Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

COSMET ANSETH BILAT FLANK LIFT

Facility

$640.00

Hospital Charge Code	37000218
Hospital Revenue Code	370
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$614.40
Rate for Payer: Aetna Commercial	$492.80
Rate for Payer: Anthem POS/PPO/Traditional	$499.20
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cigna Commercial	$531.20
Rate for Payer: First Health Commercial	$608.00
Rate for Payer: Humana Commercial	$544.00
Rate for Payer: Medical Mutual Of Ohio HMO	$524.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$472.32
Rate for Payer: Molina Healthcare Benefit Exchange	$192.00
Rate for Payer: Ohio Health Choice Commercial	$563.20
Rate for Payer: Ohio Health Group HMO	$480.00
Rate for Payer: Ohio Health Group PPO Differential	$128.00
Rate for Payer: Ohio Health Group PPO No Differential	$83.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$198.40
Rate for Payer: PHCS Commercial	$614.40
Rate for Payer: United Healthcare All Payer	$563.20

COSMETIC ANESTHESIA FACE LIFT

Professional

Both

$740.00

Hospital Charge Code	37000211
Hospital Revenue Code	370
Min. Negotiated Rate	$259.00
Max. Negotiated Rate	$740.00
Rate for Payer: Buckeye Medicare Advantage	$740.00
Rate for Payer: Cash Price	$370.00
Rate for Payer: Multiplan PHCS	$444.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$518.00
Rate for Payer: UHCCP Medicaid	$259.00

COSMETIC ANESTHESIA FACE LIFT

Facility

$740.00

Hospital Charge Code	37000211
Hospital Revenue Code	370
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$710.40
Rate for Payer: Aetna Commercial	$569.80
Rate for Payer: Anthem Medicaid	$254.49
Rate for Payer: Anthem POS/PPO/Traditional	$577.20
Rate for Payer: Cash Price	$370.00
Rate for Payer: Cigna Commercial	$614.20
Rate for Payer: First Health Commercial	$703.00
Rate for Payer: Humana Commercial	$629.00
Rate for Payer: Humana KY Medicaid	$254.49
Rate for Payer: Kentucky WC Medicaid	$257.08
Rate for Payer: Medical Mutual Of Ohio HMO	$606.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$546.12
Rate for Payer: Molina Healthcare Benefit Exchange	$222.00
Rate for Payer: Molina Healthcare Medicaid	$259.59
Rate for Payer: Ohio Health Choice Commercial	$651.20
Rate for Payer: Ohio Health Group HMO	$555.00
Rate for Payer: Ohio Health Group PPO Differential	$148.00
Rate for Payer: Ohio Health Group PPO No Differential	$96.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$229.40
Rate for Payer: PHCS Commercial	$710.40
Rate for Payer: United Healthcare All Payer	$651.20

COSMETIC ANESTHESIA FACE LIFT

Facility

$740.00

Hospital Charge Code	37000211
Hospital Revenue Code	370
Min. Negotiated Rate	$96.20
Max. Negotiated Rate	$710.40
Rate for Payer: Aetna Commercial	$569.80
Rate for Payer: Anthem POS/PPO/Traditional	$577.20
Rate for Payer: Cash Price	$370.00
Rate for Payer: Cigna Commercial	$614.20
Rate for Payer: First Health Commercial	$703.00
Rate for Payer: Humana Commercial	$629.00
Rate for Payer: Medical Mutual Of Ohio HMO	$606.80
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$546.12
Rate for Payer: Molina Healthcare Benefit Exchange	$222.00
Rate for Payer: Ohio Health Choice Commercial	$651.20
Rate for Payer: Ohio Health Group HMO	$555.00
Rate for Payer: Ohio Health Group PPO Differential	$148.00
Rate for Payer: Ohio Health Group PPO No Differential	$96.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$229.40
Rate for Payer: PHCS Commercial	$710.40
Rate for Payer: United Healthcare All Payer	$651.20

COSMETIC ANESTH NECKLIFT-MINI

Professional

Both

$210.00

Hospital Charge Code	37000229
Hospital Revenue Code	370
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$210.00
Rate for Payer: Buckeye Medicare Advantage	$210.00
Rate for Payer: Cash Price	$105.00
Rate for Payer: Multiplan PHCS	$126.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$147.00
Rate for Payer: UHCCP Medicaid	$73.50

