Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

FY Face, Neck,Chest -PP #1 50%

Professional

Both

$956.00

Hospital Charge Code	22200264
Hospital Revenue Code	222
Min. Negotiated Rate	$334.60
Max. Negotiated Rate	$956.00
Rate for Payer: Buckeye Medicare Advantage	$956.00
Rate for Payer: Cash Price	$478.00
Rate for Payer: Multiplan PHCS	$573.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$669.20
Rate for Payer: UHCCP Medicaid	$334.60

FY Face, Neck,Chest-PP#2/3 25%

Professional

Both

$478.00

Hospital Charge Code	22200679
Hospital Revenue Code	222
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$478.00
Rate for Payer: Buckeye Medicare Advantage	$478.00
Rate for Payer: Cash Price	$239.00
Rate for Payer: Multiplan PHCS	$286.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$334.60
Rate for Payer: UHCCP Medicaid	$167.30

FY Full Face

Professional

Both

$375.00

Hospital Charge Code	22200686
Hospital Revenue Code	222
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$375.00
Rate for Payer: Buckeye Medicare Advantage	$375.00
Rate for Payer: Cash Price	$187.50
Rate for Payer: Multiplan PHCS	$225.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$262.50
Rate for Payer: UHCCP Medicaid	$131.25

FY Full Face - PP #1 50%

Professional

Both

$478.00

Hospital Charge Code	22200261
Hospital Revenue Code	222
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$478.00
Rate for Payer: Buckeye Medicare Advantage	$478.00
Rate for Payer: Cash Price	$239.00
Rate for Payer: Multiplan PHCS	$286.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$334.60
Rate for Payer: UHCCP Medicaid	$167.30

FY Full Face - PP #2/3 25%

Professional

Both

$239.00

Hospital Charge Code	22200685
Hospital Revenue Code	222
Min. Negotiated Rate	$83.65
Max. Negotiated Rate	$239.00
Rate for Payer: Buckeye Medicare Advantage	$239.00
Rate for Payer: Cash Price	$119.50
Rate for Payer: Multiplan PHCS	$143.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$167.30
Rate for Payer: UHCCP Medicaid	$83.65

FY Neck or Chest

Professional

Both

$200.00

Hospital Charge Code	22200684
Hospital Revenue Code	222
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$200.00
Rate for Payer: Buckeye Medicare Advantage	$200.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Multiplan PHCS	$120.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$140.00
Rate for Payer: UHCCP Medicaid	$70.00

FY Neck or Chest - PP #1 50%

Professional

Both

$256.00

Hospital Charge Code	22200262
Hospital Revenue Code	222
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$256.00
Rate for Payer: Buckeye Medicare Advantage	$256.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Multiplan PHCS	$153.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$179.20
Rate for Payer: UHCCP Medicaid	$89.60

FY Neck or Chest-PP#2/3 25%

Professional

Both

$127.00

Hospital Charge Code	22200683
Hospital Revenue Code	222
Min. Negotiated Rate	$44.45
Max. Negotiated Rate	$127.00
Rate for Payer: Buckeye Medicare Advantage	$127.00
Rate for Payer: Cash Price	$63.50
Rate for Payer: Multiplan PHCS	$76.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$88.90
Rate for Payer: UHCCP Medicaid	$44.45

FY Upper Legs

Professional

Both

$1,100.00

Hospital Charge Code	22200711
Hospital Revenue Code	222
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Buckeye Medicare Advantage	$1,100.00
Rate for Payer: Cash Price	$550.00
Rate for Payer: Multiplan PHCS	$660.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$770.00
Rate for Payer: UHCCP Medicaid	$385.00

FY Upper Legs - PP #1 50%

Professional

Both

$1,402.50

Hospital Charge Code	22200712
Hospital Revenue Code	222
Min. Negotiated Rate	$490.88
Max. Negotiated Rate	$1,402.50
Rate for Payer: Buckeye Medicare Advantage	$1,402.50
Rate for Payer: Cash Price	$701.25
Rate for Payer: Multiplan PHCS	$841.50
Rate for Payer: Ohio Health Choice Preferred Health Choice	$981.75
Rate for Payer: UHCCP Medicaid	$490.88

