Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 9504: EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$45,607.87

Service Code	APR-DRG 9504
Hospital Charge Code	APRDRG 9504
Min. Negotiated Rate	$45,607.87
Max. Negotiated Rate	$45,607.87
Rate for Payer: Aetna CHP/Medicaid	$45,607.87
Rate for Payer: Humana OH Medicaid	$45,607.87

INPATIENT APRDRG 9511: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$5,989.16

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG 9511
Min. Negotiated Rate	$5,989.16
Max. Negotiated Rate	$5,989.16
Rate for Payer: Aetna CHP/Medicaid	$5,989.16
Rate for Payer: Humana OH Medicaid	$5,989.16

INPATIENT APRDRG 9512: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,643.64

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG 9512
Min. Negotiated Rate	$7,643.64
Max. Negotiated Rate	$7,643.64
Rate for Payer: Aetna CHP/Medicaid	$7,643.64
Rate for Payer: Humana OH Medicaid	$7,643.64

INPATIENT APRDRG 9513: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$13,942.00

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG 9513
Min. Negotiated Rate	$13,942.00
Max. Negotiated Rate	$13,942.00
Rate for Payer: Aetna CHP/Medicaid	$13,942.00
Rate for Payer: Humana OH Medicaid	$13,942.00

INPATIENT APRDRG 9514: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$30,010.73

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG 9514
Min. Negotiated Rate	$30,010.73
Max. Negotiated Rate	$30,010.73
Rate for Payer: Aetna CHP/Medicaid	$30,010.73
Rate for Payer: Humana OH Medicaid	$30,010.73

INPATIENT APRDRG 9521: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$5,997.60

Service Code	APR-DRG 9521
Hospital Charge Code	APRDRG 9521
Min. Negotiated Rate	$5,997.60
Max. Negotiated Rate	$5,997.60
Rate for Payer: Aetna CHP/Medicaid	$5,997.60
Rate for Payer: Humana OH Medicaid	$5,997.60

INPATIENT APRDRG 9522: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$6,625.10

Service Code	APR-DRG 9522
Hospital Charge Code	APRDRG 9522
Min. Negotiated Rate	$6,625.10
Max. Negotiated Rate	$6,625.10
Rate for Payer: Aetna CHP/Medicaid	$6,625.10
Rate for Payer: Humana OH Medicaid	$6,625.10

INPATIENT APRDRG 9523: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,116.02

Service Code	APR-DRG 9523
Hospital Charge Code	APRDRG 9523
Min. Negotiated Rate	$12,116.02
Max. Negotiated Rate	$12,116.02
Rate for Payer: Aetna CHP/Medicaid	$12,116.02
Rate for Payer: Humana OH Medicaid	$12,116.02

INPATIENT APRDRG 9524: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$28,060.69

Service Code	APR-DRG 9524
Hospital Charge Code	APRDRG 9524
Min. Negotiated Rate	$28,060.69
Max. Negotiated Rate	$28,060.69
Rate for Payer: Aetna CHP/Medicaid	$28,060.69
Rate for Payer: Humana OH Medicaid	$28,060.69

INPATIENT HEMODIALYSIS

Facility

$410.00

Hospital Charge Code	80000002
Hospital Revenue Code	801
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$393.60
Rate for Payer: Aetna Commercial	$315.70
Rate for Payer: Anthem Medicaid	$141.00
Rate for Payer: Anthem POS/PPO/Traditional	$319.80
Rate for Payer: Cash Price	$205.00
Rate for Payer: Cigna Commercial	$340.30
Rate for Payer: First Health Commercial	$389.50
Rate for Payer: Humana Commercial	$348.50
Rate for Payer: Humana KY Medicaid	$141.00
Rate for Payer: Kentucky WC Medicaid	$142.43
Rate for Payer: Medical Mutual Of Ohio HMO	$336.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$302.58
Rate for Payer: Molina Healthcare Benefit Exchange	$123.00
Rate for Payer: Molina Healthcare Medicaid	$143.83
Rate for Payer: Ohio Health Choice Commercial	$360.80
Rate for Payer: Ohio Health Group HMO	$307.50
Rate for Payer: Ohio Health Group PPO Differential	$82.00
Rate for Payer: Ohio Health Group PPO No Differential	$53.30
Rate for Payer: Ohio Health Group PPO SOMC Employees	$127.10
Rate for Payer: PHCS Commercial	$393.60
Rate for Payer: United Healthcare All Payer	$360.80

