Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$14,159.52

Service Code	MSDRG 804
Min. Negotiated Rate	$9,608.24
Max. Negotiated Rate	$14,159.52
Rate for Payer: Molina Healthcare Medicaid	$9,800.41
Rate for Payer: Anthem Medicaid	$9,608.24
Rate for Payer: Anthem Medicare Advantage/PPO	$10,113.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,159.52
Rate for Payer: CareSource Just4Me Medicare	$13,653.82
Rate for Payer: Humana KY Medicaid	$9,608.24
Rate for Payer: Humana Medicare Advantage	$10,113.94
Rate for Payer: Kentucky WC Medicaid	$9,704.33
Rate for Payer: Molina Healthcare Benefit Exchange	$12,136.73

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$21,177.25

Service Code	MSDRG 205
Min. Negotiated Rate	$14,370.28
Max. Negotiated Rate	$21,177.25
Rate for Payer: Anthem Medicaid	$14,370.28
Rate for Payer: Anthem Medicare Advantage/PPO	$15,126.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,177.25
Rate for Payer: CareSource Just4Me Medicare	$20,420.92
Rate for Payer: Humana KY Medicaid	$14,370.28
Rate for Payer: Humana Medicare Advantage	$15,126.61
Rate for Payer: Kentucky WC Medicaid	$14,513.98
Rate for Payer: Molina Healthcare Benefit Exchange	$18,151.93
Rate for Payer: Molina Healthcare Medicaid	$14,657.69

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$10,686.31

Service Code	MSDRG 206
Min. Negotiated Rate	$7,251.43
Max. Negotiated Rate	$10,686.31
Rate for Payer: Anthem Medicaid	$7,251.43
Rate for Payer: Anthem Medicare Advantage/PPO	$7,633.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,686.31
Rate for Payer: CareSource Just4Me Medicare	$10,304.66
Rate for Payer: Humana KY Medicaid	$7,251.43
Rate for Payer: Humana Medicare Advantage	$7,633.08
Rate for Payer: Kentucky WC Medicaid	$7,323.94
Rate for Payer: Molina Healthcare Benefit Exchange	$9,159.70
Rate for Payer: Molina Healthcare Medicaid	$7,396.45

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$21,288.40

Service Code	MSDRG 167
Min. Negotiated Rate	$14,445.70
Max. Negotiated Rate	$21,288.40
Rate for Payer: Anthem Medicaid	$14,445.70
Rate for Payer: Anthem Medicare Advantage/PPO	$15,206.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,288.40
Rate for Payer: CareSource Just4Me Medicare	$20,528.10
Rate for Payer: Humana KY Medicaid	$14,445.70
Rate for Payer: Humana Medicare Advantage	$15,206.00
Rate for Payer: Kentucky WC Medicaid	$14,590.16
Rate for Payer: Molina Healthcare Benefit Exchange	$18,247.20
Rate for Payer: Molina Healthcare Medicaid	$14,734.61

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$47,468.97

Service Code	MSDRG 166
Min. Negotiated Rate	$32,211.09
Max. Negotiated Rate	$47,468.97
Rate for Payer: Anthem Medicaid	$32,211.09
Rate for Payer: Anthem Medicare Advantage/PPO	$33,906.41
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,468.97
Rate for Payer: CareSource Just4Me Medicare	$45,773.65
Rate for Payer: Humana KY Medicaid	$32,211.09
Rate for Payer: Humana Medicare Advantage	$33,906.41
Rate for Payer: Kentucky WC Medicaid	$32,533.20
Rate for Payer: Molina Healthcare Benefit Exchange	$40,687.69
Rate for Payer: Molina Healthcare Medicaid	$32,855.31

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$15,859.26

Service Code	MSDRG 168
Min. Negotiated Rate	$10,761.64
Max. Negotiated Rate	$15,859.26
Rate for Payer: Anthem Medicaid	$10,761.64
Rate for Payer: Anthem Medicare Advantage/PPO	$11,328.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,859.26
Rate for Payer: CareSource Just4Me Medicare	$15,292.85
Rate for Payer: Humana KY Medicaid	$10,761.64
Rate for Payer: Humana Medicare Advantage	$11,328.04
Rate for Payer: Kentucky WC Medicaid	$10,869.25
Rate for Payer: Molina Healthcare Benefit Exchange	$13,593.65
Rate for Payer: Molina Healthcare Medicaid	$10,976.87

