Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

INCISE THIGH TENDON & FASCIA

Facility

$675.00

Service Code	HCPCS 27305
Hospital Charge Code	76100809
Hospital Revenue Code	761
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$519.75
Rate for Payer: Anthem POS/PPO/Traditional	$526.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$560.25
Rate for Payer: First Health Commercial	$641.25
Rate for Payer: Humana Commercial	$573.75
Rate for Payer: Medical Mutual Of Ohio HMO	$553.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$498.15
Rate for Payer: Molina Healthcare Benefit Exchange	$202.50
Rate for Payer: Ohio Health Choice Commercial	$594.00
Rate for Payer: Ohio Health Group HMO	$506.25
Rate for Payer: Ohio Health Group PPO Differential	$540.00
Rate for Payer: Ohio Health Group PPO No Differential	$587.25
Rate for Payer: Ohio Health Group PPO SOMC Employees	$465.75
Rate for Payer: PHCS Commercial	$648.00
Rate for Payer: United Healthcare All Payer	$594.00

INCISE THIGH TENDON & FASCIA

Facility

$675.00

Service Code	HCPCS 27305
Hospital Charge Code	76100809
Hospital Revenue Code	761
Min. Negotiated Rate	$232.13
Max. Negotiated Rate	$4,197.13
Rate for Payer: Aetna Commercial	$519.75
Rate for Payer: Anthem Medicaid	$232.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Anthem POS/PPO/Traditional	$526.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$560.25
Rate for Payer: First Health Commercial	$641.25
Rate for Payer: Humana Commercial	$573.75
Rate for Payer: Humana KY Medicaid	$232.13
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Kentucky WC Medicaid	$234.50
Rate for Payer: Medical Mutual Of Ohio HMO	$553.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$498.15
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54
Rate for Payer: Molina Healthcare Medicaid	$236.79
Rate for Payer: Ohio Health Choice Commercial	$594.00
Rate for Payer: Ohio Health Group HMO	$506.25
Rate for Payer: Ohio Health Group PPO Differential	$540.00
Rate for Payer: Ohio Health Group PPO No Differential	$587.25
Rate for Payer: Ohio Health Group PPO SOMC Employees	$465.75
Rate for Payer: PHCS Commercial	$648.00
Rate for Payer: United Healthcare All Payer	$594.00

INCISE THIGH TENDON & FASCIA

Professional

Both

$675.00

Service Code	HCPCS 27305
Hospital Charge Code	76100809
Hospital Revenue Code	761
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$744.62
Rate for Payer: Aetna Commercial	$680.36
Rate for Payer: Ambetter Exchange	$462.68
Rate for Payer: Anthem Medicaid	$277.49
Rate for Payer: Buckeye Individual/Medicaid	$462.68
Rate for Payer: Buckeye Medicare Advantage	$462.68
Rate for Payer: CareSource Just4Me Medicare	$555.22
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$744.62
Rate for Payer: Healthspan PPO	$616.26
Rate for Payer: Humana Medicaid	$277.49
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$583.57
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$462.68
Rate for Payer: Molina Healthcare Benefit Exchange	$462.68
Rate for Payer: Molina Healthcare CHIP/Medicaid	$283.04
Rate for Payer: Molina Healthcare Passport	$277.49
Rate for Payer: Multiplan PHCS	$405.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$601.48
Rate for Payer: UHCCP Medicaid	$236.25
Rate for Payer: Wellcare CHIP/Medicaid	$280.26
Rate for Payer: Wellcare Medicare Advantage	$462.68

INCISE THIGH TENDON & FASCIA

Professional

Both

$675.00

Service Code	HCPCS 27305
Hospital Charge Code	76100810
Hospital Revenue Code	761
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$744.62
Rate for Payer: Aetna Commercial	$680.36
Rate for Payer: Ambetter Exchange	$462.68
Rate for Payer: Anthem Medicaid	$277.49
Rate for Payer: Buckeye Individual/Medicaid	$462.68
Rate for Payer: Buckeye Medicare Advantage	$462.68
Rate for Payer: CareSource Just4Me Medicare	$555.22
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$744.62
Rate for Payer: Healthspan PPO	$616.26
Rate for Payer: Humana Medicaid	$277.49
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$583.57
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$462.68
Rate for Payer: Molina Healthcare Benefit Exchange	$462.68
Rate for Payer: Molina Healthcare CHIP/Medicaid	$283.04
Rate for Payer: Molina Healthcare Passport	$277.49
Rate for Payer: Multiplan PHCS	$405.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$601.48
Rate for Payer: UHCCP Medicaid	$236.25
Rate for Payer: Wellcare CHIP/Medicaid	$280.26
Rate for Payer: Wellcare Medicare Advantage	$462.68

