Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

HEAD HUMERAL 44MM*17MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 44MM*19MM

Facility

$7,380.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.00
Max. Negotiated Rate	$7,084.80
Rate for Payer: Aetna Commercial	$5,682.60
Rate for Payer: Anthem Medicaid	$2,537.98
Rate for Payer: Anthem POS/PPO/Traditional	$5,756.40
Rate for Payer: Cash Price	$3,690.00
Rate for Payer: Cigna Commercial	$6,125.40
Rate for Payer: First Health Commercial	$7,011.00
Rate for Payer: Humana Commercial	$6,273.00
Rate for Payer: Humana KY Medicaid	$2,537.98
Rate for Payer: Kentucky WC Medicaid	$2,563.81
Rate for Payer: Medical Mutual Of Ohio HMO	$6,051.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,446.44
Rate for Payer: Molina Healthcare Benefit Exchange	$2,214.00
Rate for Payer: Molina Healthcare Medicaid	$2,588.90
Rate for Payer: Ohio Health Choice Commercial	$6,494.40
Rate for Payer: Ohio Health Group HMO	$5,535.00
Rate for Payer: Ohio Health Group PPO Differential	$5,904.00
Rate for Payer: Ohio Health Group PPO No Differential	$6,420.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,092.20
Rate for Payer: PHCS Commercial	$7,084.80
Rate for Payer: United Healthcare All Payer	$6,494.40

HEAD HUMERAL 44MM*19MM

Facility

$7,380.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.00
Max. Negotiated Rate	$7,084.80
Rate for Payer: Aetna Commercial	$5,682.60
Rate for Payer: Anthem POS/PPO/Traditional	$5,756.40
Rate for Payer: Cash Price	$3,690.00
Rate for Payer: Cigna Commercial	$6,125.40
Rate for Payer: First Health Commercial	$7,011.00
Rate for Payer: Humana Commercial	$6,273.00
Rate for Payer: Medical Mutual Of Ohio HMO	$6,051.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,446.44
Rate for Payer: Molina Healthcare Benefit Exchange	$2,214.00
Rate for Payer: Ohio Health Choice Commercial	$6,494.40
Rate for Payer: Ohio Health Group HMO	$5,535.00
Rate for Payer: Ohio Health Group PPO Differential	$5,904.00
Rate for Payer: Ohio Health Group PPO No Differential	$6,420.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,092.20
Rate for Payer: PHCS Commercial	$7,084.80
Rate for Payer: United Healthcare All Payer	$6,494.40

HEAD HUMERAL 46MM*18MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem Medicaid	$3,228.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Humana KY Medicaid	$3,228.36
Rate for Payer: Kentucky WC Medicaid	$3,261.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Molina Healthcare Medicaid	$3,293.14
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 46MM*18MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 46MM*20MM

Facility

$7,380.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.00
Max. Negotiated Rate	$7,084.80
Rate for Payer: Aetna Commercial	$5,682.60
Rate for Payer: Anthem POS/PPO/Traditional	$5,756.40
Rate for Payer: Cash Price	$3,690.00
Rate for Payer: Cigna Commercial	$6,125.40
Rate for Payer: First Health Commercial	$7,011.00
Rate for Payer: Humana Commercial	$6,273.00
Rate for Payer: Medical Mutual Of Ohio HMO	$6,051.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,446.44
Rate for Payer: Molina Healthcare Benefit Exchange	$2,214.00
Rate for Payer: Ohio Health Choice Commercial	$6,494.40
Rate for Payer: Ohio Health Group HMO	$5,535.00
Rate for Payer: Ohio Health Group PPO Differential	$5,904.00
Rate for Payer: Ohio Health Group PPO No Differential	$6,420.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,092.20
Rate for Payer: PHCS Commercial	$7,084.80
Rate for Payer: United Healthcare All Payer	$6,494.40

HEAD HUMERAL 46MM*20MM

Facility

$7,380.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.00
Max. Negotiated Rate	$7,084.80
Rate for Payer: Aetna Commercial	$5,682.60
Rate for Payer: Anthem Medicaid	$2,537.98
Rate for Payer: Anthem POS/PPO/Traditional	$5,756.40
Rate for Payer: Cash Price	$3,690.00
Rate for Payer: Cigna Commercial	$6,125.40
Rate for Payer: First Health Commercial	$7,011.00
Rate for Payer: Humana Commercial	$6,273.00
Rate for Payer: Humana KY Medicaid	$2,537.98
Rate for Payer: Kentucky WC Medicaid	$2,563.81
Rate for Payer: Medical Mutual Of Ohio HMO	$6,051.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,446.44
Rate for Payer: Molina Healthcare Benefit Exchange	$2,214.00
Rate for Payer: Molina Healthcare Medicaid	$2,588.90
Rate for Payer: Ohio Health Choice Commercial	$6,494.40
Rate for Payer: Ohio Health Group HMO	$5,535.00
Rate for Payer: Ohio Health Group PPO Differential	$5,904.00
Rate for Payer: Ohio Health Group PPO No Differential	$6,420.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,092.20
Rate for Payer: PHCS Commercial	$7,084.80
Rate for Payer: United Healthcare All Payer	$6,494.40