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$20,432.06

Service Code	MSDRG 580
Min. Negotiated Rate	$13,864.61
Max. Negotiated Rate	$20,432.06
Rate for Payer: Anthem Medicaid	$13,864.61
Rate for Payer: Anthem Medicare Advantage/PPO	$14,594.33
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,432.06
Rate for Payer: CareSource Just4Me Medicare	$19,702.35
Rate for Payer: Humana KY Medicaid	$13,864.61
Rate for Payer: Humana Medicare Advantage	$14,594.33
Rate for Payer: Kentucky WC Medicaid	$14,003.26
Rate for Payer: Molina Healthcare Benefit Exchange	$17,513.20
Rate for Payer: Molina Healthcare Medicaid	$14,141.91

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$39,097.76

Service Code	MSDRG 579
Min. Negotiated Rate	$26,530.62
Max. Negotiated Rate	$39,097.76
Rate for Payer: Anthem Medicaid	$26,530.62
Rate for Payer: Anthem Medicare Advantage/PPO	$27,926.97
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$39,097.76
Rate for Payer: CareSource Just4Me Medicare	$37,701.41
Rate for Payer: Humana KY Medicaid	$26,530.62
Rate for Payer: Humana Medicare Advantage	$27,926.97
Rate for Payer: Kentucky WC Medicaid	$26,795.93
Rate for Payer: Molina Healthcare Benefit Exchange	$33,512.36
Rate for Payer: Molina Healthcare Medicaid	$27,061.23

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$15,753.96

Service Code	MSDRG 581
Min. Negotiated Rate	$10,690.19
Max. Negotiated Rate	$15,753.96
Rate for Payer: Anthem Medicaid	$10,690.19
Rate for Payer: Anthem Medicare Advantage/PPO	$11,252.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,753.96
Rate for Payer: CareSource Just4Me Medicare	$15,191.32
Rate for Payer: Humana KY Medicaid	$10,690.19
Rate for Payer: Humana Medicare Advantage	$11,252.83
Rate for Payer: Kentucky WC Medicaid	$10,797.09
Rate for Payer: Molina Healthcare Benefit Exchange	$13,503.40
Rate for Payer: Molina Healthcare Medicaid	$10,903.99

OTHER VASCULAR PROCEDURES WITH CC

Facility

$29,843.28

Service Code	MSDRG 253
Min. Negotiated Rate	$20,250.80
Max. Negotiated Rate	$29,843.28
Rate for Payer: Anthem Medicaid	$20,250.80
Rate for Payer: Anthem Medicare Advantage/PPO	$21,316.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,843.28
Rate for Payer: CareSource Just4Me Medicare	$28,777.45
Rate for Payer: Humana KY Medicaid	$20,250.80
Rate for Payer: Humana Medicare Advantage	$21,316.63
Rate for Payer: Kentucky WC Medicaid	$20,453.31
Rate for Payer: Molina Healthcare Benefit Exchange	$25,579.96
Rate for Payer: Molina Healthcare Medicaid	$20,655.81

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$39,233.45

Service Code	MSDRG 252
Min. Negotiated Rate	$26,622.70
Max. Negotiated Rate	$39,233.45
Rate for Payer: Anthem Medicaid	$26,622.70
Rate for Payer: Anthem Medicare Advantage/PPO	$28,023.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$39,233.45
Rate for Payer: CareSource Just4Me Medicare	$37,832.25
Rate for Payer: Humana KY Medicaid	$26,622.70
Rate for Payer: Humana Medicare Advantage	$28,023.89
Rate for Payer: Kentucky WC Medicaid	$26,888.92
Rate for Payer: Molina Healthcare Benefit Exchange	$33,628.67
Rate for Payer: Molina Healthcare Medicaid	$27,155.15

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$20,297.56

Service Code	MSDRG 254
Min. Negotiated Rate	$13,773.35
Max. Negotiated Rate	$20,297.56
Rate for Payer: Anthem Medicaid	$13,773.35
Rate for Payer: Anthem Medicare Advantage/PPO	$14,498.26
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,297.56
Rate for Payer: CareSource Just4Me Medicare	$19,572.65
Rate for Payer: Humana KY Medicaid	$13,773.35
Rate for Payer: Humana Medicare Advantage	$14,498.26
Rate for Payer: Kentucky WC Medicaid	$13,911.08
Rate for Payer: Molina Healthcare Benefit Exchange	$17,397.91
Rate for Payer: Molina Healthcare Medicaid	$14,048.81

