Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

IN PACT ADMIRAL 7*80*130

Facility

$7,946.50

Service Code	HCPCS C2623
Hospital Charge Code	27000276
Hospital Revenue Code	272
Min. Negotiated Rate	$1,033.04
Max. Negotiated Rate	$7,628.64
Rate for Payer: Aetna Commercial	$6,118.80
Rate for Payer: Anthem Medicaid	$2,732.80
Rate for Payer: Anthem POS/PPO/Traditional	$6,198.27
Rate for Payer: Cash Price	$3,973.25
Rate for Payer: Cigna Commercial	$6,595.60
Rate for Payer: First Health Commercial	$7,549.18
Rate for Payer: Humana Commercial	$6,754.52
Rate for Payer: Humana KY Medicaid	$2,732.80
Rate for Payer: Kentucky WC Medicaid	$2,760.61
Rate for Payer: Medical Mutual Of Ohio HMO	$6,516.13
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,864.52
Rate for Payer: Molina Healthcare Benefit Exchange	$2,383.95
Rate for Payer: Molina Healthcare Medicaid	$2,787.63
Rate for Payer: Ohio Health Choice Commercial	$6,992.92
Rate for Payer: Ohio Health Group HMO	$5,959.88
Rate for Payer: Ohio Health Group PPO Differential	$1,589.30
Rate for Payer: Ohio Health Group PPO No Differential	$1,033.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,463.42
Rate for Payer: PHCS Commercial	$7,628.64
Rate for Payer: United Healthcare All Payer	$6,992.92

IN PACT ADMIRAL 7*80*130

Facility

$7,946.50

Service Code	HCPCS C2623
Hospital Charge Code	27000276
Hospital Revenue Code	272
Min. Negotiated Rate	$1,033.04
Max. Negotiated Rate	$7,628.64
Rate for Payer: Aetna Commercial	$6,118.80
Rate for Payer: Anthem POS/PPO/Traditional	$6,198.27
Rate for Payer: Cash Price	$3,973.25
Rate for Payer: Cigna Commercial	$6,595.60
Rate for Payer: First Health Commercial	$7,549.18
Rate for Payer: Humana Commercial	$6,754.52
Rate for Payer: Medical Mutual Of Ohio HMO	$6,516.13
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,864.52
Rate for Payer: Molina Healthcare Benefit Exchange	$2,383.95
Rate for Payer: Ohio Health Choice Commercial	$6,992.92
Rate for Payer: Ohio Health Group HMO	$5,959.88
Rate for Payer: Ohio Health Group PPO Differential	$1,589.30
Rate for Payer: Ohio Health Group PPO No Differential	$1,033.04
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,463.42
Rate for Payer: PHCS Commercial	$7,628.64
Rate for Payer: United Healthcare All Payer	$6,992.92

INPATIENT APRDRG 0011: LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

Facility

$20,581.39

Service Code	APR-DRG 0011
Hospital Charge Code	APRDRG 0011
Min. Negotiated Rate	$20,581.39
Max. Negotiated Rate	$20,581.39
Rate for Payer: Aetna CHP/Medicaid	$20,581.39
Rate for Payer: Humana OH Medicaid	$20,581.39

INPATIENT APRDRG 0012: LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

Facility

$20,581.39

Service Code	APR-DRG 0012
Hospital Charge Code	APRDRG 0012
Min. Negotiated Rate	$20,581.39
Max. Negotiated Rate	$20,581.39
Rate for Payer: Aetna CHP/Medicaid	$20,581.39
Rate for Payer: Humana OH Medicaid	$20,581.39

INPATIENT APRDRG 0013: LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

Facility

$28,591.40

Service Code	APR-DRG 0013
Hospital Charge Code	APRDRG 0013
Min. Negotiated Rate	$28,591.40
Max. Negotiated Rate	$28,591.40
Rate for Payer: Aetna CHP/Medicaid	$28,591.40
Rate for Payer: Humana OH Medicaid	$28,591.40