FY Upper Legs-PP#2/3 25%

Professional

Both

$701.25

Hospital Charge Code	22200713
Hospital Revenue Code	222
Min. Negotiated Rate	$245.44
Max. Negotiated Rate	$701.25
Rate for Payer: Buckeye Medicare Advantage	$701.25
Rate for Payer: Cash Price	$350.62
Rate for Payer: Multiplan PHCS	$420.75
Rate for Payer: Ohio Health Choice Preferred Health Choice	$490.88
Rate for Payer: UHCCP Medicaid	$245.44

G2 CONST INSERT SZ 1-2 11MM

Facility

$13,739.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,786.07
Max. Negotiated Rate	$13,189.44
Rate for Payer: Aetna Commercial	$10,579.03
Rate for Payer: Anthem Medicaid	$4,724.84
Rate for Payer: Anthem POS/PPO/Traditional	$10,716.42
Rate for Payer: Cash Price	$6,869.50
Rate for Payer: Cigna Commercial	$11,403.37
Rate for Payer: First Health Commercial	$13,052.05
Rate for Payer: Humana Commercial	$11,678.15
Rate for Payer: Humana KY Medicaid	$4,724.84
Rate for Payer: Kentucky WC Medicaid	$4,772.93
Rate for Payer: Medical Mutual Of Ohio HMO	$11,265.98
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$10,139.38
Rate for Payer: Molina Healthcare Benefit Exchange	$4,121.70
Rate for Payer: Molina Healthcare Medicaid	$4,819.64
Rate for Payer: Ohio Health Choice Commercial	$12,090.32
Rate for Payer: Ohio Health Group HMO	$10,304.25
Rate for Payer: Ohio Health Group PPO Differential	$2,747.80
Rate for Payer: Ohio Health Group PPO No Differential	$1,786.07
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,259.09
Rate for Payer: PHCS Commercial	$13,189.44
Rate for Payer: United Healthcare All Payer	$12,090.32

G2 CONST INSERT SZ 1-2 11MM

Facility

$13,739.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,786.07
Max. Negotiated Rate	$13,189.44
Rate for Payer: Aetna Commercial	$10,579.03
Rate for Payer: Anthem POS/PPO/Traditional	$10,716.42
Rate for Payer: Cash Price	$6,869.50
Rate for Payer: Cigna Commercial	$11,403.37
Rate for Payer: First Health Commercial	$13,052.05
Rate for Payer: Humana Commercial	$11,678.15
Rate for Payer: Medical Mutual Of Ohio HMO	$11,265.98
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$10,139.38
Rate for Payer: Molina Healthcare Benefit Exchange	$4,121.70
Rate for Payer: Ohio Health Choice Commercial	$12,090.32
Rate for Payer: Ohio Health Group HMO	$10,304.25
Rate for Payer: Ohio Health Group PPO Differential	$2,747.80
Rate for Payer: Ohio Health Group PPO No Differential	$1,786.07
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,259.09
Rate for Payer: PHCS Commercial	$13,189.44
Rate for Payer: United Healthcare All Payer	$12,090.32

G2 CONST INSERT SZ 1-2 13MM

Facility

$15,378.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.14
Max. Negotiated Rate	$14,762.88
Rate for Payer: Aetna Commercial	$11,841.06
Rate for Payer: Anthem Medicaid	$5,288.49
Rate for Payer: Anthem POS/PPO/Traditional	$11,994.84
Rate for Payer: Cash Price	$7,689.00
Rate for Payer: Cigna Commercial	$12,763.74
Rate for Payer: First Health Commercial	$14,609.10
Rate for Payer: Humana Commercial	$13,071.30
Rate for Payer: Humana KY Medicaid	$5,288.49
Rate for Payer: Kentucky WC Medicaid	$5,342.32
Rate for Payer: Medical Mutual Of Ohio HMO	$12,609.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11,348.96
Rate for Payer: Molina Healthcare Benefit Exchange	$4,613.40
Rate for Payer: Molina Healthcare Medicaid	$5,394.60
Rate for Payer: Ohio Health Choice Commercial	$13,532.64
Rate for Payer: Ohio Health Group HMO	$11,533.50
Rate for Payer: Ohio Health Group PPO Differential	$3,075.60
Rate for Payer: Ohio Health Group PPO No Differential	$1,999.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,767.18
Rate for Payer: PHCS Commercial	$14,762.88
Rate for Payer: United Healthcare All Payer	$13,532.64