HEAD HUMERAL 48MM*19MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem Medicaid	$3,228.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Humana KY Medicaid	$3,228.36
Rate for Payer: Kentucky WC Medicaid	$3,261.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Molina Healthcare Medicaid	$3,293.14
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 48MM*19MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 48MM*21MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 48MM*21MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem Medicaid	$2,745.10
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Humana KY Medicaid	$2,745.10
Rate for Payer: Kentucky WC Medicaid	$2,773.03
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Molina Healthcare Medicaid	$2,800.17
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 50MM*19MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem Medicaid	$3,228.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Humana KY Medicaid	$3,228.36
Rate for Payer: Kentucky WC Medicaid	$3,261.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Molina Healthcare Medicaid	$3,293.14
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 50MM*19MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 50MM*21MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 50MM*21MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem Medicaid	$3,228.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Humana KY Medicaid	$3,228.36
Rate for Payer: Kentucky WC Medicaid	$3,261.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Molina Healthcare Medicaid	$3,293.14
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 52MM*20MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 52MM*20MM

Facility

$9,387.50

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.25
Max. Negotiated Rate	$9,012.00
Rate for Payer: Aetna Commercial	$7,228.38
Rate for Payer: Anthem Medicaid	$3,228.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,322.25
Rate for Payer: Cash Price	$4,693.75
Rate for Payer: Cigna Commercial	$7,791.62
Rate for Payer: First Health Commercial	$8,918.12
Rate for Payer: Humana Commercial	$7,979.38
Rate for Payer: Humana KY Medicaid	$3,228.36
Rate for Payer: Kentucky WC Medicaid	$3,261.22
Rate for Payer: Medical Mutual Of Ohio HMO	$7,697.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,927.98
Rate for Payer: Molina Healthcare Benefit Exchange	$2,816.25
Rate for Payer: Molina Healthcare Medicaid	$3,293.14
Rate for Payer: Ohio Health Choice Commercial	$8,261.00
Rate for Payer: Ohio Health Group HMO	$7,040.62
Rate for Payer: Ohio Health Group PPO Differential	$7,510.00
Rate for Payer: Ohio Health Group PPO No Differential	$8,167.12
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,477.38
Rate for Payer: PHCS Commercial	$9,012.00
Rate for Payer: United Healthcare All Payer	$8,261.00

HEAD HUMERAL 52MM*22MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 52MM*22MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem Medicaid	$2,745.10
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Humana KY Medicaid	$2,745.10
Rate for Payer: Kentucky WC Medicaid	$2,773.03
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Molina Healthcare Medicaid	$2,800.17
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 54MM*21MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem Medicaid	$2,745.10
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Humana KY Medicaid	$2,745.10
Rate for Payer: Kentucky WC Medicaid	$2,773.03
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Molina Healthcare Medicaid	$2,800.17
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 54MM*21MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 54MM*23MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem Medicaid	$2,745.10
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Humana KY Medicaid	$2,745.10
Rate for Payer: Kentucky WC Medicaid	$2,773.03
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Molina Healthcare Medicaid	$2,800.17
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 54MM*23MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 56MM*22MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem Medicaid	$2,745.10
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Humana KY Medicaid	$2,745.10
Rate for Payer: Kentucky WC Medicaid	$2,773.03
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Molina Healthcare Medicaid	$2,800.17
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

HEAD HUMERAL 56MM*22MM

Facility

$7,982.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,394.68
Max. Negotiated Rate	$7,662.96
Rate for Payer: Aetna Commercial	$6,146.33
Rate for Payer: Anthem POS/PPO/Traditional	$6,226.15
Rate for Payer: Cash Price	$3,991.12
Rate for Payer: Cigna Commercial	$6,625.27
Rate for Payer: First Health Commercial	$7,583.14
Rate for Payer: Humana Commercial	$6,784.91
Rate for Payer: Medical Mutual Of Ohio HMO	$6,545.44
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,890.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2,394.68
Rate for Payer: Ohio Health Choice Commercial	$7,024.38
Rate for Payer: Ohio Health Group HMO	$5,986.69
Rate for Payer: Ohio Health Group PPO Differential	$6,385.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,944.56
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,507.75
Rate for Payer: PHCS Commercial	$7,662.96
Rate for Payer: United Healthcare All Payer	$7,024.38

Know your out-of-pocket cost for care.

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