Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

BRONCHOSCOPY/LUNG BX EACH(P

Professional

Both

$448.00

Service Code	HCPCS 31628
Hospital Charge Code	410P0040
Hospital Revenue Code	410
Min. Negotiated Rate	$88.77
Max. Negotiated Rate	$503.64
Rate for Payer: Aetna Commercial	$318.44
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$88.77
Rate for Payer: Anthem Medicaid	$251.92
Rate for Payer: Buckeye Medicare Advantage	$448.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cigna Commercial	$288.94
Rate for Payer: Healthspan PPO	$503.64
Rate for Payer: Humana Medicaid	$251.92
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$243.27
Rate for Payer: Molina Healthcare CHIP/Medicaid	$256.96
Rate for Payer: Molina Healthcare Passport	$251.92
Rate for Payer: Multiplan PHCS	$268.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$313.60
Rate for Payer: UHCCP Medicaid	$93.21
Rate for Payer: Wellcare CHIP/Medicaid	$254.44

BRONCHOSCOPY/NEEDLE BX ADDL

Professional

Both

$135.00

Service Code	HCPCS 31633
Hospital Charge Code	41000044
Hospital Revenue Code	410
Min. Negotiated Rate	$38.57
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$114.26
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$38.57
Rate for Payer: Anthem Medicaid	$52.65
Rate for Payer: Buckeye Medicare Advantage	$135.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial	$102.90
Rate for Payer: Healthspan PPO	$117.19
Rate for Payer: Humana Medicaid	$52.65
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$80.90
Rate for Payer: Molina Healthcare CHIP/Medicaid	$53.70
Rate for Payer: Molina Healthcare Passport	$52.65
Rate for Payer: Multiplan PHCS	$81.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$94.50
Rate for Payer: UHCCP Medicaid	$40.50
Rate for Payer: Wellcare CHIP/Medicaid	$53.18

BRONCHOSCOPY/NEEDLE BX ADDL(P

Professional

Both

$135.00

Service Code	HCPCS 31633
Hospital Charge Code	410P0044
Hospital Revenue Code	410
Min. Negotiated Rate	$38.57
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$114.26
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$38.57
Rate for Payer: Anthem Medicaid	$52.65
Rate for Payer: Buckeye Medicare Advantage	$135.00
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial	$102.90
Rate for Payer: Healthspan PPO	$117.19
Rate for Payer: Humana Medicaid	$52.65
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$80.90
Rate for Payer: Molina Healthcare CHIP/Medicaid	$53.70
Rate for Payer: Molina Healthcare Passport	$52.65
Rate for Payer: Multiplan PHCS	$81.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$94.50
Rate for Payer: UHCCP Medicaid	$40.50
Rate for Payer: Wellcare CHIP/Medicaid	$53.18

BRONCHOSCOPY/NEEDLE BX EACH

Professional

Both

$677.00

Service Code	HCPCS 31629
Hospital Charge Code	41000041
Hospital Revenue Code	410
Min. Negotiated Rate	$128.35
Max. Negotiated Rate	$762.10
Rate for Payer: Aetna Commercial	$339.60
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$128.35
Rate for Payer: Anthem Medicaid	$222.75
Rate for Payer: Buckeye Medicare Advantage	$677.00
Rate for Payer: Cash Price	$338.50
Rate for Payer: Cash Price	$338.50
Rate for Payer: Cigna Commercial	$308.63
Rate for Payer: Healthspan PPO	$762.10
Rate for Payer: Humana Medicaid	$222.75
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$262.57
Rate for Payer: Molina Healthcare CHIP/Medicaid	$227.20
Rate for Payer: Molina Healthcare Passport	$222.75
Rate for Payer: Multiplan PHCS	$406.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$473.90
Rate for Payer: UHCCP Medicaid	$134.77
Rate for Payer: Wellcare CHIP/Medicaid	$224.98

BRONCHOSCOPY/NEEDLE BX EACH(P

Professional

Both

$677.00

Service Code	HCPCS 31629
Hospital Charge Code	410P0041
Hospital Revenue Code	410
Min. Negotiated Rate	$128.35
Max. Negotiated Rate	$762.10
Rate for Payer: Aetna Commercial	$339.60
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$128.35
Rate for Payer: Anthem Medicaid	$222.75
Rate for Payer: Buckeye Medicare Advantage	$677.00
Rate for Payer: Cash Price	$338.50
Rate for Payer: Cash Price	$338.50
Rate for Payer: Cigna Commercial	$308.63
Rate for Payer: Healthspan PPO	$762.10
Rate for Payer: Humana Medicaid	$222.75
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$262.57
Rate for Payer: Molina Healthcare CHIP/Medicaid	$227.20
Rate for Payer: Molina Healthcare Passport	$222.75
Rate for Payer: Multiplan PHCS	$406.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$473.90
Rate for Payer: UHCCP Medicaid	$134.77
Rate for Payer: Wellcare CHIP/Medicaid	$224.98

