Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

ANESTH REMOVAL OF TESTIS

Professional

Both

$8.00

Service Code	HCPCS 926
Hospital Charge Code	37000086
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH REMOVAL OF TESTIS

Facility

$8.00

Service Code	HCPCS 00926
Hospital Charge Code	37000086
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REPAIR OF CERVIX

Facility

$8.00

Service Code	HCPCS 00948
Hospital Charge Code	37000091
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REPAIR OF CERVIX

Facility

$8.00

Service Code	HCPCS 00948
Hospital Charge Code	37000091
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REPAIR OF CERVIX

Professional

Both

$8.00

Service Code	HCPCS 948
Hospital Charge Code	37000091
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH REPAIR OF HERNIA

Facility

$8.00

Service Code	HCPCS 00754
Hospital Charge Code	37000054
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REPAIR OF HERNIA

Professional

Both

$8.00

Service Code	HCPCS 754
Hospital Charge Code	37000054
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH REPAIR OF HERNIA

Professional

Both

$8.00

Service Code	HCPCS 830
Hospital Charge Code	37000066
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH REPAIR OF HERNIA

Facility

$8.00

Service Code	HCPCS 00830
Hospital Charge Code	37000066
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REPAIR OF HERNIA

Professional

Both

$3.50

Service Code	HCPCS 832
Hospital Charge Code	37000263
Hospital Revenue Code	370
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$2.45
Rate for Payer: Cash Price	$1.75
Rate for Payer: Multiplan PHCS	$2.10
Rate for Payer: Ohio Health Choice Preferred Health Choice	$2.45
Rate for Payer: UHCCP Medicaid	$1.23

ANESTH REPAIR OF HERNIA

Facility

$8.00

Service Code	HCPCS 00830
Hospital Charge Code	37000066
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REPAIR OF HERNIA

Facility

$8.00

Service Code	HCPCS 00754
Hospital Charge Code	37000054
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REVISE HIP REPAIR

Facility

$8.00

Service Code	HCPCS 01215
Hospital Charge Code	37000099
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REVISE HIP REPAIR

Facility

$8.00

Service Code	HCPCS 01215
Hospital Charge Code	37000099
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH REVISE HIP REPAIR

Professional

Both

$8.00

Service Code	HCPCS 1215
Hospital Charge Code	37000099
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH SALIVARY GLAND

Professional

Both

$8.00

Service Code	HCPCS 100
Hospital Charge Code	37000002
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH SALIVARY GLAND

Facility

$8.00

Service Code	HCPCS 00100
Hospital Charge Code	37000002
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH SALIVARY GLAND

Facility

$8.00

Service Code	HCPCS 00100
Hospital Charge Code	37000002
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH SCAR REV BRST WSLING 45

Facility

$160.00

Hospital Charge Code	37000237
Hospital Revenue Code	370
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$153.60
Rate for Payer: Aetna Commercial	$123.20
Rate for Payer: Anthem Medicaid	$55.02
Rate for Payer: Anthem POS/PPO/Traditional	$124.80
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna Commercial	$132.80
Rate for Payer: First Health Commercial	$152.00
Rate for Payer: Humana Commercial	$136.00
Rate for Payer: Humana KY Medicaid	$55.02
Rate for Payer: Kentucky WC Medicaid	$55.58
Rate for Payer: Medical Mutual Of Ohio HMO	$131.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$118.08
Rate for Payer: Molina Healthcare Benefit Exchange	$48.00
Rate for Payer: Molina Healthcare Medicaid	$56.13
Rate for Payer: Ohio Health Choice Commercial	$140.80
Rate for Payer: Ohio Health Group HMO	$120.00
Rate for Payer: Ohio Health Group PPO Differential	$128.00
Rate for Payer: Ohio Health Group PPO No Differential	$139.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$110.40
Rate for Payer: PHCS Commercial	$153.60
Rate for Payer: United Healthcare All Payer	$140.80

ANESTH SCAR REV BRST WSLING 45

Facility

$160.00

Hospital Charge Code	37000237
Hospital Revenue Code	370
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$153.60
Rate for Payer: Aetna Commercial	$123.20
Rate for Payer: Anthem POS/PPO/Traditional	$124.80
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cigna Commercial	$132.80
Rate for Payer: First Health Commercial	$152.00
Rate for Payer: Humana Commercial	$136.00
Rate for Payer: Medical Mutual Of Ohio HMO	$131.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$118.08
Rate for Payer: Molina Healthcare Benefit Exchange	$48.00
Rate for Payer: Ohio Health Choice Commercial	$140.80
Rate for Payer: Ohio Health Group HMO	$120.00
Rate for Payer: Ohio Health Group PPO Differential	$128.00
Rate for Payer: Ohio Health Group PPO No Differential	$139.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$110.40
Rate for Payer: PHCS Commercial	$153.60
Rate for Payer: United Healthcare All Payer	$140.80

ANESTH SCAR REV BRST WSLING 45

Professional

Both

$160.00

Hospital Charge Code	37000237
Hospital Revenue Code	370
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$112.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Multiplan PHCS	$96.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$112.00
Rate for Payer: UHCCP Medicaid	$56.00

ANESTH SHOULDER PROCEDURE

Facility

$8.00

Service Code	HCPCS 01620
Hospital Charge Code	37000131
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH SHOULDER PROCEDURE

Facility

$8.00

Service Code	HCPCS 01620
Hospital Charge Code	37000131
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

ANESTH SHOULDER PROCEDURE

Professional

Both

$8.00

Service Code	HCPCS 1620
Hospital Charge Code	37000131
Hospital Revenue Code	370
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.60
Rate for Payer: Cash Price	$4.00
Rate for Payer: Multiplan PHCS	$4.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5.60
Rate for Payer: UHCCP Medicaid	$2.80

ANESTH SHOULDER REPLACEMENT

Facility

$8.00

Service Code	HCPCS 01638
Hospital Charge Code	37000134
Hospital Revenue Code	370
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$7.68
Rate for Payer: Aetna Commercial	$6.16
Rate for Payer: Anthem Medicaid	$2.75
Rate for Payer: Anthem POS/PPO/Traditional	$6.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cigna Commercial	$6.64
Rate for Payer: First Health Commercial	$7.60
Rate for Payer: Humana Commercial	$6.80
Rate for Payer: Humana KY Medicaid	$2.75
Rate for Payer: Kentucky WC Medicaid	$2.78
Rate for Payer: Medical Mutual Of Ohio HMO	$6.56
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5.90
Rate for Payer: Molina Healthcare Benefit Exchange	$2.40
Rate for Payer: Molina Healthcare Medicaid	$2.81
Rate for Payer: Ohio Health Choice Commercial	$7.04
Rate for Payer: Ohio Health Group HMO	$6.00
Rate for Payer: Ohio Health Group PPO Differential	$6.40
Rate for Payer: Ohio Health Group PPO No Differential	$6.96
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5.52
Rate for Payer: PHCS Commercial	$7.68
Rate for Payer: United Healthcare All Payer	$7.04

Know your out-of-pocket cost for care.

All Charges