Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

ANES THER INTERVEN RAD ARTRL

Facility

$15.00

Service Code	HCPCS 01924
Hospital Charge Code	37000160
Hospital Revenue Code	370
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$11.55
Rate for Payer: Anthem POS/PPO/Traditional	$11.70
Rate for Payer: Cash Price	$7.50
Rate for Payer: Cigna Commercial	$12.45
Rate for Payer: First Health Commercial	$14.25
Rate for Payer: Humana Commercial	$12.75
Rate for Payer: Medical Mutual Of Ohio HMO	$12.30
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$11.07
Rate for Payer: Molina Healthcare Benefit Exchange	$4.50
Rate for Payer: Ohio Health Choice Commercial	$13.20
Rate for Payer: Ohio Health Group HMO	$11.25
Rate for Payer: Ohio Health Group PPO Differential	$12.00
Rate for Payer: Ohio Health Group PPO No Differential	$13.05
Rate for Payer: Ohio Health Group PPO SOMC Employees	$10.35
Rate for Payer: PHCS Commercial	$14.40
Rate for Payer: United Healthcare All Payer	$13.20

ANES THER INTERVEN RAD CARD

Professional

Both

$3.00

Service Code	HCPCS 1925
Hospital Charge Code	37000264
Hospital Revenue Code	370
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.10
Rate for Payer: Cash Price	$1.50
Rate for Payer: Multiplan PHCS	$1.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$2.10
Rate for Payer: UHCCP Medicaid	$1.05

ANES THER INTERVEN RAD VEIN

Professional

Both

$8.00

Service Code	HCPCS 1930
Hospital Charge Code	37000162
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

ANES THER INTERVEN RAD VEIN

Facility

$8.00

Service Code	HCPCS 01930
Hospital Charge Code	37000162
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

ANES THER INTERVEN RAD VEIN

Facility

$8.00

Service Code	HCPCS 01930
Hospital Charge Code	37000162
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

ANES THER INT RAD PROCEDURE

Facility

$8.00

Service Code	HCPCS 01931
Hospital Charge Code	37000256
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

ANES THER INT RAD PROCEDURE

Facility

$8.00

Service Code	HCPCS 01931
Hospital Charge Code	37000256
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

ANES THER INT RAD PROCEDURE

Professional

Both

$8.00

Service Code	HCPCS 1931
Hospital Charge Code	37000256
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

ANESTHESIA COSMETIC 1 HOUR

Facility

$210.00

Hospital Charge Code	37000246
Hospital Revenue Code	370
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$161.70
Rate for Payer: Anthem Medicaid	$72.22
Rate for Payer: Anthem POS/PPO/Traditional	$163.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: First Health Commercial	$199.50
Rate for Payer: Humana Commercial	$178.50
Rate for Payer: Humana KY Medicaid	$72.22
Rate for Payer: Kentucky WC Medicaid	$72.95
Rate for Payer: Medical Mutual Of Ohio HMO	$172.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$154.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63.00
Rate for Payer: Molina Healthcare Medicaid	$73.67
Rate for Payer: Ohio Health Choice Commercial	$184.80
Rate for Payer: Ohio Health Group HMO	$157.50
Rate for Payer: Ohio Health Group PPO Differential	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$144.90
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

ANESTHESIA COSMETIC 1 HOUR

Professional

Both

$210.00

Hospital Charge Code	37000246
Hospital Revenue Code	370
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$147.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Multiplan PHCS	$126.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$147.00
Rate for Payer: UHCCP Medicaid	$73.50

ANESTHESIA COSMETIC 1 HOUR

Facility

$210.00

Hospital Charge Code	37000246
Hospital Revenue Code	370
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$161.70
Rate for Payer: Anthem POS/PPO/Traditional	$163.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: First Health Commercial	$199.50
Rate for Payer: Humana Commercial	$178.50
Rate for Payer: Medical Mutual Of Ohio HMO	$172.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$154.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63.00
Rate for Payer: Ohio Health Choice Commercial	$184.80
Rate for Payer: Ohio Health Group HMO	$157.50
Rate for Payer: Ohio Health Group PPO Differential	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$144.90
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