OTITIS MEDIA AND URI WITH MCC

Facility

$13,899.80

Service Code	MSDRG 152
Min. Negotiated Rate	$9,432.01
Max. Negotiated Rate	$13,899.80
Rate for Payer: Anthem Medicaid	$9,432.01
Rate for Payer: Anthem Medicare Advantage/PPO	$9,928.43
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,899.80
Rate for Payer: CareSource Just4Me Medicare	$13,403.38
Rate for Payer: Humana KY Medicaid	$9,432.01
Rate for Payer: Humana Medicare Advantage	$9,928.43
Rate for Payer: Kentucky WC Medicaid	$9,526.33
Rate for Payer: Molina Healthcare Benefit Exchange	$11,914.12
Rate for Payer: Molina Healthcare Medicaid	$9,620.65

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$8,595.85

Service Code	MSDRG 153
Min. Negotiated Rate	$5,832.90
Max. Negotiated Rate	$8,595.85
Rate for Payer: Anthem Medicaid	$5,832.90
Rate for Payer: Anthem Medicare Advantage/PPO	$6,139.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,595.85
Rate for Payer: CareSource Just4Me Medicare	$8,288.85
Rate for Payer: Humana KY Medicaid	$5,832.90
Rate for Payer: Humana Medicare Advantage	$6,139.89
Rate for Payer: Kentucky WC Medicaid	$5,891.22
Rate for Payer: Molina Healthcare Benefit Exchange	$7,367.87
Rate for Payer: Molina Healthcare Medicaid	$5,949.55

OTOLARYNGOLOGIC EXAM

Facility

$3,283.57

Service Code	HCPCS 92502
Hospital Charge Code	76102449
Hospital Revenue Code	761
Min. Negotiated Rate	$426.86
Max. Negotiated Rate	$3,152.23
Rate for Payer: Aetna Commercial	$2,528.35
Rate for Payer: Anthem POS/PPO/Traditional	$2,561.18
Rate for Payer: Cash Price	$1,641.79
Rate for Payer: Cigna Commercial	$2,725.36
Rate for Payer: First Health Commercial	$3,119.39
Rate for Payer: Humana Commercial	$2,791.03
Rate for Payer: Medical Mutual Of Ohio HMO	$2,692.53
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,423.27
Rate for Payer: Molina Healthcare Benefit Exchange	$985.07
Rate for Payer: Ohio Health Choice Commercial	$2,889.54
Rate for Payer: Ohio Health Group HMO	$2,462.68
Rate for Payer: Ohio Health Group PPO Differential	$656.71
Rate for Payer: Ohio Health Group PPO No Differential	$426.86
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,017.91
Rate for Payer: PHCS Commercial	$3,152.23
Rate for Payer: United Healthcare All Payer	$2,889.54

OTOLARYNGOLOGIC EXAM

Facility

$3,283.57

Service Code	HCPCS 92502
Hospital Charge Code	76102449
Hospital Revenue Code	761
Min. Negotiated Rate	$426.86
Max. Negotiated Rate	$3,152.23
Rate for Payer: Aetna Commercial	$2,528.35
Rate for Payer: Anthem Medicaid	$1,129.22
Rate for Payer: Anthem Medicare Advantage/PPO	$475.79
Rate for Payer: Anthem POS/PPO/Traditional	$2,561.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$666.11
Rate for Payer: CareSource Just4Me Medicare	$642.32
Rate for Payer: Cash Price	$1,641.79
Rate for Payer: Cash Price	$1,641.79
Rate for Payer: Cigna Commercial	$2,725.36
Rate for Payer: First Health Commercial	$3,119.39
Rate for Payer: Humana Commercial	$2,791.03
Rate for Payer: Humana KY Medicaid	$1,129.22
Rate for Payer: Humana Medicare Advantage	$475.79
Rate for Payer: Kentucky WC Medicaid	$1,140.71
Rate for Payer: Medical Mutual Of Ohio HMO	$2,692.53
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,423.27
Rate for Payer: Molina Healthcare Benefit Exchange	$570.95
Rate for Payer: Molina Healthcare Medicaid	$1,151.88
Rate for Payer: Ohio Health Choice Commercial	$2,889.54
Rate for Payer: Ohio Health Group HMO	$2,462.68
Rate for Payer: Ohio Health Group PPO Differential	$656.71
Rate for Payer: Ohio Health Group PPO No Differential	$426.86
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,017.91
Rate for Payer: PHCS Commercial	$3,152.23
Rate for Payer: United Healthcare All Payer	$2,889.54

