Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

COSMETIC ANESTHESIA FACE LIFT

Professional

Both

$740.00

Hospital Charge Code	37000211
Hospital Revenue Code	370
Min. Negotiated Rate	$259.00
Max. Negotiated Rate	$518.00
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 ANESTH NECKLIFT-MINI

Facility

$210.00

Hospital Charge Code	37000229
Hospital Revenue Code	370
Min. Negotiated Rate	$63.00
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	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$144.90
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

COSMETIC ANESTH NECKLIFT-MINI

Professional

Both

$210.00

Hospital Charge Code	37000229
Hospital Revenue Code	370
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$147.00
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	$63.00
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	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$182.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$144.90
Rate for Payer: PHCS Commercial	$201.60
Rate for Payer: United Healthcare All Payer	$184.80

COSMETIC BOTOX - AP

Facility

$10.00

Hospital Charge Code	22200368
Hospital Revenue Code	222
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna Commercial	$7.70
Rate for Payer: Anthem Medicaid	$3.44
Rate for Payer: Anthem POS/PPO/Traditional	$7.80
Rate for Payer: Cash Price	$5.00
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: First Health Commercial	$9.50
Rate for Payer: Humana Commercial	$8.50
Rate for Payer: Humana KY Medicaid	$3.44
Rate for Payer: Kentucky WC Medicaid	$3.47
Rate for Payer: Medical Mutual Of Ohio HMO	$8.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7.38
Rate for Payer: Molina Healthcare Benefit Exchange	$3.00
Rate for Payer: Molina Healthcare Medicaid	$3.51
Rate for Payer: Ohio Health Choice Commercial	$8.80
Rate for Payer: Ohio Health Group HMO	$7.50
Rate for Payer: Ohio Health Group PPO Differential	$8.00
Rate for Payer: Ohio Health Group PPO No Differential	$8.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6.90
Rate for Payer: PHCS Commercial	$9.60
Rate for Payer: United Healthcare All Payer	$8.80

COSMETIC BOTOX - AP

Professional

Both

$10.00

Hospital Charge Code	22200368
Hospital Revenue Code	222
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$7.00
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 - AP

Facility

$10.00

Hospital Charge Code	22200368
Hospital Revenue Code	222
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$9.60
Rate for Payer: Aetna Commercial	$7.70
Rate for Payer: Anthem POS/PPO/Traditional	$7.80
Rate for Payer: Cash Price	$5.00
Rate for Payer: Cigna Commercial	$8.30
Rate for Payer: First Health Commercial	$9.50
Rate for Payer: Humana Commercial	$8.50
Rate for Payer: Medical Mutual Of Ohio HMO	$8.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$7.38
Rate for Payer: Molina Healthcare Benefit Exchange	$3.00
Rate for Payer: Ohio Health Choice Commercial	$8.80
Rate for Payer: Ohio Health Group HMO	$7.50
Rate for Payer: Ohio Health Group PPO Differential	$8.00
Rate for Payer: Ohio Health Group PPO No Differential	$8.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6.90
Rate for Payer: PHCS Commercial	$9.60
Rate for Payer: United Healthcare All Payer	$8.80

COSMETIC BOTOX - MD

Facility

$12.50

Hospital Charge Code	22200017
Hospital Revenue Code	222
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.62
Rate for Payer: Anthem Medicaid	$4.30
Rate for Payer: Anthem POS/PPO/Traditional	$9.75
Rate for Payer: Cash Price	$6.25
Rate for Payer: Cigna Commercial	$10.38
Rate for Payer: First Health Commercial	$11.88
Rate for Payer: Humana Commercial	$10.62
Rate for Payer: Humana KY Medicaid	$4.30
Rate for Payer: Kentucky WC Medicaid	$4.34
Rate for Payer: Medical Mutual Of Ohio HMO	$10.25
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$9.22
Rate for Payer: Molina Healthcare Benefit Exchange	$3.75
Rate for Payer: Molina Healthcare Medicaid	$4.38
Rate for Payer: Ohio Health Choice Commercial	$11.00
Rate for Payer: Ohio Health Group HMO	$9.38
Rate for Payer: Ohio Health Group PPO Differential	$10.00
Rate for Payer: Ohio Health Group PPO No Differential	$10.88
Rate for Payer: Ohio Health Group PPO SOMC Employees	$8.62
Rate for Payer: PHCS Commercial	$12.00
Rate for Payer: United Healthcare All Payer	$11.00

COSMETIC BOTOX - MD

Professional

Both

$12.50

Hospital Charge Code	22200017
Hospital Revenue Code	222
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$8.75
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 BOTOX - MD

