|
AMBI PLATE 8 SLOT 135*180MM
|
Facility
|
IP
|
$4,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$4,163.52 |
| Rate for Payer: Aetna Commercial |
$3,339.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,382.86
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,599.71
|
| Rate for Payer: First Health Commercial |
$4,120.15
|
| Rate for Payer: Humana Commercial |
$3,686.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,773.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,992.53
|
| Rate for Payer: PHCS Commercial |
$4,163.52
|
| Rate for Payer: United Healthcare All Payer |
$3,816.56
|
|
|
AMBI PLATE 8 SLOT 140*180MM
|
Facility
|
IP
|
$4,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$4,163.52 |
| Rate for Payer: Aetna Commercial |
$3,339.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,382.86
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,599.71
|
| Rate for Payer: First Health Commercial |
$4,120.15
|
| Rate for Payer: Humana Commercial |
$3,686.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,773.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,992.53
|
| Rate for Payer: PHCS Commercial |
$4,163.52
|
| Rate for Payer: United Healthcare All Payer |
$3,816.56
|
|
|
AMBI PLATE 8 SLOT 140*180MM
|
Facility
|
OP
|
$4,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$4,163.52 |
| Rate for Payer: Aetna Commercial |
$3,339.49
|
| Rate for Payer: Anthem Medicaid |
$1,491.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,382.86
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,599.71
|
| Rate for Payer: First Health Commercial |
$4,120.15
|
| Rate for Payer: Humana Commercial |
$3,686.45
|
| Rate for Payer: Humana KY Medicaid |
$1,491.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,506.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,773.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,992.53
|
| Rate for Payer: PHCS Commercial |
$4,163.52
|
| Rate for Payer: United Healthcare All Payer |
$3,816.56
|
|
|
AMBI PLATE 8 SLOT 145*180MM
|
Facility
|
OP
|
$4,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$4,163.52 |
| Rate for Payer: Aetna Commercial |
$3,339.49
|
| Rate for Payer: Anthem Medicaid |
$1,491.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,382.86
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,599.71
|
| Rate for Payer: First Health Commercial |
$4,120.15
|
| Rate for Payer: Humana Commercial |
$3,686.45
|
| Rate for Payer: Humana KY Medicaid |
$1,491.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,506.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,773.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,992.53
|
| Rate for Payer: PHCS Commercial |
$4,163.52
|
| Rate for Payer: United Healthcare All Payer |
$3,816.56
|
|
|
AMBI PLATE 8 SLOT 145*180MM
|
Facility
|
IP
|
$4,337.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.10 |
| Max. Negotiated Rate |
$4,163.52 |
| Rate for Payer: Aetna Commercial |
$3,339.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,382.86
|
| Rate for Payer: Cash Price |
$2,168.50
|
| Rate for Payer: Cigna Commercial |
$3,599.71
|
| Rate for Payer: First Health Commercial |
$4,120.15
|
| Rate for Payer: Humana Commercial |
$3,686.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,469.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,773.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,992.53
|
| Rate for Payer: PHCS Commercial |
$4,163.52
|
| Rate for Payer: United Healthcare All Payer |
$3,816.56
|
|
|
AMBI PLATE 8 SLOT 150*180MM
|
Facility
|
IP
|
$4,382.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$4,206.72 |
| Rate for Payer: Aetna Commercial |
$3,374.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.96
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$3,637.06
|
| Rate for Payer: First Health Commercial |
$4,162.90
|
| Rate for Payer: Humana Commercial |
$3,724.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,505.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,812.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.58
|
| Rate for Payer: PHCS Commercial |
$4,206.72
|
| Rate for Payer: United Healthcare All Payer |
$3,856.16
|
|
|
AMBI PLATE 8 SLOT 150*180MM
|
Facility
|
OP
|
$4,382.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$4,206.72 |
| Rate for Payer: Aetna Commercial |
$3,374.14
|
| Rate for Payer: Anthem Medicaid |
$1,506.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.96
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$3,637.06
|
| Rate for Payer: First Health Commercial |
$4,162.90
|
| Rate for Payer: Humana Commercial |
$3,724.70
|
| Rate for Payer: Humana KY Medicaid |