INPATIENT HEMODIALYSIS

Professional

Both

$396.00

Hospital Charge Code	80000002
Hospital Revenue Code	801
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$396.00
Rate for Payer: Buckeye Medicare Advantage	$396.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Multiplan PHCS	$237.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$277.20
Rate for Payer: UHCCP Medicaid	$138.60

INPATIENT HEMODIALYSIS

Facility

$410.00

Hospital Charge Code	80000002
Hospital Revenue Code	801
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$393.60
Rate for Payer: Aetna Commercial	$315.70
Rate for Payer: Anthem POS/PPO/Traditional	$319.80
Rate for Payer: Cash Price	$205.00
Rate for Payer: Cigna Commercial	$340.30
Rate for Payer: First Health Commercial	$389.50
Rate for Payer: Humana Commercial	$348.50
Rate for Payer: Medical Mutual Of Ohio HMO	$336.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$302.58
Rate for Payer: Molina Healthcare Benefit Exchange	$123.00
Rate for Payer: Ohio Health Choice Commercial	$360.80
Rate for Payer: Ohio Health Group HMO	$307.50
Rate for Payer: Ohio Health Group PPO Differential	$82.00
Rate for Payer: Ohio Health Group PPO No Differential	$53.30
Rate for Payer: Ohio Health Group PPO SOMC Employees	$127.10
Rate for Payer: PHCS Commercial	$393.60
Rate for Payer: United Healthcare All Payer	$360.80

INR

Professional

Both

$41.00

Service Code	HCPCS 85610
Hospital Charge Code	30000620
Hospital Revenue Code	300
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$7.43
Rate for Payer: Buckeye Medicare Advantage	$41.00
Rate for Payer: Cash Price	$20.50
Rate for Payer: Cash Price	$20.50
Rate for Payer: Cigna Commercial	$5.37
Rate for Payer: Healthspan PPO	$4.12
Rate for Payer: Multiplan PHCS	$24.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$28.70
Rate for Payer: UHCCP Medicaid	$14.35
Rate for Payer: Wellcare CHIP/Medicaid	$2.57

INR

Facility

$41.00

Service Code	HCPCS 85610
Hospital Charge Code	30000620
Hospital Revenue Code	300
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$39.36
Rate for Payer: Aetna Commercial	$31.57
Rate for Payer: Anthem POS/PPO/Traditional	$32.92
Rate for Payer: Cash Price	$20.50
Rate for Payer: Cigna Commercial	$34.03
Rate for Payer: First Health Commercial	$38.95
Rate for Payer: Humana Commercial	$34.85
Rate for Payer: Medical Mutual Of Ohio HMO	$33.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$30.26
Rate for Payer: Molina Healthcare Benefit Exchange	$12.30
Rate for Payer: Ohio Health Choice Commercial	$36.08
Rate for Payer: Ohio Health Group HMO	$30.75
Rate for Payer: Ohio Health Group PPO Differential	$8.20
Rate for Payer: Ohio Health Group PPO No Differential	$5.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12.71
Rate for Payer: PHCS Commercial	$39.36
Rate for Payer: United Healthcare All Payer	$36.08

INR

Facility

$41.00

Service Code	HCPCS 85610
Hospital Charge Code	30000620
Hospital Revenue Code	300
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$39.36
Rate for Payer: Aetna Commercial	$31.57
Rate for Payer: Anthem Medicaid	$4.29
Rate for Payer: Anthem Medicare Advantage/PPO	$4.29
Rate for Payer: Anthem POS/PPO/Traditional	$32.92
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6.01
Rate for Payer: CareSource Just4Me Medicare	$4.29
Rate for Payer: Cash Price	$20.50
Rate for Payer: Cash Price	$20.50
Rate for Payer: Cigna Commercial	$34.03
Rate for Payer: First Health Commercial	$38.95
Rate for Payer: Humana Commercial	$34.85
Rate for Payer: Humana KY Medicaid	$4.29
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: Kentucky WC Medicaid	$4.33
Rate for Payer: Medical Mutual Of Ohio HMO	$33.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$30.26
Rate for Payer: Molina Healthcare Benefit Exchange	$5.15
Rate for Payer: Molina Healthcare Medicaid	$4.38
Rate for Payer: Ohio Health Choice Commercial	$36.08
Rate for Payer: Ohio Health Group HMO	$30.75
Rate for Payer: Ohio Health Group PPO Differential	$8.20
Rate for Payer: Ohio Health Group PPO No Differential	$5.33
Rate for Payer: Ohio Health Group PPO SOMC Employees	$12.71
Rate for Payer: PHCS Commercial	$39.36
Rate for Payer: United Healthcare All Payer	$36.08