INCISE THIGH TENDON & FASCI(P

Professional

Both

$675.00

Service Code	HCPCS 27305
Hospital Charge Code	761P0810
Hospital Revenue Code	761
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$744.62
Rate for Payer: Aetna Commercial	$680.36
Rate for Payer: Ambetter Exchange	$462.68
Rate for Payer: Anthem Medicaid	$277.49
Rate for Payer: Buckeye Individual/Medicaid	$462.68
Rate for Payer: Buckeye Medicare Advantage	$462.68
Rate for Payer: CareSource Just4Me Medicare	$555.22
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$744.62
Rate for Payer: Healthspan PPO	$616.26
Rate for Payer: Humana Medicaid	$277.49
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$583.57
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$462.68
Rate for Payer: Molina Healthcare Benefit Exchange	$462.68
Rate for Payer: Molina Healthcare CHIP/Medicaid	$283.04
Rate for Payer: Molina Healthcare Passport	$277.49
Rate for Payer: Multiplan PHCS	$405.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$601.48
Rate for Payer: UHCCP Medicaid	$236.25
Rate for Payer: Wellcare CHIP/Medicaid	$280.26
Rate for Payer: Wellcare Medicare Advantage	$462.68

INCISE THIGH TENDON & FASCI(P

Professional

Both

$675.00

Service Code	HCPCS 27305
Hospital Charge Code	761P0809
Hospital Revenue Code	761
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$744.62
Rate for Payer: Aetna Commercial	$680.36
Rate for Payer: Ambetter Exchange	$462.68
Rate for Payer: Anthem Medicaid	$277.49
Rate for Payer: Buckeye Individual/Medicaid	$462.68
Rate for Payer: Buckeye Medicare Advantage	$462.68
Rate for Payer: CareSource Just4Me Medicare	$555.22
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cigna Commercial	$744.62
Rate for Payer: Healthspan PPO	$616.26
Rate for Payer: Humana Medicaid	$277.49
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$583.57
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$462.68
Rate for Payer: Molina Healthcare Benefit Exchange	$462.68
Rate for Payer: Molina Healthcare CHIP/Medicaid	$283.04
Rate for Payer: Molina Healthcare Passport	$277.49
Rate for Payer: Multiplan PHCS	$405.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$601.48
Rate for Payer: UHCCP Medicaid	$236.25
Rate for Payer: Wellcare CHIP/Medicaid	$280.26
Rate for Payer: Wellcare Medicare Advantage	$462.68

INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION

Facility

$3,702.27

Service Code	CPT 10180
Hospital Revenue Code	360
Min. Negotiated Rate	$2,644.48
Max. Negotiated Rate	$3,702.27
Rate for Payer: Anthem Medicare Advantage/PPO	$2,644.48
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,702.27
Rate for Payer: CareSource Just4Me Medicare	$3,570.05
Rate for Payer: Humana Medicare Advantage	$2,644.48
Rate for Payer: Molina Healthcare Benefit Exchange	$3,173.38

INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;

Facility

$3,702.27

Service Code	CPT 21501
Hospital Revenue Code	360
Min. Negotiated Rate	$2,644.48
Max. Negotiated Rate	$3,702.27
Rate for Payer: Anthem Medicare Advantage/PPO	$2,644.48
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,702.27
Rate for Payer: CareSource Just4Me Medicare	$3,570.05
Rate for Payer: Humana Medicare Advantage	$2,644.48
Rate for Payer: Molina Healthcare Benefit Exchange	$3,173.38

INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA

Facility

$4,197.13

Service Code	CPT 25028
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE

Facility

$516.82

Service Code	CPT 10061
Hospital Revenue Code	360
Min. Negotiated Rate	$369.16
Max. Negotiated Rate	$516.82
Rate for Payer: Anthem Medicare Advantage/PPO	$369.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$516.82
Rate for Payer: CareSource Just4Me Medicare	$498.37
Rate for Payer: Humana Medicare Advantage	$369.16
Rate for Payer: Molina Healthcare Benefit Exchange	$442.99