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$2,054.81

Service Code	CPT 31622
Hospital Revenue Code	360
Min. Negotiated Rate	$1,467.72
Max. Negotiated Rate	$2,054.81
Rate for Payer: Anthem Medicare Advantage/PPO	$1,467.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,054.81
Rate for Payer: CareSource Just4Me Medicare	$1,981.42
Rate for Payer: Humana Medicare Advantage	$1,467.72
Rate for Payer: Molina Healthcare Benefit Exchange	$1,761.26

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE

Facility

$2,054.81

Service Code	CPT 31624
Hospital Revenue Code	360
Min. Negotiated Rate	$1,467.72
Max. Negotiated Rate	$2,054.81
Rate for Payer: Anthem Medicare Advantage/PPO	$1,467.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,054.81
Rate for Payer: CareSource Just4Me Medicare	$1,981.42
Rate for Payer: Humana Medicare Advantage	$1,467.72
Rate for Payer: Molina Healthcare Benefit Exchange	$1,761.26

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES

Facility

$2,054.81

Service Code	CPT 31625
Hospital Revenue Code	360
Min. Negotiated Rate	$1,467.72
Max. Negotiated Rate	$2,054.81
Rate for Payer: Anthem Medicare Advantage/PPO	$1,467.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,054.81
Rate for Payer: CareSource Just4Me Medicare	$1,981.42
Rate for Payer: Humana Medicare Advantage	$1,467.72
Rate for Payer: Molina Healthcare Benefit Exchange	$1,761.26

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL THERMOPLASTY, 1 LOBE

Facility

$8,286.08

Service Code	CPT 31660
Hospital Revenue Code	360
Min. Negotiated Rate	$5,918.63
Max. Negotiated Rate	$8,286.08
Rate for Payer: Anthem Medicare Advantage/PPO	$5,918.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,286.08
Rate for Payer: CareSource Just4Me Medicare	$7,990.15
Rate for Payer: Humana Medicare Advantage	$5,918.63
Rate for Payer: Molina Healthcare Benefit Exchange	$7,102.36

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS

Facility

$2,054.81

Service Code	CPT 31623
Hospital Revenue Code	360
Min. Negotiated Rate	$1,467.72
Max. Negotiated Rate	$2,054.81
Rate for Payer: Anthem Medicare Advantage/PPO	$1,467.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,054.81
Rate for Payer: CareSource Just4Me Medicare	$1,981.42
Rate for Payer: Humana Medicare Advantage	$1,467.72
Rate for Payer: Molina Healthcare Benefit Exchange	$1,761.26

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY METHOD OTHER THAN EXCISION (EG, LASER THERAPY, CRYOTHERAPY)

Facility

$4,533.70

Service Code	CPT 31641
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES

Facility

$4,533.70

Service Code	CPT 31653
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), ONE OR TWO MEDIASTINAL AND/OR HILAR LYMPH NODE STATIONS OR STRUCTURES

Facility

$4,533.70

Service Code	CPT 31652
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH EXCISION OF TUMOR

Facility

$4,533.70

Service Code	CPT 31640
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF FIDUCIAL MARKERS, SINGLE OR MULTIPLE

Facility

$8,286.08

Service Code	CPT 31626
Hospital Revenue Code	360
Min. Negotiated Rate	$5,918.63
Max. Negotiated Rate	$8,286.08
Rate for Payer: Anthem Medicare Advantage/PPO	$5,918.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,286.08
Rate for Payer: CareSource Just4Me Medicare	$7,990.15
Rate for Payer: Humana Medicare Advantage	$5,918.63
Rate for Payer: Molina Healthcare Benefit Exchange	$7,102.36

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF TRACHEAL STENT(S) (INCLUDES TRACHEAL/BRONCHIAL DILATION AS REQUIRED)

Facility

$8,286.08

Service Code	CPT 31631
Hospital Revenue Code	360
Min. Negotiated Rate	$5,918.63
Max. Negotiated Rate	$8,286.08
Rate for Payer: Anthem Medicare Advantage/PPO	$5,918.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,286.08
Rate for Payer: CareSource Just4Me Medicare	$7,990.15
Rate for Payer: Humana Medicare Advantage	$5,918.63
Rate for Payer: Molina Healthcare Benefit Exchange	$7,102.36

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH REMOVAL OF FOREIGN BODY

Facility

$2,054.81

Service Code	CPT 31635
Hospital Revenue Code	360
Min. Negotiated Rate	$1,467.72
Max. Negotiated Rate	$2,054.81
Rate for Payer: Anthem Medicare Advantage/PPO	$1,467.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,054.81
Rate for Payer: CareSource Just4Me Medicare	$1,981.42
Rate for Payer: Humana Medicare Advantage	$1,467.72
Rate for Payer: Molina Healthcare Benefit Exchange	$1,761.26

