Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

ANESTH AXIL-BRACH ANEURYSM

Facility

$8.00

Service Code	HCPCS 01652
Hospital Charge Code	37000135
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 AXIL-BRACH ANEURYSM

Professional

Both

$8.00

Service Code	HCPCS 1652
Hospital Charge Code	37000135
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 AXIL-BRACH ANEURYSM

Facility

$8.00

Service Code	HCPCS 01652
Hospital Charge Code	37000135
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 BICEPS TENDON REPAIR

Facility

$8.00

Service Code	HCPCS 01716
Hospital Charge Code	37000140
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 BICEPS TENDON REPAIR

Facility

$8.00

Service Code	HCPCS 01716
Hospital Charge Code	37000140
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 BICEPS TENDON REPAIR

Professional

Both

$8.00

Service Code	HCPCS 1716
Hospital Charge Code	37000140
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 BIOPSY OF NOSE

Facility

$8.00

Service Code	HCPCS 00164
Hospital Charge Code	37000011
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 BIOPSY OF NOSE

Professional

Both

$8.00

Service Code	HCPCS 164
Hospital Charge Code	37000011
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 BIOPSY OF NOSE

Facility

$8.00

Service Code	HCPCS 00164
Hospital Charge Code	37000011
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 BLADDER STONE SURG

Facility

$8.00

Service Code	HCPCS 00870
Hospital Charge Code	37000075
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 BLADDER STONE SURG

Professional

Both

$8.00

Service Code	HCPCS 870
Hospital Charge Code	37000075
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 BLADDER STONE SURG

Facility

$8.00

Service Code	HCPCS 00870
Hospital Charge Code	37000075
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 BLADDER SURGERY

Facility

$8.00

Service Code	HCPCS 00910
Hospital Charge Code	37000080
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 BLADDER SURGERY

Facility

$8.00

Service Code	HCPCS 00910
Hospital Charge Code	37000080
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 BLADDER SURGERY

Professional

Both

$8.00

Service Code	HCPCS 910
Hospital Charge Code	37000080
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 BLADDER TUMOR SURG

Facility

$8.00

Service Code	HCPCS 00912
Hospital Charge Code	37000081
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 BLADDER TUMOR SURG

Facility

$8.00

Service Code	HCPCS 00912
Hospital Charge Code	37000081
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 BLADDER TUMOR SURG

Professional

Both

$8.00

Service Code	HCPCS 912
Hospital Charge Code	37000081
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 BLEEDING CONTROL

Facility

$4.00

Service Code	HCPCS 00916
Hospital Charge Code	37000278
Hospital Revenue Code	370
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$3.84
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Anthem Medicaid	$1.38
Rate for Payer: Anthem POS/PPO/Traditional	$3.12
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cigna Commercial	$3.32
Rate for Payer: First Health Commercial	$3.80
Rate for Payer: Humana Commercial	$3.40
Rate for Payer: Humana KY Medicaid	$1.38
Rate for Payer: Kentucky WC Medicaid	$1.39
Rate for Payer: Medical Mutual Of Ohio HMO	$3.28
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2.95
Rate for Payer: Molina Healthcare Benefit Exchange	$1.20
Rate for Payer: Molina Healthcare Medicaid	$1.40
Rate for Payer: Ohio Health Choice Commercial	$3.52
Rate for Payer: Ohio Health Group HMO	$3.00
Rate for Payer: Ohio Health Group PPO Differential	$3.20
Rate for Payer: Ohio Health Group PPO No Differential	$3.48
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2.76
Rate for Payer: PHCS Commercial	$3.84
Rate for Payer: United Healthcare All Payer	$3.52

ANESTH BLEEDING CONTROL

Facility

$4.00

Service Code	HCPCS 00916
Hospital Charge Code	37000278
Hospital Revenue Code	370
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$3.84
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Anthem POS/PPO/Traditional	$3.12
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cigna Commercial	$3.32
Rate for Payer: First Health Commercial	$3.80
Rate for Payer: Humana Commercial	$3.40
Rate for Payer: Medical Mutual Of Ohio HMO	$3.28
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2.95
Rate for Payer: Molina Healthcare Benefit Exchange	$1.20
Rate for Payer: Ohio Health Choice Commercial	$3.52
Rate for Payer: Ohio Health Group HMO	$3.00
Rate for Payer: Ohio Health Group PPO Differential	$3.20
Rate for Payer: Ohio Health Group PPO No Differential	$3.48
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2.76
Rate for Payer: PHCS Commercial	$3.84
Rate for Payer: United Healthcare All Payer	$3.52

ANESTH BLEEDING CONTROL

Professional

Both

$4.00

Service Code	HCPCS 916
Hospital Charge Code	37000278
Hospital Revenue Code	370
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.80
Rate for Payer: Cash Price	$2.00
Rate for Payer: Multiplan PHCS	$2.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$2.80
Rate for Payer: UHCCP Medicaid	$1.40

ANESTH BLEPHAROPLASTY

Professional

Both

$8.00

Service Code	HCPCS 103
Hospital Charge Code	37000003
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 BLEPHAROPLASTY

Facility

$8.00

Service Code	HCPCS 00103
Hospital Charge Code	37000003
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 BLEPHAROPLASTY

Facility

$8.00

Service Code	HCPCS 00103
Hospital Charge Code	37000003
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 BLEPHAROPLSTY LOW W/EXT

Professional

Both

$530.00

Hospital Charge Code	37000226
Hospital Revenue Code	370
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$371.00
Rate for Payer: Cash Price	$265.00
Rate for Payer: Multiplan PHCS	$318.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$371.00
Rate for Payer: UHCCP Medicaid	$185.50

Know your out-of-pocket cost for care.

All Charges