G2 CONST INSERT SZ 1-2 13MM

Facility

$15,378.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.14
Max. Negotiated Rate	$14,762.88
Rate for Payer: Aetna Commercial	$11,841.06
Rate for Payer: Anthem POS/PPO/Traditional	$11,994.84
Rate for Payer: Cash Price	$7,689.00
Rate for Payer: Cigna Commercial	$12,763.74
Rate for Payer: First Health Commercial	$14,609.10
Rate for Payer: Humana Commercial	$13,071.30
Rate for Payer: Medical Mutual Of Ohio HMO	$12,609.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11,348.96
Rate for Payer: Molina Healthcare Benefit Exchange	$4,613.40
Rate for Payer: Ohio Health Choice Commercial	$13,532.64
Rate for Payer: Ohio Health Group HMO	$11,533.50
Rate for Payer: Ohio Health Group PPO Differential	$3,075.60
Rate for Payer: Ohio Health Group PPO No Differential	$1,999.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,767.18
Rate for Payer: PHCS Commercial	$14,762.88
Rate for Payer: United Healthcare All Payer	$13,532.64

G2 CONST INSERT SZ 1-2 15MM

Facility

$15,378.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.14
Max. Negotiated Rate	$14,762.88
Rate for Payer: Aetna Commercial	$11,841.06
Rate for Payer: Anthem POS/PPO/Traditional	$11,994.84
Rate for Payer: Cash Price	$7,689.00
Rate for Payer: Cigna Commercial	$12,763.74
Rate for Payer: First Health Commercial	$14,609.10
Rate for Payer: Humana Commercial	$13,071.30
Rate for Payer: Medical Mutual Of Ohio HMO	$12,609.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11,348.96
Rate for Payer: Molina Healthcare Benefit Exchange	$4,613.40
Rate for Payer: Ohio Health Choice Commercial	$13,532.64
Rate for Payer: Ohio Health Group HMO	$11,533.50
Rate for Payer: Ohio Health Group PPO Differential	$3,075.60
Rate for Payer: Ohio Health Group PPO No Differential	$1,999.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,767.18
Rate for Payer: PHCS Commercial	$14,762.88
Rate for Payer: United Healthcare All Payer	$13,532.64

G2 CONST INSERT SZ 1-2 15MM

Facility

$15,378.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.14
Max. Negotiated Rate	$14,762.88
Rate for Payer: Aetna Commercial	$11,841.06
Rate for Payer: Anthem Medicaid	$5,288.49
Rate for Payer: Anthem POS/PPO/Traditional	$11,994.84
Rate for Payer: Cash Price	$7,689.00
Rate for Payer: Cigna Commercial	$12,763.74
Rate for Payer: First Health Commercial	$14,609.10
Rate for Payer: Humana Commercial	$13,071.30
Rate for Payer: Humana KY Medicaid	$5,288.49
Rate for Payer: Kentucky WC Medicaid	$5,342.32
Rate for Payer: Medical Mutual Of Ohio HMO	$12,609.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11,348.96
Rate for Payer: Molina Healthcare Benefit Exchange	$4,613.40
Rate for Payer: Molina Healthcare Medicaid	$5,394.60
Rate for Payer: Ohio Health Choice Commercial	$13,532.64
Rate for Payer: Ohio Health Group HMO	$11,533.50
Rate for Payer: Ohio Health Group PPO Differential	$3,075.60
Rate for Payer: Ohio Health Group PPO No Differential	$1,999.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,767.18
Rate for Payer: PHCS Commercial	$14,762.88
Rate for Payer: United Healthcare All Payer	$13,532.64

G2 CONST INSERT SZ 1-2 18MM

Facility

$15,378.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.14
Max. Negotiated Rate	$14,762.88
Rate for Payer: Aetna Commercial	$11,841.06
Rate for Payer: Anthem Medicaid	$5,288.49
Rate for Payer: Anthem POS/PPO/Traditional	$11,994.84
Rate for Payer: Cash Price	$7,689.00
Rate for Payer: Cigna Commercial	$12,763.74
Rate for Payer: First Health Commercial	$14,609.10
Rate for Payer: Humana Commercial	$13,071.30
Rate for Payer: Humana KY Medicaid	$5,288.49
Rate for Payer: Kentucky WC Medicaid	$5,342.32
Rate for Payer: Medical Mutual Of Ohio HMO	$12,609.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11,348.96
Rate for Payer: Molina Healthcare Benefit Exchange	$4,613.40
Rate for Payer: Molina Healthcare Medicaid	$5,394.60
Rate for Payer: Ohio Health Choice Commercial	$13,532.64
Rate for Payer: Ohio Health Group HMO	$11,533.50
Rate for Payer: Ohio Health Group PPO Differential	$3,075.60
Rate for Payer: Ohio Health Group PPO No Differential	$1,999.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,767.18
Rate for Payer: PHCS Commercial	$14,762.88
Rate for Payer: United Healthcare All Payer	$13,532.64