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL

Facility

$2,054.81

Service Code	CPT 31645
Hospital Revenue Code	360
Min. Negotiated Rate	$1,467.72
Max. Negotiated Rate	$2,054.81
Rate for Payer: Anthem Medicare Advantage/PPO	$1,467.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,054.81
Rate for Payer: CareSource Just4Me Medicare	$1,981.42
Rate for Payer: Humana Medicare Advantage	$1,467.72
Rate for Payer: Molina Healthcare Benefit Exchange	$1,761.26

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE

Facility

$4,533.70

Service Code	CPT 31630
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE

Facility

$4,533.70

Service Code	CPT 31628
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), TRACHEA, MAIN STEM AND/OR LOBAR BRONCHUS(I)

Facility

$4,533.70

Service Code	CPT 31629
Hospital Revenue Code	360
Min. Negotiated Rate	$3,238.36
Max. Negotiated Rate	$4,533.70
Rate for Payer: Anthem Medicare Advantage/PPO	$3,238.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,533.70
Rate for Payer: CareSource Just4Me Medicare	$4,371.79
Rate for Payer: Humana Medicare Advantage	$3,238.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,886.03

BRONCHOSCOPY TREAT BLOCKAGE

Professional

Both

$516.00

Service Code	HCPCS 31641
Hospital Charge Code	41000050
Hospital Revenue Code	410
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$434.17
Rate for Payer: Anthem Medicaid	$341.25
Rate for Payer: Buckeye Medicare Advantage	$516.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cigna Commercial	$394.85
Rate for Payer: Healthspan PPO	$338.98
Rate for Payer: Humana Medicaid	$341.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$335.82
Rate for Payer: Molina Healthcare CHIP/Medicaid	$348.08
Rate for Payer: Molina Healthcare Passport	$341.25
Rate for Payer: Multiplan PHCS	$309.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$361.20
Rate for Payer: UHCCP Medicaid	$180.60
Rate for Payer: Wellcare CHIP/Medicaid	$344.66

BRONCHOSCOPY TREAT BLOCKAGE(P

Professional

Both

$516.00

Service Code	HCPCS 31641
Hospital Charge Code	410P0050
Hospital Revenue Code	410
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$434.17
Rate for Payer: Anthem Medicaid	$341.25
Rate for Payer: Buckeye Medicare Advantage	$516.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cash Price	$258.00
Rate for Payer: Cigna Commercial	$394.85
Rate for Payer: Healthspan PPO	$338.98
Rate for Payer: Humana Medicaid	$341.25
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$335.82
Rate for Payer: Molina Healthcare CHIP/Medicaid	$348.08
Rate for Payer: Molina Healthcare Passport	$341.25
Rate for Payer: Multiplan PHCS	$309.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$361.20
Rate for Payer: UHCCP Medicaid	$180.60
Rate for Payer: Wellcare CHIP/Medicaid	$344.66

BRONCHOSCOPY W/BIOPSY(S)

Professional

Both

$374.00

Service Code	HCPCS 31625
Hospital Charge Code	41000037
Hospital Revenue Code	410
Min. Negotiated Rate	$79.08
Max. Negotiated Rate	$420.84
Rate for Payer: Aetna Commercial	$285.80
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$79.08
Rate for Payer: Anthem Medicaid	$210.12
Rate for Payer: Buckeye Medicare Advantage	$374.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cigna Commercial	$259.62
Rate for Payer: Healthspan PPO	$420.84
Rate for Payer: Humana Medicaid	$210.12
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$219.32
Rate for Payer: Molina Healthcare CHIP/Medicaid	$214.32
Rate for Payer: Molina Healthcare Passport	$210.12
Rate for Payer: Multiplan PHCS	$224.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$261.80
Rate for Payer: UHCCP Medicaid	$83.03
Rate for Payer: Wellcare CHIP/Medicaid	$212.22

BRONCHOSCOPY W/BIOPSY(S)(P

Professional

Both

$374.00

Service Code	HCPCS 31625
Hospital Charge Code	410P0037
Hospital Revenue Code	410
Min. Negotiated Rate	$79.08
Max. Negotiated Rate	$420.84
Rate for Payer: Aetna Commercial	$285.80
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$79.08
Rate for Payer: Anthem Medicaid	$210.12
Rate for Payer: Buckeye Medicare Advantage	$374.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cash Price	$187.00
Rate for Payer: Cigna Commercial	$259.62
Rate for Payer: Healthspan PPO	$420.84
Rate for Payer: Humana Medicaid	$210.12
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$219.32
Rate for Payer: Molina Healthcare CHIP/Medicaid	$214.32
Rate for Payer: Molina Healthcare Passport	$210.12
Rate for Payer: Multiplan PHCS	$224.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$261.80
Rate for Payer: UHCCP Medicaid	$83.03
Rate for Payer: Wellcare CHIP/Medicaid	$212.22

Know your out-of-pocket cost for care.

All Charges