Facility

$12.50

Hospital Charge Code	22200017
Hospital Revenue Code	222
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.62
Rate for Payer: Anthem POS/PPO/Traditional	$9.75
Rate for Payer: Cash Price	$6.25
Rate for Payer: Cigna Commercial	$10.38
Rate for Payer: First Health Commercial	$11.88
Rate for Payer: Humana Commercial	$10.62
Rate for Payer: Medical Mutual Of Ohio HMO	$10.25
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$9.22
Rate for Payer: Molina Healthcare Benefit Exchange	$3.75
Rate for Payer: Ohio Health Choice Commercial	$11.00
Rate for Payer: Ohio Health Group HMO	$9.38
Rate for Payer: Ohio Health Group PPO Differential	$10.00
Rate for Payer: Ohio Health Group PPO No Differential	$10.88
Rate for Payer: Ohio Health Group PPO SOMC Employees	$8.62
Rate for Payer: PHCS Commercial	$12.00
Rate for Payer: United Healthcare All Payer	$11.00

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	$30.10
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 1-2 MUSC

Facility

$43.00

Hospital Charge Code	22200672
Hospital Revenue Code	222
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$41.28
Rate for Payer: Aetna Commercial	$33.11
Rate for Payer: Anthem POS/PPO/Traditional	$33.54
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cigna Commercial	$35.69
Rate for Payer: First Health Commercial	$40.85
Rate for Payer: Humana Commercial	$36.55
Rate for Payer: Medical Mutual Of Ohio HMO	$35.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$31.73
Rate for Payer: Molina Healthcare Benefit Exchange	$12.90
Rate for Payer: Ohio Health Choice Commercial	$37.84
Rate for Payer: Ohio Health Group HMO	$32.25
Rate for Payer: Ohio Health Group PPO Differential	$34.40
Rate for Payer: Ohio Health Group PPO No Differential	$37.41
Rate for Payer: Ohio Health Group PPO SOMC Employees	$29.67
Rate for Payer: PHCS Commercial	$41.28
Rate for Payer: United Healthcare All Payer	$37.84

COSMETIC DRY NEEDLING 1-2 MUSC

Facility

$43.00

Hospital Charge Code	22200672
Hospital Revenue Code	222
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$41.28
Rate for Payer: Aetna Commercial	$33.11
Rate for Payer: Anthem Medicaid	$14.79
Rate for Payer: Anthem POS/PPO/Traditional	$33.54
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cigna Commercial	$35.69
Rate for Payer: First Health Commercial	$40.85
Rate for Payer: Humana Commercial	$36.55
Rate for Payer: Humana KY Medicaid	$14.79
Rate for Payer: Kentucky WC Medicaid	$14.94
Rate for Payer: Medical Mutual Of Ohio HMO	$35.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$31.73
Rate for Payer: Molina Healthcare Benefit Exchange	$12.90
Rate for Payer: Molina Healthcare Medicaid	$15.08
Rate for Payer: Ohio Health Choice Commercial	$37.84
Rate for Payer: Ohio Health Group HMO	$32.25
Rate for Payer: Ohio Health Group PPO Differential	$34.40
Rate for Payer: Ohio Health Group PPO No Differential	$37.41
Rate for Payer: Ohio Health Group PPO SOMC Employees	$29.67
Rate for Payer: PHCS Commercial	$41.28
Rate for Payer: United Healthcare All Payer	$37.84

COSMETIC DRY NEEDLING 3 + MUSC

Facility

$43.00

Hospital Charge Code	22200673
Hospital Revenue Code	222
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$41.28
Rate for Payer: Aetna Commercial	$33.11
Rate for Payer: Anthem Medicaid	$14.79
Rate for Payer: Anthem POS/PPO/Traditional	$33.54
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cigna Commercial	$35.69
Rate for Payer: First Health Commercial	$40.85
Rate for Payer: Humana Commercial	$36.55
Rate for Payer: Humana KY Medicaid	$14.79
Rate for Payer: Kentucky WC Medicaid	$14.94
Rate for Payer: Medical Mutual Of Ohio HMO	$35.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$31.73
Rate for Payer: Molina Healthcare Benefit Exchange	$12.90
Rate for Payer: Molina Healthcare Medicaid	$15.08
Rate for Payer: Ohio Health Choice Commercial	$37.84
Rate for Payer: Ohio Health Group HMO	$32.25
Rate for Payer: Ohio Health Group PPO Differential	$34.40
Rate for Payer: Ohio Health Group PPO No Differential	$37.41
Rate for Payer: Ohio Health Group PPO SOMC Employees	$29.67
Rate for Payer: PHCS Commercial	$41.28
Rate for Payer: United Healthcare All Payer	$37.84