OTOLARYNGOLOGIC EXAM

Professional

Both

$3,283.57

Service Code	HCPCS 92502
Hospital Charge Code	76102449
Hospital Revenue Code	761
Min. Negotiated Rate	$77.27
Max. Negotiated Rate	$3,283.57
Rate for Payer: Aetna Commercial	$121.26
Rate for Payer: Anthem Medicaid	$77.27
Rate for Payer: Buckeye Medicare Advantage	$3,283.57
Rate for Payer: Cash Price	$1,641.79
Rate for Payer: Cash Price	$1,641.79
Rate for Payer: Cigna Commercial	$143.58
Rate for Payer: Healthspan PPO	$116.73
Rate for Payer: Humana Medicaid	$77.27
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$112.64
Rate for Payer: Molina Healthcare CHIP/Medicaid	$78.82
Rate for Payer: Molina Healthcare Passport	$77.27
Rate for Payer: Multiplan PHCS	$1,970.14
Rate for Payer: Ohio Health Choice Preferred Health Choice	$2,298.50
Rate for Payer: UHCCP Medicaid	$1,149.25
Rate for Payer: Wellcare CHIP/Medicaid	$78.04

OTOLARYNGOLOGIC EXAM(P

Professional

Both

$300.00

Service Code	HCPCS 92502
Hospital Charge Code	761P2449
Hospital Revenue Code	761
Min. Negotiated Rate	$77.27
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$121.26
Rate for Payer: Anthem Medicaid	$77.27
Rate for Payer: Buckeye Medicare Advantage	$300.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$143.58
Rate for Payer: Healthspan PPO	$116.73
Rate for Payer: Humana Medicaid	$77.27
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$112.64
Rate for Payer: Molina Healthcare CHIP/Medicaid	$78.82
Rate for Payer: Molina Healthcare Passport	$77.27
Rate for Payer: Multiplan PHCS	$180.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$210.00
Rate for Payer: UHCCP Medicaid	$105.00
Rate for Payer: Wellcare CHIP/Medicaid	$78.04

OTOLARYNGOLOGIC EXAM(T

Facility

$2,983.57

Service Code	HCPCS 92502
Hospital Charge Code	761T2449
Hospital Revenue Code	761
Min. Negotiated Rate	$387.86
Max. Negotiated Rate	$2,864.23
Rate for Payer: Aetna Commercial	$2,297.35
Rate for Payer: Anthem Medicaid	$1,026.05
Rate for Payer: Anthem Medicare Advantage/PPO	$475.79
Rate for Payer: Anthem POS/PPO/Traditional	$2,327.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$666.11
Rate for Payer: CareSource Just4Me Medicare	$642.32
Rate for Payer: Cash Price	$1,491.79
Rate for Payer: Cash Price	$1,491.79
Rate for Payer: Cigna Commercial	$2,476.36
Rate for Payer: First Health Commercial	$2,834.39
Rate for Payer: Humana Commercial	$2,536.03
Rate for Payer: Humana KY Medicaid	$1,026.05
Rate for Payer: Humana Medicare Advantage	$475.79
Rate for Payer: Kentucky WC Medicaid	$1,036.49
Rate for Payer: Medical Mutual Of Ohio HMO	$2,446.53
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,201.87
Rate for Payer: Molina Healthcare Benefit Exchange	$570.95
Rate for Payer: Molina Healthcare Medicaid	$1,046.64
Rate for Payer: Ohio Health Choice Commercial	$2,625.54
Rate for Payer: Ohio Health Group HMO	$2,237.68
Rate for Payer: Ohio Health Group PPO Differential	$596.71
Rate for Payer: Ohio Health Group PPO No Differential	$387.86
Rate for Payer: Ohio Health Group PPO SOMC Employees	$924.91
Rate for Payer: PHCS Commercial	$2,864.23
Rate for Payer: United Healthcare All Payer	$2,625.54

OTOLARYNGOLOGIC EXAM(T

Facility

$2,983.57

Service Code	HCPCS 92502
Hospital Charge Code	761T2449
Hospital Revenue Code	761
Min. Negotiated Rate	$387.86
Max. Negotiated Rate	$2,864.23
Rate for Payer: Aetna Commercial	$2,297.35
Rate for Payer: Anthem POS/PPO/Traditional	$2,327.18
Rate for Payer: Cash Price	$1,491.79
Rate for Payer: Cigna Commercial	$2,476.36
Rate for Payer: First Health Commercial	$2,834.39
Rate for Payer: Humana Commercial	$2,536.03
Rate for Payer: Medical Mutual Of Ohio HMO	$2,446.53
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,201.87
Rate for Payer: Molina Healthcare Benefit Exchange	$895.07
Rate for Payer: Ohio Health Choice Commercial	$2,625.54
Rate for Payer: Ohio Health Group HMO	$2,237.68
Rate for Payer: Ohio Health Group PPO Differential	$596.71
Rate for Payer: Ohio Health Group PPO No Differential	$387.86
Rate for Payer: Ohio Health Group PPO SOMC Employees	$924.91
Rate for Payer: PHCS Commercial	$2,864.23
Rate for Payer: United Healthcare All Payer	$2,625.54

