Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

UNIVERS APEX STEM SZ 13MM

Facility

$20,656.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$6,196.88
Max. Negotiated Rate	$19,830.00
Rate for Payer: Aetna Commercial	$15,905.31
Rate for Payer: Anthem Medicaid	$7,103.68
Rate for Payer: Anthem POS/PPO/Traditional	$16,111.88
Rate for Payer: Cash Price	$10,328.12
Rate for Payer: Cigna Commercial	$17,144.69
Rate for Payer: First Health Commercial	$19,623.44
Rate for Payer: Humana Commercial	$17,557.81
Rate for Payer: Humana KY Medicaid	$7,103.68
Rate for Payer: Kentucky WC Medicaid	$7,175.98
Rate for Payer: Medical Mutual Of Ohio HMO	$16,938.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$15,244.31
Rate for Payer: Molina Healthcare Benefit Exchange	$6,196.88
Rate for Payer: Molina Healthcare Medicaid	$7,246.21
Rate for Payer: Ohio Health Choice Commercial	$18,177.50
Rate for Payer: Ohio Health Group HMO	$15,492.19
Rate for Payer: Ohio Health Group PPO Differential	$16,525.00
Rate for Payer: Ohio Health Group PPO No Differential	$17,970.94
Rate for Payer: Ohio Health Group PPO SOMC Employees	$14,252.81
Rate for Payer: PHCS Commercial	$19,830.00
Rate for Payer: United Healthcare All Payer	$18,177.50

UNIVERS APEX STEM SZ 8MM

Facility

$20,656.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$6,196.88
Max. Negotiated Rate	$19,830.00
Rate for Payer: Aetna Commercial	$15,905.31
Rate for Payer: Anthem POS/PPO/Traditional	$16,111.88
Rate for Payer: Cash Price	$10,328.12
Rate for Payer: Cigna Commercial	$17,144.69
Rate for Payer: First Health Commercial	$19,623.44
Rate for Payer: Humana Commercial	$17,557.81
Rate for Payer: Medical Mutual Of Ohio HMO	$16,938.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$15,244.31
Rate for Payer: Molina Healthcare Benefit Exchange	$6,196.88
Rate for Payer: Ohio Health Choice Commercial	$18,177.50
Rate for Payer: Ohio Health Group HMO	$15,492.19
Rate for Payer: Ohio Health Group PPO Differential	$16,525.00
Rate for Payer: Ohio Health Group PPO No Differential	$17,970.94
Rate for Payer: Ohio Health Group PPO SOMC Employees	$14,252.81
Rate for Payer: PHCS Commercial	$19,830.00
Rate for Payer: United Healthcare All Payer	$18,177.50

UNIVERS APEX STEM SZ 8MM

Facility

$20,656.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$6,196.88
Max. Negotiated Rate	$19,830.00
Rate for Payer: Aetna Commercial	$15,905.31
Rate for Payer: Anthem Medicaid	$7,103.68
Rate for Payer: Anthem POS/PPO/Traditional	$16,111.88
Rate for Payer: Cash Price	$10,328.12
Rate for Payer: Cigna Commercial	$17,144.69
Rate for Payer: First Health Commercial	$19,623.44
Rate for Payer: Humana Commercial	$17,557.81
Rate for Payer: Humana KY Medicaid	$7,103.68
Rate for Payer: Kentucky WC Medicaid	$7,175.98
Rate for Payer: Medical Mutual Of Ohio HMO	$16,938.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$15,244.31
Rate for Payer: Molina Healthcare Benefit Exchange	$6,196.88
Rate for Payer: Molina Healthcare Medicaid	$7,246.21
Rate for Payer: Ohio Health Choice Commercial	$18,177.50
Rate for Payer: Ohio Health Group HMO	$15,492.19
Rate for Payer: Ohio Health Group PPO Differential	$16,525.00
Rate for Payer: Ohio Health Group PPO No Differential	$17,970.94
Rate for Payer: Ohio Health Group PPO SOMC Employees	$14,252.81
Rate for Payer: PHCS Commercial	$19,830.00
Rate for Payer: United Healthcare All Payer	$18,177.50

UNIVERS APEX STEM SZ 9MM

Facility

$20,656.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$6,196.88
Max. Negotiated Rate	$19,830.00
Rate for Payer: Aetna Commercial	$15,905.31
Rate for Payer: Anthem POS/PPO/Traditional	$16,111.88
Rate for Payer: Cash Price	$10,328.12
Rate for Payer: Cigna Commercial	$17,144.69
Rate for Payer: First Health Commercial	$19,623.44
Rate for Payer: Humana Commercial	$17,557.81
Rate for Payer: Medical Mutual Of Ohio HMO	$16,938.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$15,244.31
Rate for Payer: Molina Healthcare Benefit Exchange	$6,196.88
Rate for Payer: Ohio Health Choice Commercial	$18,177.50
Rate for Payer: Ohio Health Group HMO	$15,492.19
Rate for Payer: Ohio Health Group PPO Differential	$16,525.00
Rate for Payer: Ohio Health Group PPO No Differential	$17,970.94
Rate for Payer: Ohio Health Group PPO SOMC Employees	$14,252.81
Rate for Payer: PHCS Commercial	$19,830.00
Rate for Payer: United Healthcare All Payer	$18,177.50