ANESTHESIA COSMETIC 3 HOUR

Professional

Both

$640.00

Hospital Charge Code	37000245
Hospital Revenue Code	370
Min. Negotiated Rate	$224.00
Max. Negotiated Rate	$448.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Multiplan PHCS	$384.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$448.00
Rate for Payer: UHCCP Medicaid	$224.00

ANESTHESIA COSMETIC 3 HOUR

Facility

$640.00

Hospital Charge Code	37000245
Hospital Revenue Code	370
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$614.40
Rate for Payer: Aetna Commercial	$492.80
Rate for Payer: Anthem POS/PPO/Traditional	$499.20
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cigna Commercial	$531.20
Rate for Payer: First Health Commercial	$608.00
Rate for Payer: Humana Commercial	$544.00
Rate for Payer: Medical Mutual Of Ohio HMO	$524.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$472.32
Rate for Payer: Molina Healthcare Benefit Exchange	$192.00
Rate for Payer: Ohio Health Choice Commercial	$563.20
Rate for Payer: Ohio Health Group HMO	$480.00
Rate for Payer: Ohio Health Group PPO Differential	$512.00
Rate for Payer: Ohio Health Group PPO No Differential	$556.80
Rate for Payer: Ohio Health Group PPO SOMC Employees	$441.60
Rate for Payer: PHCS Commercial	$614.40
Rate for Payer: United Healthcare All Payer	$563.20

ANESTHESIA COSMETIC 3 HOUR

Facility

$640.00

Hospital Charge Code	37000245
Hospital Revenue Code	370
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$614.40
Rate for Payer: Aetna Commercial	$492.80
Rate for Payer: Anthem Medicaid	$220.10
Rate for Payer: Anthem POS/PPO/Traditional	$499.20
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cigna Commercial	$531.20
Rate for Payer: First Health Commercial	$608.00
Rate for Payer: Humana Commercial	$544.00
Rate for Payer: Humana KY Medicaid	$220.10
Rate for Payer: Kentucky WC Medicaid	$222.34
Rate for Payer: Medical Mutual Of Ohio HMO	$524.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$472.32
Rate for Payer: Molina Healthcare Benefit Exchange	$192.00
Rate for Payer: Molina Healthcare Medicaid	$224.51
Rate for Payer: Ohio Health Choice Commercial	$563.20
Rate for Payer: Ohio Health Group HMO	$480.00
Rate for Payer: Ohio Health Group PPO Differential	$512.00
Rate for Payer: Ohio Health Group PPO No Differential	$556.80
Rate for Payer: Ohio Health Group PPO SOMC Employees	$441.60
Rate for Payer: PHCS Commercial	$614.40
Rate for Payer: United Healthcare All Payer	$563.20

ANESTHESIA COSMETIC BROW LIFT

Facility

$430.00

Hospital Charge Code	37000187
Hospital Revenue Code	370
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$412.80
Rate for Payer: Aetna Commercial	$331.10
Rate for Payer: Anthem POS/PPO/Traditional	$335.40
Rate for Payer: Cash Price	$215.00
Rate for Payer: Cigna Commercial	$356.90
Rate for Payer: First Health Commercial	$408.50
Rate for Payer: Humana Commercial	$365.50
Rate for Payer: Medical Mutual Of Ohio HMO	$352.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$317.34
Rate for Payer: Molina Healthcare Benefit Exchange	$129.00
Rate for Payer: Ohio Health Choice Commercial	$378.40
Rate for Payer: Ohio Health Group HMO	$322.50
Rate for Payer: Ohio Health Group PPO Differential	$344.00
Rate for Payer: Ohio Health Group PPO No Differential	$374.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$296.70
Rate for Payer: PHCS Commercial	$412.80
Rate for Payer: United Healthcare All Payer	$378.40