COSMETIC ANESTH NECKLIFT-MINI

Facility

$210.00

Hospital Charge Code	37000229
Hospital Revenue Code	370
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$161.70
Rate for Payer: Anthem POS/PPO/Traditional	$163.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: First Health Commercial	$199.50
Rate for Payer: Humana Commercial	$178.50
Rate for Payer: Medical Mutual Of Ohio HMO	$172.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$154.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63.00
Rate for Payer: Ohio Health Choice Commercial	$184.80
Rate for Payer: Ohio Health Group HMO	$157.50
Rate for Payer: Ohio Health Group PPO Differential	$42.00
Rate for Payer: Ohio Health Group PPO No Differential	$27.30
Rate for Payer: Ohio Health Group PPO SOMC Employees	$65.10
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

COSMETIC ANESTH NECKLIFT-MINI

Facility

$210.00

Hospital Charge Code	37000229
Hospital Revenue Code	370
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$161.70
Rate for Payer: Anthem Medicaid	$72.22
Rate for Payer: Anthem POS/PPO/Traditional	$163.80
Rate for Payer: Cash Price	$105.00
Rate for Payer: Cigna Commercial	$174.30
Rate for Payer: First Health Commercial	$199.50
Rate for Payer: Humana Commercial	$178.50
Rate for Payer: Humana KY Medicaid	$72.22
Rate for Payer: Kentucky WC Medicaid	$72.95
Rate for Payer: Medical Mutual Of Ohio HMO	$172.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$154.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63.00
Rate for Payer: Molina Healthcare Medicaid	$73.67
Rate for Payer: Ohio Health Choice Commercial	$184.80
Rate for Payer: Ohio Health Group HMO	$157.50
Rate for Payer: Ohio Health Group PPO Differential	$42.00
Rate for Payer: Ohio Health Group PPO No Differential	$27.30
Rate for Payer: Ohio Health Group PPO SOMC Employees	$65.10
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

COSMETIC BOTOX - AP

Professional

Both

$10.00

Hospital Charge Code	22200368
Hospital Revenue Code	222
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$10.00
Rate for Payer: Buckeye Medicare Advantage	$10.00
Rate for Payer: Cash Price	$5.00
Rate for Payer: Multiplan PHCS	$6.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$7.00
Rate for Payer: UHCCP Medicaid	$3.50

COSMETIC BOTOX - MD

Professional

Both

$12.50

Hospital Charge Code	22200017
Hospital Revenue Code	222
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$12.50
Rate for Payer: Buckeye Medicare Advantage	$12.50
Rate for Payer: Cash Price	$6.25
Rate for Payer: Multiplan PHCS	$7.50
Rate for Payer: Ohio Health Choice Preferred Health Choice	$8.75
Rate for Payer: UHCCP Medicaid	$4.38

COSMETIC DRY NEEDLING 1-2 MUSC

Professional

Both

$43.00

Hospital Charge Code	22200672
Hospital Revenue Code	222
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$43.00
Rate for Payer: Buckeye Medicare Advantage	$43.00
Rate for Payer: Cash Price	$21.50
Rate for Payer: Multiplan PHCS	$25.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$30.10
Rate for Payer: UHCCP Medicaid	$15.05

COSMETIC DRY NEEDLING 3 + MUSC

Professional

Both

$43.00

Hospital Charge Code	22200673
Hospital Revenue Code	222
Min. Negotiated Rate	$15.05
Max. Negotiated Rate	$43.00
Rate for Payer: Buckeye Medicare Advantage	$43.00
Rate for Payer: Cash Price	$21.50
Rate for Payer: Multiplan PHCS	$25.80
Rate for Payer: Ohio Health Choice Preferred Health Choice	$30.10
Rate for Payer: UHCCP Medicaid	$15.05

COSMETIC FACILITY/IMP/ADD FEE

Professional

Both

$1.00

Hospital Charge Code	22200198
Hospital Revenue Code	222
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$1.00
Rate for Payer: Buckeye Medicare Advantage	$1.00
Rate for Payer: Cash Price	$0.50
Rate for Payer: Multiplan PHCS	$0.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$0.70
Rate for Payer: UHCCP Medicaid	$0.35