G2 CONST INSERT SZ 1-2 18MM

Facility

$15,378.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.14
Max. Negotiated Rate	$14,762.88
Rate for Payer: Aetna Commercial	$11,841.06
Rate for Payer: Anthem POS/PPO/Traditional	$11,994.84
Rate for Payer: Cash Price	$7,689.00
Rate for Payer: Cigna Commercial	$12,763.74
Rate for Payer: First Health Commercial	$14,609.10
Rate for Payer: Humana Commercial	$13,071.30
Rate for Payer: Medical Mutual Of Ohio HMO	$12,609.96
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11,348.96
Rate for Payer: Molina Healthcare Benefit Exchange	$4,613.40
Rate for Payer: Ohio Health Choice Commercial	$13,532.64
Rate for Payer: Ohio Health Group HMO	$11,533.50
Rate for Payer: Ohio Health Group PPO Differential	$3,075.60
Rate for Payer: Ohio Health Group PPO No Differential	$1,999.14
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,767.18
Rate for Payer: PHCS Commercial	$14,762.88
Rate for Payer: United Healthcare All Payer	$13,532.64

G2 CONST INSERT SZ 1-2 21MM

Facility

$9,870.60

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.18
Max. Negotiated Rate	$9,475.78
Rate for Payer: Aetna Commercial	$7,600.36
Rate for Payer: Anthem Medicaid	$3,394.50
Rate for Payer: Anthem POS/PPO/Traditional	$7,699.07
Rate for Payer: Cash Price	$4,935.30
Rate for Payer: Cigna Commercial	$8,192.60
Rate for Payer: First Health Commercial	$9,377.07
Rate for Payer: Humana Commercial	$8,390.01
Rate for Payer: Humana KY Medicaid	$3,394.50
Rate for Payer: Kentucky WC Medicaid	$3,429.05
Rate for Payer: Medical Mutual Of Ohio HMO	$8,093.89
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7,284.50
Rate for Payer: Molina Healthcare Benefit Exchange	$2,961.18
Rate for Payer: Molina Healthcare Medicaid	$3,462.61
Rate for Payer: Ohio Health Choice Commercial	$8,686.13
Rate for Payer: Ohio Health Group HMO	$7,402.95
Rate for Payer: Ohio Health Group PPO Differential	$1,974.12
Rate for Payer: Ohio Health Group PPO No Differential	$1,283.18
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,059.89
Rate for Payer: PHCS Commercial	$9,475.78
Rate for Payer: United Healthcare All Payer	$8,686.13

G2 CONST INSERT SZ 1-2 21MM

Facility

$9,870.60

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.18
Max. Negotiated Rate	$9,475.78
Rate for Payer: Aetna Commercial	$7,600.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,699.07
Rate for Payer: Cash Price	$4,935.30
Rate for Payer: Cigna Commercial	$8,192.60
Rate for Payer: First Health Commercial	$9,377.07
Rate for Payer: Humana Commercial	$8,390.01
Rate for Payer: Medical Mutual Of Ohio HMO	$8,093.89
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7,284.50
Rate for Payer: Molina Healthcare Benefit Exchange	$2,961.18
Rate for Payer: Ohio Health Choice Commercial	$8,686.13
Rate for Payer: Ohio Health Group HMO	$7,402.95
Rate for Payer: Ohio Health Group PPO Differential	$1,974.12
Rate for Payer: Ohio Health Group PPO No Differential	$1,283.18
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,059.89
Rate for Payer: PHCS Commercial	$9,475.78
Rate for Payer: United Healthcare All Payer	$8,686.13