ANESTHESIA COSMETIC BROW LIFT

Facility

$430.00

Hospital Charge Code	37000187
Hospital Revenue Code	370
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$412.80
Rate for Payer: Aetna Commercial	$331.10
Rate for Payer: Anthem Medicaid	$147.88
Rate for Payer: Anthem POS/PPO/Traditional	$335.40
Rate for Payer: Cash Price	$215.00
Rate for Payer: Cigna Commercial	$356.90
Rate for Payer: First Health Commercial	$408.50
Rate for Payer: Humana Commercial	$365.50
Rate for Payer: Humana KY Medicaid	$147.88
Rate for Payer: Kentucky WC Medicaid	$149.38
Rate for Payer: Medical Mutual Of Ohio HMO	$352.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$317.34
Rate for Payer: Molina Healthcare Benefit Exchange	$129.00
Rate for Payer: Molina Healthcare Medicaid	$150.84
Rate for Payer: Ohio Health Choice Commercial	$378.40
Rate for Payer: Ohio Health Group HMO	$322.50
Rate for Payer: Ohio Health Group PPO Differential	$344.00
Rate for Payer: Ohio Health Group PPO No Differential	$374.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$296.70
Rate for Payer: PHCS Commercial	$412.80
Rate for Payer: United Healthcare All Payer	$378.40

ANESTHESIA COSMETIC BROW LIFT

Professional

Both

$430.00

Hospital Charge Code	37000187
Hospital Revenue Code	370
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$301.00
Rate for Payer: Cash Price	$215.00
Rate for Payer: Multiplan PHCS	$258.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$301.00
Rate for Payer: UHCCP Medicaid	$150.50

ANESTHESIA COSMETIC OTOPLASTY

Facility

$210.00

Hospital Charge Code	37000188
Hospital Revenue Code	370
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$161.70
Rate for Payer: Anthem POS/PPO/Traditional	$163.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: First Health Commercial	$199.50
Rate for Payer: Humana Commercial	$178.50
Rate for Payer: Medical Mutual Of Ohio HMO	$172.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$154.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63.00
Rate for Payer: Ohio Health Choice Commercial	$184.80
Rate for Payer: Ohio Health Group HMO	$157.50
Rate for Payer: Ohio Health Group PPO Differential	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$144.90
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

ANESTHESIA COSMETIC OTOPLASTY

Facility

$210.00

Hospital Charge Code	37000188
Hospital Revenue Code	370
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$161.70
Rate for Payer: Anthem Medicaid	$72.22
Rate for Payer: Anthem POS/PPO/Traditional	$163.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: First Health Commercial	$199.50
Rate for Payer: Humana Commercial	$178.50
Rate for Payer: Humana KY Medicaid	$72.22
Rate for Payer: Kentucky WC Medicaid	$72.95
Rate for Payer: Medical Mutual Of Ohio HMO	$172.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$154.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63.00
Rate for Payer: Molina Healthcare Medicaid	$73.67
Rate for Payer: Ohio Health Choice Commercial	$184.80
Rate for Payer: Ohio Health Group HMO	$157.50
Rate for Payer: Ohio Health Group PPO Differential	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$144.90
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

ANESTHESIA COSMETIC OTOPLASTY

Professional

Both

$210.00

Hospital Charge Code	37000188
Hospital Revenue Code	370
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$147.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Multiplan PHCS	$126.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$147.00
Rate for Payer: UHCCP Medicaid	$73.50

ANESTHESIA COSMETIC THIGH LIFT

Professional

Both

$630.00

Hospital Charge Code	37000203
Hospital Revenue Code	370
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$441.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Multiplan PHCS	$378.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$441.00
Rate for Payer: UHCCP Medicaid	$220.50