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$257.03

Service Code	CPT 10060
Hospital Revenue Code	360
Min. Negotiated Rate	$183.59
Max. Negotiated Rate	$257.03
Rate for Payer: Anthem Medicare Advantage/PPO	$183.59
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$257.03
Rate for Payer: CareSource Just4Me Medicare	$247.85
Rate for Payer: Humana Medicare Advantage	$183.59
Rate for Payer: Molina Healthcare Benefit Exchange	$220.31

INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA)

Facility

$2,649.89

Service Code	CPT 54700
Hospital Revenue Code	360
Min. Negotiated Rate	$1,892.78
Max. Negotiated Rate	$2,649.89
Rate for Payer: Anthem Medicare Advantage/PPO	$1,892.78
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,649.89
Rate for Payer: CareSource Just4Me Medicare	$2,555.25
Rate for Payer: Humana Medicare Advantage	$1,892.78
Rate for Payer: Molina Healthcare Benefit Exchange	$2,271.34

INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION

Facility

$2,095.90

Service Code	CPT 10140
Hospital Revenue Code	360
Min. Negotiated Rate	$1,497.07
Max. Negotiated Rate	$2,095.90
Rate for Payer: Anthem Medicare Advantage/PPO	$1,497.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,095.90
Rate for Payer: CareSource Just4Me Medicare	$2,021.04
Rate for Payer: Humana Medicare Advantage	$1,497.07
Rate for Payer: Molina Healthcare Benefit Exchange	$1,796.48

INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS

Facility

$393.50

Service Code	CPT 56405
Hospital Revenue Code	360
Min. Negotiated Rate	$281.07
Max. Negotiated Rate	$393.50
Rate for Payer: Anthem Medicare Advantage/PPO	$281.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$393.50
Rate for Payer: CareSource Just4Me Medicare	$379.44
Rate for Payer: Humana Medicare Advantage	$281.07
Rate for Payer: Molina Healthcare Benefit Exchange	$337.28

INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA

Facility

$4,197.13

Service Code	CPT 26990
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL

Facility

$1,179.36

Service Code	CPT 46050
Hospital Revenue Code	360
Min. Negotiated Rate	$842.40
Max. Negotiated Rate	$1,179.36
Rate for Payer: Anthem Medicare Advantage/PPO	$842.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,179.36
Rate for Payer: CareSource Just4Me Medicare	$1,137.24
Rate for Payer: Humana Medicare Advantage	$842.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,010.88

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE

Facility

$516.82

Service Code	CPT 10120
Hospital Revenue Code	360
Min. Negotiated Rate	$369.16
Max. Negotiated Rate	$516.82
Rate for Payer: Anthem Medicare Advantage/PPO	$369.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$516.82
Rate for Payer: CareSource Just4Me Medicare	$498.37
Rate for Payer: Humana Medicare Advantage	$369.16
Rate for Payer: Molina Healthcare Benefit Exchange	$442.99

INCISION BONE CORTEX FOOT

Facility

$780.00

Service Code	HCPCS 28005
Hospital Charge Code	76100966
Hospital Revenue Code	761
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$748.80
Rate for Payer: Aetna Commercial	$600.60
Rate for Payer: Anthem POS/PPO/Traditional	$608.40
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cigna Commercial	$647.40
Rate for Payer: First Health Commercial	$741.00
Rate for Payer: Humana Commercial	$663.00
Rate for Payer: Medical Mutual Of Ohio HMO	$639.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$575.64
Rate for Payer: Molina Healthcare Benefit Exchange	$234.00
Rate for Payer: Ohio Health Choice Commercial	$686.40
Rate for Payer: Ohio Health Group HMO	$585.00
Rate for Payer: Ohio Health Group PPO Differential	$624.00
Rate for Payer: Ohio Health Group PPO No Differential	$678.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$538.20
Rate for Payer: PHCS Commercial	$748.80
Rate for Payer: United Healthcare All Payer	$686.40

INCISION BONE CORTEX FOOT

Professional

Both

$780.00

Service Code	HCPCS 28005
Hospital Charge Code	76100966
Hospital Revenue Code	761
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$1,001.30
Rate for Payer: Aetna Commercial	$922.92
Rate for Payer: Ambetter Exchange	$542.33
Rate for Payer: Anthem Medicaid	$348.73
Rate for Payer: Buckeye Individual/Medicaid	$542.33
Rate for Payer: Buckeye Medicare Advantage	$542.33
Rate for Payer: CareSource Just4Me Medicare	$650.80
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cigna Commercial	$1,001.30
Rate for Payer: Healthspan PPO	$835.97
Rate for Payer: Humana Medicaid	$348.73
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$739.89
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$542.33
Rate for Payer: Molina Healthcare Benefit Exchange	$542.33
Rate for Payer: Molina Healthcare CHIP/Medicaid	$355.70
Rate for Payer: Molina Healthcare Passport	$348.73
Rate for Payer: Multiplan PHCS	$468.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$705.03
Rate for Payer: UHCCP Medicaid	$273.00
Rate for Payer: Wellcare CHIP/Medicaid	$352.22
Rate for Payer: Wellcare Medicare Advantage	$542.33