INPATIENT APRDRG 0014: LIVER TRANSPLANT &/OR INTESTINAL TRANSPLANT

Facility

$67,663.16

Service Code	APR-DRG 0014
Hospital Charge Code	APRDRG 0014
Min. Negotiated Rate	$67,663.16
Max. Negotiated Rate	$67,663.16
Rate for Payer: Aetna CHP/Medicaid	$67,663.16
Rate for Payer: Humana OH Medicaid	$67,663.16

INPATIENT APRDRG 0021: HEART &/OR LUNG TRANSPLANT

Facility

$85,029.77

Service Code	APR-DRG 0021
Hospital Charge Code	APRDRG 0021
Min. Negotiated Rate	$85,029.77
Max. Negotiated Rate	$85,029.77
Rate for Payer: Aetna CHP/Medicaid	$85,029.77
Rate for Payer: Humana OH Medicaid	$85,029.77

INPATIENT APRDRG 0022: HEART &/OR LUNG TRANSPLANT

Facility

$85,029.77

Service Code	APR-DRG 0022
Hospital Charge Code	APRDRG 0022
Min. Negotiated Rate	$85,029.77
Max. Negotiated Rate	$85,029.77
Rate for Payer: Aetna CHP/Medicaid	$85,029.77
Rate for Payer: Humana OH Medicaid	$85,029.77

INPATIENT APRDRG 0023: HEART &/OR LUNG TRANSPLANT

Facility

$85,029.77

Service Code	APR-DRG 0023
Hospital Charge Code	APRDRG 0023
Min. Negotiated Rate	$85,029.77
Max. Negotiated Rate	$85,029.77
Rate for Payer: Aetna CHP/Medicaid	$85,029.77
Rate for Payer: Humana OH Medicaid	$85,029.77

INPATIENT APRDRG 0024: HEART &/OR LUNG TRANSPLANT

Facility

$191,831.60

Service Code	APR-DRG 0024
Hospital Charge Code	APRDRG 0024
Min. Negotiated Rate	$191,831.60
Max. Negotiated Rate	$191,831.60
Rate for Payer: Aetna CHP/Medicaid	$191,831.60
Rate for Payer: Humana OH Medicaid	$191,831.60

INPATIENT APRDRG 0041: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$30,501.82

Service Code	APR-DRG 0041
Hospital Charge Code	APRDRG 0041
Min. Negotiated Rate	$30,501.82
Max. Negotiated Rate	$30,501.82
Rate for Payer: Aetna CHP/Medicaid	$30,501.82
Rate for Payer: Humana OH Medicaid	$30,501.82

INPATIENT APRDRG 0042: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$30,501.82

Service Code	APR-DRG 0042
Hospital Charge Code	APRDRG 0042
Min. Negotiated Rate	$30,501.82
Max. Negotiated Rate	$30,501.82
Rate for Payer: Aetna CHP/Medicaid	$30,501.82
Rate for Payer: Humana OH Medicaid	$30,501.82

INPATIENT APRDRG 0043: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$58,417.00

Service Code	APR-DRG 0043
Hospital Charge Code	APRDRG 0043
Min. Negotiated Rate	$58,417.00
Max. Negotiated Rate	$58,417.00
Rate for Payer: Aetna CHP/Medicaid	$58,417.00
Rate for Payer: Humana OH Medicaid	$58,417.00

INPATIENT APRDRG 0044: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE

Facility

$77,093.81

Service Code	APR-DRG 0044
Hospital Charge Code	APRDRG 0044
Min. Negotiated Rate	$77,093.81
Max. Negotiated Rate	$77,093.81
Rate for Payer: Aetna CHP/Medicaid	$77,093.81
Rate for Payer: Humana OH Medicaid	$77,093.81

INPATIENT APRDRG 0051: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$23,697.44

Service Code	APR-DRG 0051
Hospital Charge Code	APRDRG 0051
Min. Negotiated Rate	$23,697.44
Max. Negotiated Rate	$23,697.44
Rate for Payer: Aetna CHP/Medicaid	$23,697.44
Rate for Payer: Humana OH Medicaid	$23,697.44