ANESTHESIA COSMETIC THIGH LIFT

Facility

$630.00

Hospital Charge Code	37000203
Hospital Revenue Code	370
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$604.80
Rate for Payer: Aetna Commercial	$485.10
Rate for Payer: Anthem POS/PPO/Traditional	$491.40
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial	$522.90
Rate for Payer: First Health Commercial	$598.50
Rate for Payer: Humana Commercial	$535.50
Rate for Payer: Medical Mutual Of Ohio HMO	$516.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$464.94
Rate for Payer: Molina Healthcare Benefit Exchange	$189.00
Rate for Payer: Ohio Health Choice Commercial	$554.40
Rate for Payer: Ohio Health Group HMO	$472.50
Rate for Payer: Ohio Health Group PPO Differential	$504.00
Rate for Payer: Ohio Health Group PPO No Differential	$548.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$434.70
Rate for Payer: PHCS Commercial	$604.80
Rate for Payer: United Healthcare All Payer	$554.40

ANESTHESIA COSMETIC THIGH LIFT

Facility

$630.00

Hospital Charge Code	37000203
Hospital Revenue Code	370
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$604.80
Rate for Payer: Aetna Commercial	$485.10
Rate for Payer: Anthem Medicaid	$216.66
Rate for Payer: Anthem POS/PPO/Traditional	$491.40
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial	$522.90
Rate for Payer: First Health Commercial	$598.50
Rate for Payer: Humana Commercial	$535.50
Rate for Payer: Humana KY Medicaid	$216.66
Rate for Payer: Kentucky WC Medicaid	$218.86
Rate for Payer: Medical Mutual Of Ohio HMO	$516.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$464.94
Rate for Payer: Molina Healthcare Benefit Exchange	$189.00
Rate for Payer: Molina Healthcare Medicaid	$221.00
Rate for Payer: Ohio Health Choice Commercial	$554.40
Rate for Payer: Ohio Health Group HMO	$472.50
Rate for Payer: Ohio Health Group PPO Differential	$504.00
Rate for Payer: Ohio Health Group PPO No Differential	$548.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$434.70
Rate for Payer: PHCS Commercial	$604.80
Rate for Payer: United Healthcare All Payer	$554.40

ANESTHESIA COSM LIPO ANY W/OTH

Facility

$105.00

Hospital Charge Code	37000235
Hospital Revenue Code	370
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$100.80
Rate for Payer: Aetna Commercial	$80.85
Rate for Payer: Anthem Medicaid	$36.11
Rate for Payer: Anthem POS/PPO/Traditional	$81.90
Rate for Payer: Cash Price	$52.50
Rate for Payer: Cigna Commercial	$87.15
Rate for Payer: First Health Commercial	$99.75
Rate for Payer: Humana Commercial	$89.25
Rate for Payer: Humana KY Medicaid	$36.11
Rate for Payer: Kentucky WC Medicaid	$36.48
Rate for Payer: Medical Mutual Of Ohio HMO	$86.10
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$77.49
Rate for Payer: Molina Healthcare Benefit Exchange	$31.50
Rate for Payer: Molina Healthcare Medicaid	$36.83
Rate for Payer: Ohio Health Choice Commercial	$92.40
Rate for Payer: Ohio Health Group HMO	$78.75
Rate for Payer: Ohio Health Group PPO Differential	$84.00
Rate for Payer: Ohio Health Group PPO No Differential	$91.35
Rate for Payer: Ohio Health Group PPO SOMC Employees	$72.45
Rate for Payer: PHCS Commercial	$100.80
Rate for Payer: United Healthcare All Payer	$92.40

ANESTHESIA COSM LIPO ANY W/OTH

Professional

Both

$105.00

Hospital Charge Code	37000235
Hospital Revenue Code	370
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$73.50
Rate for Payer: Cash Price	$52.50
Rate for Payer: Multiplan PHCS	$63.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$73.50
Rate for Payer: UHCCP Medicaid	$36.75

Know your out-of-pocket cost for care.

All Charges