Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

LINER HUMERAL L/42+6 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+3

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+3

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+3 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+3 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+6

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+6

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+6 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL M/39+6 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+3

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+3

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+3 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+3 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+6

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+6

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+6 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER HUMERAL S/36+6 CONST

Facility

$6,704.75

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,011.42
Max. Negotiated Rate	$6,436.56
Rate for Payer: Aetna Commercial	$5,162.66
Rate for Payer: Anthem Medicaid	$2,305.76
Rate for Payer: Anthem POS/PPO/Traditional	$5,229.70
Rate for Payer: Cash Price	$3,352.38
Rate for Payer: Cigna Commercial	$5,564.94
Rate for Payer: First Health Commercial	$6,369.51
Rate for Payer: Humana Commercial	$5,699.04
Rate for Payer: Humana KY Medicaid	$2,305.76
Rate for Payer: Kentucky WC Medicaid	$2,329.23
Rate for Payer: Medical Mutual Of Ohio HMO	$5,497.90
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,948.11
Rate for Payer: Molina Healthcare Benefit Exchange	$2,011.42
Rate for Payer: Molina Healthcare Medicaid	$2,352.03
Rate for Payer: Ohio Health Choice Commercial	$5,900.18
Rate for Payer: Ohio Health Group HMO	$5,028.56
Rate for Payer: Ohio Health Group PPO Differential	$5,363.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,833.13
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,626.28
Rate for Payer: PHCS Commercial	$6,436.56
Rate for Payer: United Healthcare All Payer	$5,900.18

LINER LGVITY CONSTRAINED HH 28

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED HH 28

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem Medicaid	$6,226.30
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Humana KY Medicaid	$6,226.30
Rate for Payer: Kentucky WC Medicaid	$6,289.67
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Molina Healthcare Medicaid	$6,351.23
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED II 28

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem Medicaid	$6,226.30
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Humana KY Medicaid	$6,226.30
Rate for Payer: Kentucky WC Medicaid	$6,289.67
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Molina Healthcare Medicaid	$6,351.23
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED II 28

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED KK 32

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED KK 32

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem Medicaid	$6,226.30
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Humana KY Medicaid	$6,226.30
Rate for Payer: Kentucky WC Medicaid	$6,289.67
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Molina Healthcare Medicaid	$6,351.23
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED LL 28

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

LINER LGVITY CONSTRAINED LL 28

Facility

$18,104.98

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.49
Max. Negotiated Rate	$17,380.78
Rate for Payer: Aetna Commercial	$13,940.83
Rate for Payer: Anthem Medicaid	$6,226.30
Rate for Payer: Anthem POS/PPO/Traditional	$14,121.88
Rate for Payer: Cash Price	$9,052.49
Rate for Payer: Cigna Commercial	$15,027.13
Rate for Payer: First Health Commercial	$17,199.73
Rate for Payer: Humana Commercial	$15,389.23
Rate for Payer: Humana KY Medicaid	$6,226.30
Rate for Payer: Kentucky WC Medicaid	$6,289.67
Rate for Payer: Medical Mutual Of Ohio HMO	$14,846.08
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$13,361.48
Rate for Payer: Molina Healthcare Benefit Exchange	$5,431.49
Rate for Payer: Molina Healthcare Medicaid	$6,351.23
Rate for Payer: Ohio Health Choice Commercial	$15,932.38
Rate for Payer: Ohio Health Group HMO	$13,578.74
Rate for Payer: Ohio Health Group PPO Differential	$14,483.98
Rate for Payer: Ohio Health Group PPO No Differential	$15,751.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12,492.44
Rate for Payer: PHCS Commercial	$17,380.78
Rate for Payer: United Healthcare All Payer	$15,932.38

Know your out-of-pocket cost for care.

All Charges