UNIVERS APEX STEM SZ 9MM

Facility

$20,656.25

Service Code	HCPCS C1776
Hospital Charge Code	27000011
Hospital Revenue Code	278
Min. Negotiated Rate	$6,196.88
Max. Negotiated Rate	$19,830.00
Rate for Payer: Aetna Commercial	$15,905.31
Rate for Payer: Anthem Medicaid	$7,103.68
Rate for Payer: Anthem POS/PPO/Traditional	$16,111.88
Rate for Payer: Cash Price	$10,328.12
Rate for Payer: Cigna Commercial	$17,144.69
Rate for Payer: First Health Commercial	$19,623.44
Rate for Payer: Humana Commercial	$17,557.81
Rate for Payer: Humana KY Medicaid	$7,103.68
Rate for Payer: Kentucky WC Medicaid	$7,175.98
Rate for Payer: Medical Mutual Of Ohio HMO	$16,938.12
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$15,244.31
Rate for Payer: Molina Healthcare Benefit Exchange	$6,196.88
Rate for Payer: Molina Healthcare Medicaid	$7,246.21
Rate for Payer: Ohio Health Choice Commercial	$18,177.50
Rate for Payer: Ohio Health Group HMO	$15,492.19
Rate for Payer: Ohio Health Group PPO Differential	$16,525.00
Rate for Payer: Ohio Health Group PPO No Differential	$17,970.94
Rate for Payer: Ohio Health Group PPO SOMC Employees	$14,252.81
Rate for Payer: PHCS Commercial	$19,830.00
Rate for Payer: United Healthcare All Payer	$18,177.50

UNIVERSA URET STENT 6*22-32

Facility

$1,167.40

Service Code	HCPCS C2617
Hospital Charge Code	27000129
Hospital Revenue Code	272
Min. Negotiated Rate	$350.22
Max. Negotiated Rate	$1,120.70
Rate for Payer: Aetna Commercial	$898.90
Rate for Payer: Anthem Medicaid	$401.47
Rate for Payer: Anthem POS/PPO/Traditional	$910.57
Rate for Payer: Cash Price	$583.70
Rate for Payer: Cigna Commercial	$968.94
Rate for Payer: First Health Commercial	$1,109.03
Rate for Payer: Humana Commercial	$992.29
Rate for Payer: Humana KY Medicaid	$401.47
Rate for Payer: Kentucky WC Medicaid	$405.55
Rate for Payer: Medical Mutual Of Ohio HMO	$957.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$861.54
Rate for Payer: Molina Healthcare Benefit Exchange	$350.22
Rate for Payer: Molina Healthcare Medicaid	$409.52
Rate for Payer: Ohio Health Choice Commercial	$1,027.31
Rate for Payer: Ohio Health Group HMO	$875.55
Rate for Payer: Ohio Health Group PPO Differential	$933.92
Rate for Payer: Ohio Health Group PPO No Differential	$1,015.64
Rate for Payer: Ohio Health Group PPO SOMC Employees	$805.51
Rate for Payer: PHCS Commercial	$1,120.70
Rate for Payer: United Healthcare All Payer	$1,027.31

UNIVERSA URET STENT 6*22-32

Facility

$1,167.40

Service Code	HCPCS C2617
Hospital Charge Code	27000129
Hospital Revenue Code	272
Min. Negotiated Rate	$350.22
Max. Negotiated Rate	$1,120.70
Rate for Payer: Aetna Commercial	$898.90
Rate for Payer: Anthem POS/PPO/Traditional	$910.57
Rate for Payer: Cash Price	$583.70
Rate for Payer: Cigna Commercial	$968.94
Rate for Payer: First Health Commercial	$1,109.03
Rate for Payer: Humana Commercial	$992.29
Rate for Payer: Medical Mutual Of Ohio HMO	$957.27
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$861.54
Rate for Payer: Molina Healthcare Benefit Exchange	$350.22
Rate for Payer: Ohio Health Choice Commercial	$1,027.31
Rate for Payer: Ohio Health Group HMO	$875.55
Rate for Payer: Ohio Health Group PPO Differential	$933.92
Rate for Payer: Ohio Health Group PPO No Differential	$1,015.64
Rate for Payer: Ohio Health Group PPO SOMC Employees	$805.51
Rate for Payer: PHCS Commercial	$1,120.70
Rate for Payer: United Healthcare All Payer	$1,027.31

