Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

HALDOL (HALOPERIDOL) .5MG/1TAB

Facility

$4.46

Service Code	NDC 378035101
Hospital Charge Code	25000747
Hospital Revenue Code	637
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$3.43
Rate for Payer: Anthem POS/PPO/Traditional	$3.48
Rate for Payer: Cash Price	$2.23
Rate for Payer: Cigna Commercial	$3.70
Rate for Payer: First Health Commercial	$4.24
Rate for Payer: Humana Commercial	$3.79
Rate for Payer: Medical Mutual Of Ohio HMO	$3.66
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3.29
Rate for Payer: Molina Healthcare Benefit Exchange	$1.34
Rate for Payer: Ohio Health Choice Commercial	$3.92
Rate for Payer: Ohio Health Group HMO	$3.34
Rate for Payer: Ohio Health Group PPO Differential	$0.89
Rate for Payer: Ohio Health Group PPO No Differential	$0.58
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1.38
Rate for Payer: PHCS Commercial	$4.28
Rate for Payer: United Healthcare All Payer	$3.92

HALDOL (HALOPERIDOL) .5MG/1TAB

Facility

$4.46

Service Code	NDC 378035101
Hospital Charge Code	25000747
Hospital Revenue Code	637
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$3.43
Rate for Payer: Anthem Medicaid	$1.53
Rate for Payer: Anthem POS/PPO/Traditional	$3.48
Rate for Payer: Cash Price	$2.23
Rate for Payer: Cigna Commercial	$3.70
Rate for Payer: First Health Commercial	$4.24
Rate for Payer: Humana Commercial	$3.79
Rate for Payer: Humana KY Medicaid	$1.53
Rate for Payer: Kentucky WC Medicaid	$1.55
Rate for Payer: Medical Mutual Of Ohio HMO	$3.66
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3.29
Rate for Payer: Molina Healthcare Benefit Exchange	$1.34
Rate for Payer: Molina Healthcare Medicaid	$1.56
Rate for Payer: Ohio Health Choice Commercial	$3.92
Rate for Payer: Ohio Health Group HMO	$3.34
Rate for Payer: Ohio Health Group PPO Differential	$0.89
Rate for Payer: Ohio Health Group PPO No Differential	$0.58
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1.38
Rate for Payer: PHCS Commercial	$4.28
Rate for Payer: United Healthcare All Payer	$3.92

Half Leg Laser Hair Removal

Professional

Both

$350.00

Hospital Charge Code	22200188
Hospital Revenue Code	222
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$350.00
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$122.50

Half Leg LsrHairRem-PP#1 50%

Professional

Both

$446.00

Hospital Charge Code	22200352
Hospital Revenue Code	222
Min. Negotiated Rate	$156.10
Max. Negotiated Rate	$446.00
Rate for Payer: Buckeye Medicare Advantage	$446.00
Rate for Payer: Cash Price	$223.00
Rate for Payer: Multiplan PHCS	$267.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$312.20
Rate for Payer: UHCCP Medicaid	$156.10

Half Leg LsrHairRem-PP#2/3 25%

Professional

Both

$223.00

Hospital Charge Code	22200468
Hospital Revenue Code	222
Min. Negotiated Rate	$78.05
Max. Negotiated Rate	$223.00
Rate for Payer: Buckeye Medicare Advantage	$223.00
Rate for Payer: Cash Price	$111.50
Rate for Payer: Multiplan PHCS	$133.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$156.10
Rate for Payer: UHCCP Medicaid	$78.05

HALO ARMS

Professional

Both

$750.00

Hospital Charge Code	22200230
Hospital Revenue Code	222
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$750.00
Rate for Payer: Buckeye Medicare Advantage	$750.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Multiplan PHCS	$450.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$525.00
Rate for Payer: UHCCP Medicaid	$262.50

Halo Arms - PP #1 50%

Professional

Both

$956.00

Hospital Charge Code	22200231
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

Halo Arms - PP #2/3 25%

Professional

Both

$478.00

Hospital Charge Code	22200481
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

HALO CHEST

Professional

Both

$750.00

Hospital Charge Code	22200228
Hospital Revenue Code	222
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$750.00
Rate for Payer: Buckeye Medicare Advantage	$750.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Multiplan PHCS	$450.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$525.00
Rate for Payer: UHCCP Medicaid	$262.50

Halo Chest - PP #1 50%

Professional

Both

$956.00

Hospital Charge Code	22200229
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

Halo Chest - PP #2/3 25%

Professional

Both

$478.00

Hospital Charge Code	22200480
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

HALO FULL FACE

Professional

Both

$1,300.00

Hospital Charge Code	22200224
Hospital Revenue Code	222
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$1,300.00
Rate for Payer: Buckeye Medicare Advantage	$1,300.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Multiplan PHCS	$780.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$910.00
Rate for Payer: UHCCP Medicaid	$455.00

Halo Full Face -PP #1 50%

Professional

Both

$1,659.00

Hospital Charge Code	22200225
Hospital Revenue Code	222
Min. Negotiated Rate	$580.65
Max. Negotiated Rate	$1,659.00
Rate for Payer: Buckeye Medicare Advantage	$1,659.00
Rate for Payer: Cash Price	$829.50
Rate for Payer: Multiplan PHCS	$995.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,161.30
Rate for Payer: UHCCP Medicaid	$580.65