$1,506.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,505.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,812.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.58
|
| Rate for Payer: PHCS Commercial |
$4,206.72
|
| Rate for Payer: United Healthcare All Payer |
$3,856.16
|
|
|
AMBI PLATE 8 SLOT 90*164MM
|
Facility
|
OP
|
$4,317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.25 |
| Max. Negotiated Rate |
$4,144.80 |
| Rate for Payer: Aetna Commercial |
$3,324.47
|
| Rate for Payer: Anthem Medicaid |
$1,484.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.65
|
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Cigna Commercial |
$3,583.53
|
| Rate for Payer: First Health Commercial |
$4,101.62
|
| Rate for Payer: Humana Commercial |
$3,669.88
|
| Rate for Payer: Humana KY Medicaid |
$1,484.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,540.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,186.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,295.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,799.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,238.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,454.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,979.07
|
| Rate for Payer: PHCS Commercial |
$4,144.80
|
| Rate for Payer: United Healthcare All Payer |
$3,799.40
|
|
|
AMBI PLATE 8 SLOT 90*164MM
|
Facility
|
IP
|
$4,317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.25 |
| Max. Negotiated Rate |
$4,144.80 |
| Rate for Payer: Aetna Commercial |
$3,324.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.65
|
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Cigna Commercial |
$3,583.53
|
| Rate for Payer: First Health Commercial |
$4,101.62
|
| Rate for Payer: Humana Commercial |
$3,669.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,540.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,186.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,295.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,799.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,238.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,454.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,979.07
|
| Rate for Payer: PHCS Commercial |
$4,144.80
|
| Rate for Payer: United Healthcare All Payer |
$3,799.40
|
|
|
AMBI PLATE 8 SLOT 95*164MM
|
Facility
|
OP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem Medicaid |
$1,335.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Humana KY Medicaid |
$1,335.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE 8 SLOT 95*164MM
|
Facility
|
IP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATEI 4 SLOT 130*100MM
|
Facility
|
OP
|
$3,814.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.28 |
| Max. Negotiated Rate |
$3,661.68 |
| Rate for Payer: Aetna Commercial |
$2,936.97
|
| Rate for Payer: Anthem Medicaid |
$1,311.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.11
|
| Rate for Payer: Cash Price |
$1,907.12
|
| Rate for Payer: Cigna Commercial |
$3,165.83
|
| Rate for Payer: First Health Commercial |
$3,623.54
|
| Rate for Payer: Humana Commercial |
$3,242.11
|
| Rate for Payer: Humana KY Medicaid |
$1,311.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,325.07
|
| 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: Molina Healthcare Benefit Exchange |
$1,144.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,338.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,356.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,051.40
|
| 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: PHCS Commercial |
$3,661.68
|
| Rate for Payer: United Healthcare All Payer |
$3,356.54
|
|
|
AMBI PLATEI 4 SLOT 130*100MM
|
Facility
|
IP
|
$3,814.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.28 |
| Max. Negotiated Rate |
$3,661.68 |
| Rate for Payer: Aetna Commercial |
$2,936.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,975.11
|
| Rate for Payer: Cash Price |
$1,907.12
|
| Rate for Payer: Cigna Commercial |
$3,165.83
|
| Rate for Payer: First Health Commercial |
$3,623.54
|
| Rate for Payer: Humana Commercial |
$3,242.11
|
| 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: Molina Healthcare Benefit Exchange |
$1,144.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,356.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,860.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,051.40
|
| 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: PHCS Commercial |
$3,661.68
|
| Rate for Payer: United Healthcare All Payer |
$3,356.54
|
|
|
AMBI PLATE SHORT BARREL 4H 140
|
Facility
|
IP
|
$3,368.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.62 |
| Max. Negotiated Rate |
$3,234.00 |
| Rate for Payer: Aetna Commercial |