UNLISTED LAPAROSCOPIC PROCEDURE, LIVER

Facility

$7,547.16

Service Code	CPT 47379
Hospital Revenue Code	360
Min. Negotiated Rate	$5,390.83
Max. Negotiated Rate	$7,547.16
Rate for Payer: Anthem Medicare Advantage/PPO	$5,390.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,547.16
Rate for Payer: CareSource Just4Me Medicare	$7,277.62
Rate for Payer: Humana Medicare Advantage	$5,390.83
Rate for Payer: Molina Healthcare Benefit Exchange	$6,469.00

UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM

Facility

$7,547.16

Service Code	CPT 49329
Hospital Revenue Code	360
Min. Negotiated Rate	$5,390.83
Max. Negotiated Rate	$7,547.16
Rate for Payer: Anthem Medicare Advantage/PPO	$5,390.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,547.16
Rate for Payer: CareSource Just4Me Medicare	$7,277.62
Rate for Payer: Humana Medicare Advantage	$5,390.83
Rate for Payer: Molina Healthcare Benefit Exchange	$6,469.00

UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY

Facility

$7,547.16

Service Code	CPT 49659
Hospital Revenue Code	360
Min. Negotiated Rate	$5,390.83
Max. Negotiated Rate	$7,547.16
Rate for Payer: Anthem Medicare Advantage/PPO	$5,390.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,547.16
Rate for Payer: CareSource Just4Me Medicare	$7,277.62
Rate for Payer: Humana Medicare Advantage	$5,390.83
Rate for Payer: Molina Healthcare Benefit Exchange	$6,469.00

UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY

Facility

$7,547.16

Service Code	CPT 58679
Hospital Revenue Code	360
Min. Negotiated Rate	$5,390.83
Max. Negotiated Rate	$7,547.16
Rate for Payer: Anthem Medicare Advantage/PPO	$5,390.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,547.16
Rate for Payer: CareSource Just4Me Medicare	$7,277.62
Rate for Payer: Humana Medicare Advantage	$5,390.83
Rate for Payer: Molina Healthcare Benefit Exchange	$6,469.00

UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD

Facility

$7,547.16

Service Code	CPT 55559
Hospital Revenue Code	360
Min. Negotiated Rate	$5,390.83
Max. Negotiated Rate	$7,547.16
Rate for Payer: Anthem Medicare Advantage/PPO	$5,390.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,547.16
Rate for Payer: CareSource Just4Me Medicare	$7,277.62
Rate for Payer: Humana Medicare Advantage	$5,390.83
Rate for Payer: Molina Healthcare Benefit Exchange	$6,469.00

UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN

Facility

$7,547.16

Service Code	CPT 38129
Hospital Revenue Code	360
Min. Negotiated Rate	$5,390.83
Max. Negotiated Rate	$7,547.16
Rate for Payer: Anthem Medicare Advantage/PPO	$5,390.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,547.16
Rate for Payer: CareSource Just4Me Medicare	$7,277.62
Rate for Payer: Humana Medicare Advantage	$5,390.83
Rate for Payer: Molina Healthcare Benefit Exchange	$6,469.00

UNLISTED PROCEDURE, BREAST

Professional

Both

$3,000.00

Service Code	HCPCS 19499
Hospital Charge Code	76102664
Hospital Revenue Code	761
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2,100.00
Rate for Payer: Anthem Medicaid	$325.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$325.00
Rate for Payer: Molina Healthcare CHIP/Medicaid	$331.50
Rate for Payer: Molina Healthcare Passport	$325.00
Rate for Payer: Multiplan PHCS	$1,800.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$2,100.00
Rate for Payer: UHCCP Medicaid	$1,050.00
Rate for Payer: Wellcare CHIP/Medicaid	$328.25

UNLISTED PROCEDURE, BREAST

Facility

$4,953.45

Service Code	CPT 19499
Hospital Charge Code	76102664
Hospital Revenue Code	360
Min. Negotiated Rate	$3,538.18
Max. Negotiated Rate	$4,953.45
Rate for Payer: Anthem Medicare Advantage/PPO	$3,538.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,953.45
Rate for Payer: CareSource Just4Me Medicare	$4,776.54
Rate for Payer: Humana Medicare Advantage	$3,538.18
Rate for Payer: Molina Healthcare Benefit Exchange	$4,245.82