COSMETIC FOLLOW-UP

Professional

Both

$25.00

Hospital Charge Code	22200072
Hospital Revenue Code	222
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$25.00
Rate for Payer: Buckeye Medicare Advantage	$25.00
Rate for Payer: Cash Price	$12.50
Rate for Payer: Multiplan PHCS	$15.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$17.50
Rate for Payer: UHCCP Medicaid	$8.75

COSMETIC PROCEDURE $100

Professional

Both

$100.00

Hospital Charge Code	22200001
Hospital Revenue Code	222
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$100.00
Rate for Payer: Buckeye Medicare Advantage	$100.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Multiplan PHCS	$60.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$70.00
Rate for Payer: UHCCP Medicaid	$35.00

COSMETIC PROCEDURE $200

Professional

Both

$200.00

Hospital Charge Code	22200002
Hospital Revenue Code	222
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$200.00
Rate for Payer: Buckeye Medicare Advantage	$200.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Multiplan PHCS	$120.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$140.00
Rate for Payer: UHCCP Medicaid	$70.00

COSMETIC PROCEDURE $300

Professional

Both

$300.00

Hospital Charge Code	22200003
Hospital Revenue Code	222
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$300.00
Rate for Payer: Buckeye Medicare Advantage	$300.00
Rate for Payer: Cash Price	$150.00
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

COSMETIC PROCEDURE $400

Professional

Both

$400.00

Hospital Charge Code	22200004
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

COSMETIC PROCEDURE $500

Professional

Both

$500.00

Hospital Charge Code	22200005
Hospital Revenue Code	222
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$500.00
Rate for Payer: Buckeye Medicare Advantage	$500.00
Rate for Payer: Cash Price	$250.00
Rate for Payer: Multiplan PHCS	$300.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$350.00
Rate for Payer: UHCCP Medicaid	$175.00

COSMETIC PROCEDURE $600

Professional

Both

$600.00

Hospital Charge Code	22200006
Hospital Revenue Code	222
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$600.00
Rate for Payer: Buckeye Medicare Advantage	$600.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Multiplan PHCS	$360.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$420.00
Rate for Payer: UHCCP Medicaid	$210.00

COSMETIC PROCEDURE $700

Professional

Both

$700.00

Hospital Charge Code	22200007
Hospital Revenue Code	222
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$700.00
Rate for Payer: Buckeye Medicare Advantage	$700.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Multiplan PHCS	$420.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$490.00
Rate for Payer: UHCCP Medicaid	$245.00

COSMETIC PROCEDURE $800

Professional

Both

$800.00

Hospital Charge Code	22200008
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

COSMETIC PROCEDURE $900

Professional

Both

$900.00

Hospital Charge Code	22200009
Hospital Revenue Code	222
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$900.00
Rate for Payer: Buckeye Medicare Advantage	$900.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Multiplan PHCS	$540.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$630.00
Rate for Payer: UHCCP Medicaid	$315.00

COSM IUI HORMONE PELLET INSRT

Professional

Both

$350.00

Hospital Charge Code	22200726
Hospital Revenue Code	222
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$350.00
Rate for Payer: Buckeye Medicare Advantage	$350.00
Rate for Payer: Cash Price	$175.00
Rate for Payer: Multiplan PHCS	$210.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$245.00
Rate for Payer: UHCCP Medicaid	$122.50

COSM MAMMO W/IMPLANT

Professional

Both

$1,750.00

Hospital Charge Code	22200690
Hospital Revenue Code	222
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$1,750.00
Rate for Payer: Buckeye Medicare Advantage	$1,750.00
Rate for Payer: Cash Price	$875.00
Rate for Payer: Multiplan PHCS	$1,050.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,225.00
Rate for Payer: UHCCP Medicaid	$612.50

COSM MAMMO W/IMPLANT-80

Professional

Both

$875.00

Hospital Charge Code	22200691
Hospital Revenue Code	222
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$875.00
Rate for Payer: Buckeye Medicare Advantage	$875.00
Rate for Payer: Cash Price	$437.50
Rate for Payer: Multiplan PHCS	$525.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$612.50
Rate for Payer: UHCCP Medicaid	$306.25

Know your out-of-pocket cost for care.

All Charges