INPATIENT APRDRG 0052: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$23,697.44

Service Code	APR-DRG 0052
Hospital Charge Code	APRDRG 0052
Min. Negotiated Rate	$23,697.44
Max. Negotiated Rate	$23,697.44
Rate for Payer: Aetna CHP/Medicaid	$23,697.44
Rate for Payer: Humana OH Medicaid	$23,697.44

INPATIENT APRDRG 0053: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$39,388.76

Service Code	APR-DRG 0053
Hospital Charge Code	APRDRG 0053
Min. Negotiated Rate	$39,388.76
Max. Negotiated Rate	$39,388.76
Rate for Payer: Aetna CHP/Medicaid	$39,388.76
Rate for Payer: Humana OH Medicaid	$39,388.76

INPATIENT APRDRG 0054: TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE

Facility

$54,425.31

Service Code	APR-DRG 0054
Hospital Charge Code	APRDRG 0054
Min. Negotiated Rate	$54,425.31
Max. Negotiated Rate	$54,425.31
Rate for Payer: Aetna CHP/Medicaid	$54,425.31
Rate for Payer: Humana OH Medicaid	$54,425.31

INPATIENT APRDRG 0061: PANCREAS TRANSPLANT

Facility

$20,201.38

Service Code	APR-DRG 0061
Hospital Charge Code	APRDRG 0061
Min. Negotiated Rate	$20,201.38
Max. Negotiated Rate	$20,201.38
Rate for Payer: Aetna CHP/Medicaid	$20,201.38
Rate for Payer: Humana OH Medicaid	$20,201.38

INPATIENT APRDRG 0062: PANCREAS TRANSPLANT

Facility

$20,201.38

Service Code	APR-DRG 0062
Hospital Charge Code	APRDRG 0062
Min. Negotiated Rate	$20,201.38
Max. Negotiated Rate	$20,201.38
Rate for Payer: Aetna CHP/Medicaid	$20,201.38
Rate for Payer: Humana OH Medicaid	$20,201.38

INPATIENT APRDRG 0063: PANCREAS TRANSPLANT

Facility

$20,201.38

Service Code	APR-DRG 0063
Hospital Charge Code	APRDRG 0063
Min. Negotiated Rate	$20,201.38
Max. Negotiated Rate	$20,201.38
Rate for Payer: Aetna CHP/Medicaid	$20,201.38
Rate for Payer: Humana OH Medicaid	$20,201.38

INPATIENT APRDRG 0064: PANCREAS TRANSPLANT

Facility

$20,201.38

Service Code	APR-DRG 0064
Hospital Charge Code	APRDRG 0064
Min. Negotiated Rate	$20,201.38
Max. Negotiated Rate	$20,201.38
Rate for Payer: Aetna CHP/Medicaid	$20,201.38
Rate for Payer: Humana OH Medicaid	$20,201.38

INPATIENT APRDRG 0071: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$64,065.77

Service Code	APR-DRG 0071
Hospital Charge Code	APRDRG 0071
Min. Negotiated Rate	$64,065.77
Max. Negotiated Rate	$64,065.77
Rate for Payer: Aetna CHP/Medicaid	$64,065.77
Rate for Payer: Humana OH Medicaid	$64,065.77

INPATIENT APRDRG 0072: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$64,065.77

Service Code	APR-DRG 0072
Hospital Charge Code	APRDRG 0072
Min. Negotiated Rate	$64,065.77
Max. Negotiated Rate	$64,065.77
Rate for Payer: Aetna CHP/Medicaid	$64,065.77
Rate for Payer: Humana OH Medicaid	$64,065.77

INPATIENT APRDRG 0073: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$80,031.22

Service Code	APR-DRG 0073
Hospital Charge Code	APRDRG 0073
Min. Negotiated Rate	$80,031.22
Max. Negotiated Rate	$80,031.22
Rate for Payer: Aetna CHP/Medicaid	$80,031.22
Rate for Payer: Humana OH Medicaid	$80,031.22

Know your out-of-pocket cost for care.

All Charges