Halo Full Face-PP#2/3 25%

Professional

Both

$828.00

Hospital Charge Code	22200478
Hospital Revenue Code	222
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$828.00
Rate for Payer: Buckeye Medicare Advantage	$828.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Multiplan PHCS	$496.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$579.60
Rate for Payer: UHCCP Medicaid	$289.80

HALO HANDS

Professional

Both

$525.00

Hospital Charge Code	22200232
Hospital Revenue Code	222
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$525.00
Rate for Payer: Buckeye Medicare Advantage	$525.00
Rate for Payer: Cash Price	$262.50
Rate for Payer: Multiplan PHCS	$315.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$367.50
Rate for Payer: UHCCP Medicaid	$183.75

Halo Hands - PP #1 50%

Professional

Both

$670.00

Hospital Charge Code	22200233
Hospital Revenue Code	222
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$670.00
Rate for Payer: Buckeye Medicare Advantage	$670.00
Rate for Payer: Cash Price	$335.00
Rate for Payer: Multiplan PHCS	$402.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$469.00
Rate for Payer: UHCCP Medicaid	$234.50

Halo Hands - PP #2/3 25%

Professional

Both

$334.00

Hospital Charge Code	22200482
Hospital Revenue Code	222
Min. Negotiated Rate	$116.90
Max. Negotiated Rate	$334.00
Rate for Payer: Buckeye Medicare Advantage	$334.00
Rate for Payer: Cash Price	$167.00
Rate for Payer: Multiplan PHCS	$200.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$233.80
Rate for Payer: UHCCP Medicaid	$116.90

HALO NECK

Professional

Both

$525.00

Hospital Charge Code	22200226
Hospital Revenue Code	222
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$525.00
Rate for Payer: Buckeye Medicare Advantage	$525.00
Rate for Payer: Cash Price	$262.50
Rate for Payer: Multiplan PHCS	$315.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$367.50
Rate for Payer: UHCCP Medicaid	$183.75

Halo Neck - PP #1 50%

Professional

Both

$670.00

Hospital Charge Code	22200227
Hospital Revenue Code	222
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$670.00
Rate for Payer: Buckeye Medicare Advantage	$670.00
Rate for Payer: Cash Price	$335.00
Rate for Payer: Multiplan PHCS	$402.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$469.00
Rate for Payer: UHCCP Medicaid	$234.50

Halo Neck - PP #2/3 25%

Professional

Both

$334.00

Hospital Charge Code	22200479
Hospital Revenue Code	222
Min. Negotiated Rate	$116.90
Max. Negotiated Rate	$334.00
Rate for Payer: Buckeye Medicare Advantage	$334.00
Rate for Payer: Cash Price	$167.00
Rate for Payer: Multiplan PHCS	$200.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$233.80
Rate for Payer: UHCCP Medicaid	$116.90

HALO PARTIAL FACE - 3 AREAS

Professional

Both

$780.00

Hospital Charge Code	22200234
Hospital Revenue Code	222
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$780.00
Rate for Payer: Buckeye Medicare Advantage	$780.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Multiplan PHCS	$468.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$546.00
Rate for Payer: UHCCP Medicaid	$273.00

HALO PARTIAL FACE - 4 AREAS

Professional

Both

$1,040.00

Hospital Charge Code	22200236
Hospital Revenue Code	222
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,040.00
Rate for Payer: Buckeye Medicare Advantage	$1,040.00
Rate for Payer: Cash Price	$520.00
Rate for Payer: Multiplan PHCS	$624.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$728.00
Rate for Payer: UHCCP Medicaid	$364.00

Halo Partl Face-3Area-PP#1 50%

Professional

Both

$995.00

Hospital Charge Code	22200235
Hospital Revenue Code	222
Min. Negotiated Rate	$348.25
Max. Negotiated Rate	$995.00
Rate for Payer: Buckeye Medicare Advantage	$995.00
Rate for Payer: Cash Price	$497.50
Rate for Payer: Multiplan PHCS	$597.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$696.50
Rate for Payer: UHCCP Medicaid	$348.25

Halo Partl Face-4Area-PP#1 50%

Professional

Both

$1,326.00

Hospital Charge Code	22200237
Hospital Revenue Code	222
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$1,326.00
Rate for Payer: Buckeye Medicare Advantage	$1,326.00
Rate for Payer: Cash Price	$663.00
Rate for Payer: Multiplan PHCS	$795.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$928.20
Rate for Payer: UHCCP Medicaid	$464.10

Halo Partl Face4AreaPP#2/3 25%

Professional

Both

$663.00

Hospital Charge Code	22200485
Hospital Revenue Code	222
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$663.00
Rate for Payer: Buckeye Medicare Advantage	$663.00
Rate for Payer: Cash Price	$331.50
Rate for Payer: Multiplan PHCS	$397.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$464.10
Rate for Payer: UHCCP Medicaid	$232.05

Know your out-of-pocket cost for care.

All Charges