UNLISTED PROCEDURE, BREAST

Facility

$4,953.45

Service Code	CPT 19499
Hospital Revenue Code	360
Min. Negotiated Rate	$3,538.18
Max. Negotiated Rate	$4,953.45
Rate for Payer: Anthem Medicare Advantage/PPO	$3,538.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,953.45
Rate for Payer: CareSource Just4Me Medicare	$4,776.54
Rate for Payer: Humana Medicare Advantage	$3,538.18
Rate for Payer: Molina Healthcare Benefit Exchange	$4,245.82

UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)

Facility

$260.23

Service Code	CPT 58999
Hospital Revenue Code	360
Min. Negotiated Rate	$185.88
Max. Negotiated Rate	$260.23
Rate for Payer: Anthem Medicare Advantage/PPO	$185.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$260.23
Rate for Payer: CareSource Just4Me Medicare	$250.94
Rate for Payer: Humana Medicare Advantage	$185.88
Rate for Payer: Molina Healthcare Benefit Exchange	$223.06

UNLISTED PROCEDURE, FEMUR OR KNEE

Facility

$310.30

Service Code	CPT 27599
Hospital Revenue Code	360
Min. Negotiated Rate	$221.64
Max. Negotiated Rate	$310.30
Rate for Payer: Anthem Medicare Advantage/PPO	$221.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$310.30
Rate for Payer: CareSource Just4Me Medicare	$299.21
Rate for Payer: Humana Medicare Advantage	$221.64
Rate for Payer: Molina Healthcare Benefit Exchange	$265.97

UNLISTED PROCEDURE, FOOT OR TOES

Facility

$310.30

Service Code	CPT 28899
Hospital Revenue Code	360
Min. Negotiated Rate	$221.64
Max. Negotiated Rate	$310.30
Rate for Payer: Anthem Medicare Advantage/PPO	$221.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$310.30
Rate for Payer: CareSource Just4Me Medicare	$299.21
Rate for Payer: Humana Medicare Advantage	$221.64
Rate for Payer: Molina Healthcare Benefit Exchange	$265.97

UNLISTED PROCEDURE, LARYNX

Professional

Both

$70.00

Service Code	HCPCS 31599
Hospital Charge Code	41000027
Hospital Revenue Code	410
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$470.07
Rate for Payer: Anthem Medicaid	$460.85
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$460.85
Rate for Payer: Molina Healthcare CHIP/Medicaid	$470.07
Rate for Payer: Molina Healthcare Passport	$460.85
Rate for Payer: Multiplan PHCS	$42.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$49.00
Rate for Payer: UHCCP Medicaid	$24.50
Rate for Payer: Wellcare CHIP/Medicaid	$465.46

UNLISTED PROCEDURE, LARYNX(P

Professional

Both

$70.00

Service Code	HCPCS 31599
Hospital Charge Code	410P0027
Hospital Revenue Code	410
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$470.07
Rate for Payer: Anthem Medicaid	$460.85
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$460.85
Rate for Payer: Molina Healthcare CHIP/Medicaid	$470.07
Rate for Payer: Molina Healthcare Passport	$460.85
Rate for Payer: Multiplan PHCS	$42.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$49.00
Rate for Payer: UHCCP Medicaid	$24.50
Rate for Payer: Wellcare CHIP/Medicaid	$465.46

UNLISTED PROCEDURE, LUNGS AND PLEURA

Facility

$799.76

Service Code	CPT 32999
Hospital Revenue Code	360
Min. Negotiated Rate	$571.26
Max. Negotiated Rate	$799.76
Rate for Payer: Anthem Medicare Advantage/PPO	$571.26
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$799.76
Rate for Payer: CareSource Just4Me Medicare	$771.20
Rate for Payer: Humana Medicare Advantage	$571.26
Rate for Payer: Molina Healthcare Benefit Exchange	$685.51

UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY

Facility

$260.23

Service Code	CPT 59899
Hospital Revenue Code	360
Min. Negotiated Rate	$185.88
Max. Negotiated Rate	$260.23
Rate for Payer: Anthem Medicare Advantage/PPO	$185.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$260.23
Rate for Payer: CareSource Just4Me Medicare	$250.94
Rate for Payer: Humana Medicare Advantage	$185.88
Rate for Payer: Molina Healthcare Benefit Exchange	$223.06

UNLISTED PROCEDURE, PELVIS OR HIP JOINT

Facility

$310.30

Service Code	CPT 27299
Hospital Revenue Code	360
Min. Negotiated Rate	$221.64
Max. Negotiated Rate	$310.30
Rate for Payer: Anthem Medicare Advantage/PPO	$221.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$310.30
Rate for Payer: CareSource Just4Me Medicare	$299.21
Rate for Payer: Humana Medicare Advantage	$221.64
Rate for Payer: Molina Healthcare Benefit Exchange	$265.97

UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE

Facility

$257.03

Service Code	CPT 17999
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

Know your out-of-pocket cost for care.

All Charges