OTOPLASTY BILATERAL

Professional

Both

$800.00

Hospital Charge Code	22200043
Hospital Revenue Code	222
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$800.00
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Multiplan PHCS	$480.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$560.00
Rate for Payer: UHCCP Medicaid	$280.00

OTOPLASTY BILATERAL -80

Professional

Both

$400.00

Hospital Charge Code	22200376
Hospital Revenue Code	222
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$400.00
Rate for Payer: Buckeye Medicare Advantage	$400.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Multiplan PHCS	$240.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$280.00
Rate for Payer: UHCCP Medicaid	$140.00

OT RE EVAL CARE PLAN

Facility

$135.00

Service Code	HCPCS 97168
Hospital Charge Code	43000022
Hospital Revenue Code	434
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna Commercial	$103.95
Rate for Payer: Anthem POS/PPO/Traditional	$105.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial	$112.05
Rate for Payer: First Health Commercial	$128.25
Rate for Payer: Humana Commercial	$114.75
Rate for Payer: Medical Mutual Of Ohio HMO	$110.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$99.63
Rate for Payer: Molina Healthcare Benefit Exchange	$40.50
Rate for Payer: Ohio Health Choice Commercial	$118.80
Rate for Payer: Ohio Health Group HMO	$101.25
Rate for Payer: Ohio Health Group PPO Differential	$27.00
Rate for Payer: Ohio Health Group PPO No Differential	$17.55
Rate for Payer: Ohio Health Group PPO SOMC Employees	$41.85
Rate for Payer: PHCS Commercial	$129.60
Rate for Payer: United Healthcare All Payer	$118.80

OT RE EVAL CARE PLAN

Facility

$135.00

Service Code	HCPCS 97168
Hospital Charge Code	43000022
Hospital Revenue Code	434
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna Commercial	$103.95
Rate for Payer: Anthem Medicaid	$46.43
Rate for Payer: Anthem POS/PPO/Traditional	$105.30
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial	$112.05
Rate for Payer: First Health Commercial	$128.25
Rate for Payer: Humana Commercial	$114.75
Rate for Payer: Humana KY Medicaid	$46.43
Rate for Payer: Kentucky WC Medicaid	$46.90
Rate for Payer: Medical Mutual Of Ohio HMO	$110.70
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$99.63
Rate for Payer: Molina Healthcare Benefit Exchange	$40.50
Rate for Payer: Molina Healthcare Medicaid	$47.36
Rate for Payer: Ohio Health Choice Commercial	$118.80
Rate for Payer: Ohio Health Group HMO	$101.25
Rate for Payer: Ohio Health Group PPO Differential	$27.00
Rate for Payer: Ohio Health Group PPO No Differential	$17.55
Rate for Payer: Ohio Health Group PPO SOMC Employees	$41.85
Rate for Payer: PHCS Commercial	$129.60
Rate for Payer: United Healthcare All Payer	$118.80

OT WHIRLPOOL-EXTREMITY

Facility

$149.00

Service Code	HCPCS 97022
Hospital Charge Code	43000007
Hospital Revenue Code	431
Min. Negotiated Rate	$19.37
Max. Negotiated Rate	$143.04
Rate for Payer: Aetna Commercial	$114.73
Rate for Payer: Anthem POS/PPO/Traditional	$116.22
Rate for Payer: Cash Price	$74.50
Rate for Payer: Cigna Commercial	$123.67
Rate for Payer: First Health Commercial	$141.55
Rate for Payer: Humana Commercial	$126.65
Rate for Payer: Medical Mutual Of Ohio HMO	$122.18
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$109.96
Rate for Payer: Molina Healthcare Benefit Exchange	$44.70
Rate for Payer: Ohio Health Choice Commercial	$131.12
Rate for Payer: Ohio Health Group HMO	$111.75
Rate for Payer: Ohio Health Group PPO Differential	$29.80
Rate for Payer: Ohio Health Group PPO No Differential	$19.37
Rate for Payer: Ohio Health Group PPO SOMC Employees	$46.19
Rate for Payer: PHCS Commercial	$143.04
Rate for Payer: United Healthcare All Payer	$131.12

Know your out-of-pocket cost for care.

All Charges