INCISION BONE CORTEX FOOT

Facility

$780.00

Service Code	HCPCS 28005
Hospital Charge Code	76100966
Hospital Revenue Code	761
Min. Negotiated Rate	$268.24
Max. Negotiated Rate	$4,197.13
Rate for Payer: Aetna Commercial	$600.60
Rate for Payer: Anthem Medicaid	$268.24
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Anthem POS/PPO/Traditional	$608.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cigna Commercial	$647.40
Rate for Payer: First Health Commercial	$741.00
Rate for Payer: Humana Commercial	$663.00
Rate for Payer: Humana KY Medicaid	$268.24
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Kentucky WC Medicaid	$270.97
Rate for Payer: Medical Mutual Of Ohio HMO	$639.60
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$575.64
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54
Rate for Payer: Molina Healthcare Medicaid	$273.62
Rate for Payer: Ohio Health Choice Commercial	$686.40
Rate for Payer: Ohio Health Group HMO	$585.00
Rate for Payer: Ohio Health Group PPO Differential	$624.00
Rate for Payer: Ohio Health Group PPO No Differential	$678.60
Rate for Payer: Ohio Health Group PPO SOMC Employees	$538.20
Rate for Payer: PHCS Commercial	$748.80
Rate for Payer: United Healthcare All Payer	$686.40

INCISION BONE CORTEX FOOT(P

Professional

Both

$780.00

Service Code	HCPCS 28005
Hospital Charge Code	761P0966
Hospital Revenue Code	761
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$1,001.30
Rate for Payer: Aetna Commercial	$922.92
Rate for Payer: Ambetter Exchange	$542.33
Rate for Payer: Anthem Medicaid	$348.73
Rate for Payer: Buckeye Individual/Medicaid	$542.33
Rate for Payer: Buckeye Medicare Advantage	$542.33
Rate for Payer: CareSource Just4Me Medicare	$650.80
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Cigna Commercial	$1,001.30
Rate for Payer: Healthspan PPO	$835.97
Rate for Payer: Humana Medicaid	$348.73
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$739.89
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$542.33
Rate for Payer: Molina Healthcare Benefit Exchange	$542.33
Rate for Payer: Molina Healthcare CHIP/Medicaid	$355.70
Rate for Payer: Molina Healthcare Passport	$348.73
Rate for Payer: Multiplan PHCS	$468.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$705.03
Rate for Payer: UHCCP Medicaid	$273.00
Rate for Payer: Wellcare CHIP/Medicaid	$352.22
Rate for Payer: Wellcare Medicare Advantage	$542.33

INCISION BX EYELID SKIN INCLID

Facility

$786.00

Service Code	HCPCS 67810
Hospital Charge Code	761T2390
Hospital Revenue Code	761
Min. Negotiated Rate	$270.31
Max. Negotiated Rate	$754.56
Rate for Payer: Aetna Commercial	$605.22
Rate for Payer: Anthem Medicaid	$270.31
Rate for Payer: Anthem Medicare Advantage/PPO	$276.21
Rate for Payer: Anthem POS/PPO/Traditional	$613.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$386.69
Rate for Payer: CareSource Just4Me Medicare	$372.88
Rate for Payer: Cash Price	$393.00
Rate for Payer: Cash Price	$393.00
Rate for Payer: Cigna Commercial	$652.38
Rate for Payer: First Health Commercial	$746.70
Rate for Payer: Humana Commercial	$668.10
Rate for Payer: Humana KY Medicaid	$270.31
Rate for Payer: Humana Medicare Advantage	$276.21
Rate for Payer: Kentucky WC Medicaid	$273.06
Rate for Payer: Medical Mutual Of Ohio HMO	$644.52
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$580.07
Rate for Payer: Molina Healthcare Benefit Exchange	$331.45
Rate for Payer: Molina Healthcare Medicaid	$275.73
Rate for Payer: Ohio Health Choice Commercial	$691.68
Rate for Payer: Ohio Health Group HMO	$589.50
Rate for Payer: Ohio Health Group PPO Differential	$628.80
Rate for Payer: Ohio Health Group PPO No Differential	$683.82
Rate for Payer: Ohio Health Group PPO SOMC Employees	$542.34
Rate for Payer: PHCS Commercial	$754.56
Rate for Payer: United Healthcare All Payer	$691.68