$2,593.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.62
|
| Rate for Payer: Cash Price |
$1,684.38
|
| Rate for Payer: Cigna Commercial |
$2,796.06
|
| Rate for Payer: First Health Commercial |
$3,200.31
|
| Rate for Payer: Humana Commercial |
$2,863.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,695.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.44
|
| Rate for Payer: PHCS Commercial |
$3,234.00
|
| Rate for Payer: United Healthcare All Payer |
$2,964.50
|
|
|
AMBI PLATE SHORT BARREL 4H 140
|
Facility
|
OP
|
$3,368.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.62 |
| Max. Negotiated Rate |
$3,234.00 |
| Rate for Payer: Aetna Commercial |
$2,593.94
|
| Rate for Payer: Anthem Medicaid |
$1,158.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.62
|
| Rate for Payer: Cash Price |
$1,684.38
|
| Rate for Payer: Cigna Commercial |
$2,796.06
|
| Rate for Payer: First Health Commercial |
$3,200.31
|
| Rate for Payer: Humana Commercial |
$2,863.44
|
| Rate for Payer: Humana KY Medicaid |
$1,158.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,695.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.44
|
| Rate for Payer: PHCS Commercial |
$3,234.00
|
| Rate for Payer: United Healthcare All Payer |
$2,964.50
|
|
|
AMBI PLATE SHORT BARREL 5H 130
|
Facility
|
IP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 130
|
Facility
|
OP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem Medicaid |
$1,335.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Humana KY Medicaid |
$1,335.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 135
|
Facility
|
IP
|
$3,885.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.59 |
| Max. Negotiated Rate |
$3,729.90 |
| Rate for Payer: Aetna Commercial |
$2,991.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,030.54
|
| Rate for Payer: Cash Price |
$1,942.66
|
| Rate for Payer: Cigna Commercial |
$3,224.81
|
| Rate for Payer: First Health Commercial |
$3,691.04
|
| Rate for Payer: Humana Commercial |
$3,302.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,185.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,913.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,380.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.86
|
| Rate for Payer: PHCS Commercial |
$3,729.90
|
| Rate for Payer: United Healthcare All Payer |
$3,419.07
|
|
|
AMBI PLATE SHORT BARREL 5H 135
|
Facility
|
OP
|
$3,885.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.59 |
| Max. Negotiated Rate |
$3,729.90 |
| Rate for Payer: Aetna Commercial |
$2,991.69
|
| Rate for Payer: Anthem Medicaid |
$1,336.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,030.54
|
| Rate for Payer: Cash Price |
$1,942.66
|
| Rate for Payer: Cigna Commercial |
$3,224.81
|
| Rate for Payer: First Health Commercial |
$3,691.04
|
| Rate for Payer: Humana Commercial |
$3,302.51
|
| Rate for Payer: Humana KY Medicaid |
$1,336.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,185.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,913.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,380.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.86
|
| Rate for Payer: PHCS Commercial |
$3,729.90
|
| Rate for Payer: United Healthcare All Payer |
$3,419.07
|
|
|
AMBI PLATE SHORT BARREL 5H 140
|
Facility
|
OP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem Medicaid |
$1,335.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Humana KY Medicaid |
$1,335.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 140
|
Facility
|
IP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 145
|
Facility
|
OP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem Medicaid |
$1,335.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Humana KY Medicaid |
$1,335.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 145
|
Facility
|
IP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 150
|
Facility
|
OP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem Medicaid |
$1,335.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Humana KY Medicaid |
$1,335.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
|
AMBI PLATE SHORT BARREL 5H 150
|
Facility
|
IP
|
$3,883.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$3,728.10 |
| Rate for Payer: Aetna Commercial |
$2,990.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.08
|
| Rate for Payer: Cash Price |
$1,941.72
|
| Rate for Payer: Cigna Commercial |
$3,223.26
|
| Rate for Payer: First Health Commercial |
$3,689.27
|
| Rate for Payer: Humana Commercial |
$3,300.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.57
|
| Rate for Payer: PHCS Commercial |
$3,728.10
|
| Rate for Payer: United Healthcare All Payer |
$3,417.43
|
|
