Payer: Cash Price |
$1,738.75
|
| Rate for Payer: Cigna Commercial |
$2,886.32
|
| Rate for Payer: First Health Commercial |
$3,303.62
|
| Rate for Payer: Humana Commercial |
$2,955.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,078.02
|
| Rate for Payer: PHCS Commercial |
$3,338.40
|
| Rate for Payer: United Healthcare All Payer |
$3,060.20
|
|
|
AMBI PLATE SHORT BARREL 4H 140
|
Facility
|
OP
|
$3,477.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.08 |
| Max. Negotiated Rate |
$3,338.40 |
| Rate for Payer: Aetna Commercial |
$2,677.68
|
| Rate for Payer: Anthem Medicaid |
$1,195.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.45
|
| Rate for Payer: Cash Price |
$1,738.75
|
| Rate for Payer: Cigna Commercial |
$2,886.32
|
| Rate for Payer: First Health Commercial |
$3,303.62
|
| Rate for Payer: Humana Commercial |
$2,955.88
|
| Rate for Payer: Humana KY Medicaid |
$1,195.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,208.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,078.02
|
| Rate for Payer: PHCS Commercial |
$3,338.40
|
| Rate for Payer: United Healthcare All Payer |
$3,060.20
|
|
|
AMBI PLATE SHORT BARREL 5H 130
|
Facility
|
OP
|
$3,957.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.52 |
| Max. Negotiated Rate |
$3,799.56 |
| Rate for Payer: Aetna Commercial |
$3,047.57
|
| Rate for Payer: Anthem Medicaid |
$1,361.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,087.15
|
| Rate for Payer: Cash Price |
$1,978.94
|
| Rate for Payer: Cigna Commercial |
$3,285.04
|
| Rate for Payer: First Health Commercial |
$3,759.99
|
| Rate for Payer: Humana Commercial |
$3,364.20
|
| Rate for Payer: Humana KY Medicaid |
$1,361.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.94
|
| Rate for Payer: PHCS Commercial |
$3,799.56
|
| Rate for Payer: United Healthcare All Payer |
$3,482.93
|
|