INCISION BX EYELID SKIN INCLID

Facility

$1,056.00

Service Code	HCPCS 67810
Hospital Charge Code	76102390
Hospital Revenue Code	761
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$1,013.76
Rate for Payer: Aetna Commercial	$813.12
Rate for Payer: Anthem POS/PPO/Traditional	$823.68
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cigna Commercial	$876.48
Rate for Payer: First Health Commercial	$1,003.20
Rate for Payer: Humana Commercial	$897.60
Rate for Payer: Medical Mutual Of Ohio HMO	$865.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$779.33
Rate for Payer: Molina Healthcare Benefit Exchange	$316.80
Rate for Payer: Ohio Health Choice Commercial	$929.28
Rate for Payer: Ohio Health Group HMO	$792.00
Rate for Payer: Ohio Health Group PPO Differential	$844.80
Rate for Payer: Ohio Health Group PPO No Differential	$918.72
Rate for Payer: Ohio Health Group PPO SOMC Employees	$728.64
Rate for Payer: PHCS Commercial	$1,013.76
Rate for Payer: United Healthcare All Payer	$929.28

INCISION BX EYELID SKIN INCLID

Facility

$786.00

Service Code	HCPCS 67810
Hospital Charge Code	761T2390
Hospital Revenue Code	761
Min. Negotiated Rate	$235.80
Max. Negotiated Rate	$754.56
Rate for Payer: Aetna Commercial	$605.22
Rate for Payer: Anthem POS/PPO/Traditional	$613.08
Rate for Payer: Cash Price	$393.00
Rate for Payer: Cigna Commercial	$652.38
Rate for Payer: First Health Commercial	$746.70
Rate for Payer: Humana Commercial	$668.10
Rate for Payer: Medical Mutual Of Ohio HMO	$644.52
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$580.07
Rate for Payer: Molina Healthcare Benefit Exchange	$235.80
Rate for Payer: Ohio Health Choice Commercial	$691.68
Rate for Payer: Ohio Health Group HMO	$589.50
Rate for Payer: Ohio Health Group PPO Differential	$628.80
Rate for Payer: Ohio Health Group PPO No Differential	$683.82
Rate for Payer: Ohio Health Group PPO SOMC Employees	$542.34
Rate for Payer: PHCS Commercial	$754.56
Rate for Payer: United Healthcare All Payer	$691.68

INCISION BX EYELID SKIN INCLID

Facility

$1,056.00

Service Code	HCPCS 67810
Hospital Charge Code	76102390
Hospital Revenue Code	761
Min. Negotiated Rate	$276.21
Max. Negotiated Rate	$1,013.76
Rate for Payer: Aetna Commercial	$813.12
Rate for Payer: Anthem Medicaid	$363.16
Rate for Payer: Anthem Medicare Advantage/PPO	$276.21
Rate for Payer: Anthem POS/PPO/Traditional	$823.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$386.69
Rate for Payer: CareSource Just4Me Medicare	$372.88
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cigna Commercial	$876.48
Rate for Payer: First Health Commercial	$1,003.20
Rate for Payer: Humana Commercial	$897.60
Rate for Payer: Humana KY Medicaid	$363.16
Rate for Payer: Humana Medicare Advantage	$276.21
Rate for Payer: Kentucky WC Medicaid	$366.85
Rate for Payer: Medical Mutual Of Ohio HMO	$865.92
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$779.33
Rate for Payer: Molina Healthcare Benefit Exchange	$331.45
Rate for Payer: Molina Healthcare Medicaid	$370.44
Rate for Payer: Ohio Health Choice Commercial	$929.28
Rate for Payer: Ohio Health Group HMO	$792.00
Rate for Payer: Ohio Health Group PPO Differential	$844.80
Rate for Payer: Ohio Health Group PPO No Differential	$918.72
Rate for Payer: Ohio Health Group PPO SOMC Employees	$728.64
Rate for Payer: PHCS Commercial	$1,013.76
Rate for Payer: United Healthcare All Payer	$929.28

Know your out-of-pocket cost for care.

All Charges