G2 CONST INSERT SZ 1-2 25MM

Facility

$9,870.60

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.18
Max. Negotiated Rate	$9,475.78
Rate for Payer: Aetna Commercial	$7,600.36
Rate for Payer: Anthem Medicaid	$3,394.50
Rate for Payer: Anthem POS/PPO/Traditional	$7,699.07
Rate for Payer: Cash Price	$4,935.30
Rate for Payer: Cigna Commercial	$8,192.60
Rate for Payer: First Health Commercial	$9,377.07
Rate for Payer: Humana Commercial	$8,390.01
Rate for Payer: Humana KY Medicaid	$3,394.50
Rate for Payer: Kentucky WC Medicaid	$3,429.05
Rate for Payer: Medical Mutual Of Ohio HMO	$8,093.89
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7,284.50
Rate for Payer: Molina Healthcare Benefit Exchange	$2,961.18
Rate for Payer: Molina Healthcare Medicaid	$3,462.61
Rate for Payer: Ohio Health Choice Commercial	$8,686.13
Rate for Payer: Ohio Health Group HMO	$7,402.95
Rate for Payer: Ohio Health Group PPO Differential	$1,974.12
Rate for Payer: Ohio Health Group PPO No Differential	$1,283.18
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,059.89
Rate for Payer: PHCS Commercial	$9,475.78
Rate for Payer: United Healthcare All Payer	$8,686.13

G2 CONST INSERT SZ 1-2 25MM

Facility

$9,870.60

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.18
Max. Negotiated Rate	$9,475.78
Rate for Payer: Aetna Commercial	$7,600.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,699.07
Rate for Payer: Cash Price	$4,935.30
Rate for Payer: Cigna Commercial	$8,192.60
Rate for Payer: First Health Commercial	$9,377.07
Rate for Payer: Humana Commercial	$8,390.01
Rate for Payer: Medical Mutual Of Ohio HMO	$8,093.89
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7,284.50
Rate for Payer: Molina Healthcare Benefit Exchange	$2,961.18
Rate for Payer: Ohio Health Choice Commercial	$8,686.13
Rate for Payer: Ohio Health Group HMO	$7,402.95
Rate for Payer: Ohio Health Group PPO Differential	$1,974.12
Rate for Payer: Ohio Health Group PPO No Differential	$1,283.18
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,059.89
Rate for Payer: PHCS Commercial	$9,475.78
Rate for Payer: United Healthcare All Payer	$8,686.13

G2 CONST INSERT SZ 1-2 30MM

Facility

$9,870.60

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.18
Max. Negotiated Rate	$9,475.78
Rate for Payer: Aetna Commercial	$7,600.36
Rate for Payer: Anthem POS/PPO/Traditional	$7,699.07
Rate for Payer: Cash Price	$4,935.30
Rate for Payer: Cigna Commercial	$8,192.60
Rate for Payer: First Health Commercial	$9,377.07
Rate for Payer: Humana Commercial	$8,390.01
Rate for Payer: Medical Mutual Of Ohio HMO	$8,093.89
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7,284.50
Rate for Payer: Molina Healthcare Benefit Exchange	$2,961.18
Rate for Payer: Ohio Health Choice Commercial	$8,686.13
Rate for Payer: Ohio Health Group HMO	$7,402.95
Rate for Payer: Ohio Health Group PPO Differential	$1,974.12
Rate for Payer: Ohio Health Group PPO No Differential	$1,283.18
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,059.89
Rate for Payer: PHCS Commercial	$9,475.78
Rate for Payer: United Healthcare All Payer	$8,686.13

G2 CONST INSERT SZ 1-2 30MM

Facility

$9,870.60

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$1,283.18
Max. Negotiated Rate	$9,475.78
Rate for Payer: Aetna Commercial	$7,600.36
Rate for Payer: Anthem Medicaid	$3,394.50
Rate for Payer: Anthem POS/PPO/Traditional	$7,699.07
Rate for Payer: Cash Price	$4,935.30
Rate for Payer: Cigna Commercial	$8,192.60
Rate for Payer: First Health Commercial	$9,377.07
Rate for Payer: Humana Commercial	$8,390.01
Rate for Payer: Humana KY Medicaid	$3,394.50
Rate for Payer: Kentucky WC Medicaid	$3,429.05
Rate for Payer: Medical Mutual Of Ohio HMO	$8,093.89
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7,284.50
Rate for Payer: Molina Healthcare Benefit Exchange	$2,961.18
Rate for Payer: Molina Healthcare Medicaid	$3,462.61
Rate for Payer: Ohio Health Choice Commercial	$8,686.13
Rate for Payer: Ohio Health Group HMO	$7,402.95
Rate for Payer: Ohio Health Group PPO Differential	$1,974.12
Rate for Payer: Ohio Health Group PPO No Differential	$1,283.18
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,059.89
Rate for Payer: PHCS Commercial	$9,475.78
Rate for Payer: United Healthcare All Payer	$8,686.13

Know your out-of-pocket cost for care.

All Charges