INS ART C/R GII SZ 1-2 11MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem Medicaid	$1,478.77
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Humana KY Medicaid	$1,478.77
Rate for Payer: Kentucky WC Medicaid	$1,493.82
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Molina Healthcare Medicaid	$1,508.44
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 11MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 13MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 13MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem Medicaid	$1,478.77
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Humana KY Medicaid	$1,478.77
Rate for Payer: Kentucky WC Medicaid	$1,493.82
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Molina Healthcare Medicaid	$1,508.44
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 15MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 15MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem Medicaid	$1,478.77
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Humana KY Medicaid	$1,478.77
Rate for Payer: Kentucky WC Medicaid	$1,493.82
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Molina Healthcare Medicaid	$1,508.44
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 18MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 18MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$559.00
Max. Negotiated Rate	$4,128.00
Rate for Payer: Aetna Commercial	$3,311.00
Rate for Payer: Anthem Medicaid	$1,478.77
Rate for Payer: Anthem POS/PPO/Traditional	$3,354.00
Rate for Payer: Cash Price	$2,150.00
Rate for Payer: Cigna Commercial	$3,569.00
Rate for Payer: First Health Commercial	$4,085.00
Rate for Payer: Humana Commercial	$3,655.00
Rate for Payer: Humana KY Medicaid	$1,478.77
Rate for Payer: Kentucky WC Medicaid	$1,493.82
Rate for Payer: Medical Mutual Of Ohio HMO	$3,526.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,173.40
Rate for Payer: Molina Healthcare Benefit Exchange	$1,290.00
Rate for Payer: Molina Healthcare Medicaid	$1,508.44
Rate for Payer: Ohio Health Choice Commercial	$3,784.00
Rate for Payer: Ohio Health Group HMO	$3,225.00
Rate for Payer: Ohio Health Group PPO Differential	$860.00
Rate for Payer: Ohio Health Group PPO No Differential	$559.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,333.00
Rate for Payer: PHCS Commercial	$4,128.00
Rate for Payer: United Healthcare All Payer	$3,784.00

INS ART C/R GII SZ 1-2 9MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$4,800.00
Rate for Payer: Aetna Commercial	$3,850.00
Rate for Payer: Anthem POS/PPO/Traditional	$3,900.00
Rate for Payer: Cash Price	$2,500.00
Rate for Payer: Cigna Commercial	$4,150.00
Rate for Payer: First Health Commercial	$4,750.00
Rate for Payer: Humana Commercial	$4,250.00
Rate for Payer: Medical Mutual Of Ohio HMO	$4,100.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,690.00
Rate for Payer: Molina Healthcare Benefit Exchange	$1,500.00
Rate for Payer: Ohio Health Choice Commercial	$4,400.00
Rate for Payer: Ohio Health Group HMO	$3,750.00
Rate for Payer: Ohio Health Group PPO Differential	$1,000.00
Rate for Payer: Ohio Health Group PPO No Differential	$650.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,550.00
Rate for Payer: PHCS Commercial	$4,800.00
Rate for Payer: United Healthcare All Payer	$4,400.00

INS ART C/R GII SZ 1-2 9MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$650.00
Max. Negotiated Rate	$4,800.00
Rate for Payer: Aetna Commercial	$3,850.00
Rate for Payer: Anthem Medicaid	$1,719.50
Rate for Payer: Anthem POS/PPO/Traditional	$3,900.00
Rate for Payer: Cash Price	$2,500.00
Rate for Payer: Cigna Commercial	$4,150.00
Rate for Payer: First Health Commercial	$4,750.00
Rate for Payer: Humana Commercial	$4,250.00
Rate for Payer: Humana KY Medicaid	$1,719.50
Rate for Payer: Kentucky WC Medicaid	$1,737.00
Rate for Payer: Medical Mutual Of Ohio HMO	$4,100.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,690.00
Rate for Payer: Molina Healthcare Benefit Exchange	$1,500.00
Rate for Payer: Molina Healthcare Medicaid	$1,754.00
Rate for Payer: Ohio Health Choice Commercial	$4,400.00
Rate for Payer: Ohio Health Group HMO	$3,750.00
Rate for Payer: Ohio Health Group PPO Differential	$1,000.00
Rate for Payer: Ohio Health Group PPO No Differential	$650.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,550.00
Rate for Payer: PHCS Commercial	$4,800.00
Rate for Payer: United Healthcare All Payer	$4,400.00

Know your out-of-pocket cost for care.

All Charges