COSMETIC DRY NEEDLING 3 + MUSC

Facility

$43.00

Hospital Charge Code	22200673
Hospital Revenue Code	222
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$41.28
Rate for Payer: Aetna Commercial	$33.11
Rate for Payer: Anthem POS/PPO/Traditional	$33.54
Rate for Payer: Cash Price	$21.50
Rate for Payer: Cigna Commercial	$35.69
Rate for Payer: First Health Commercial	$40.85
Rate for Payer: Humana Commercial	$36.55
Rate for Payer: Medical Mutual Of Ohio HMO	$35.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$31.73
Rate for Payer: Molina Healthcare Benefit Exchange	$12.90
Rate for Payer: Ohio Health Choice Commercial	$37.84
Rate for Payer: Ohio Health Group HMO	$32.25
Rate for Payer: Ohio Health Group PPO Differential	$34.40
Rate for Payer: Ohio Health Group PPO No Differential	$37.41
Rate for Payer: Ohio Health Group PPO SOMC Employees	$29.67
Rate for Payer: PHCS Commercial	$41.28
Rate for Payer: United Healthcare All Payer	$37.84

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	$30.10
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	$0.70
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

Facility

$25.00

Hospital Charge Code	22200072
Hospital Revenue Code	222
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: Anthem Medicaid	$8.60
Rate for Payer: Anthem POS/PPO/Traditional	$19.50
Rate for Payer: Cash Price	$12.50
Rate for Payer: Cigna Commercial	$20.75
Rate for Payer: First Health Commercial	$23.75
Rate for Payer: Humana Commercial	$21.25
Rate for Payer: Humana KY Medicaid	$8.60
Rate for Payer: Kentucky WC Medicaid	$8.69
Rate for Payer: Medical Mutual Of Ohio HMO	$20.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$18.45
Rate for Payer: Molina Healthcare Benefit Exchange	$7.50
Rate for Payer: Molina Healthcare Medicaid	$8.77
Rate for Payer: Ohio Health Choice Commercial	$22.00
Rate for Payer: Ohio Health Group HMO	$18.75
Rate for Payer: Ohio Health Group PPO Differential	$20.00
Rate for Payer: Ohio Health Group PPO No Differential	$21.75
Rate for Payer: Ohio Health Group PPO SOMC Employees	$17.25
Rate for Payer: PHCS Commercial	$24.00
Rate for Payer: United Healthcare All Payer	$22.00

COSMETIC FOLLOW-UP

Professional

Both

$25.00

Hospital Charge Code	22200072
Hospital Revenue Code	222
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$17.50
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 FOLLOW-UP

Facility

$25.00

Hospital Charge Code	22200072
Hospital Revenue Code	222
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: Anthem POS/PPO/Traditional	$19.50
Rate for Payer: Cash Price	$12.50
Rate for Payer: Cigna Commercial	$20.75
Rate for Payer: First Health Commercial	$23.75
Rate for Payer: Humana Commercial	$21.25
Rate for Payer: Medical Mutual Of Ohio HMO	$20.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$18.45
Rate for Payer: Molina Healthcare Benefit Exchange	$7.50
Rate for Payer: Ohio Health Choice Commercial	$22.00
Rate for Payer: Ohio Health Group HMO	$18.75
Rate for Payer: Ohio Health Group PPO Differential	$20.00
Rate for Payer: Ohio Health Group PPO No Differential	$21.75
Rate for Payer: Ohio Health Group PPO SOMC Employees	$17.25
Rate for Payer: PHCS Commercial	$24.00
Rate for Payer: United Healthcare All Payer	$22.00

COSMETIC PROCEDURE $100

Professional

Both

$100.00

Hospital Charge Code	22200001
Hospital Revenue Code	222
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$70.00
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 $100

Facility

$100.00

Hospital Charge Code	22200001
Hospital Revenue Code	222
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$77.00
Rate for Payer: Anthem Medicaid	$34.39
Rate for Payer: Anthem POS/PPO/Traditional	$78.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: First Health Commercial	$95.00
Rate for Payer: Humana Commercial	$85.00
Rate for Payer: Humana KY Medicaid	$34.39
Rate for Payer: Kentucky WC Medicaid	$34.74
Rate for Payer: Medical Mutual Of Ohio HMO	$82.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$73.80
Rate for Payer: Molina Healthcare Benefit Exchange	$30.00
Rate for Payer: Molina Healthcare Medicaid	$35.08
Rate for Payer: Ohio Health Choice Commercial	$88.00
Rate for Payer: Ohio Health Group HMO	$75.00
Rate for Payer: Ohio Health Group PPO Differential	$80.00
Rate for Payer: Ohio Health Group PPO No Differential	$87.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$69.00
Rate for Payer: PHCS Commercial	$96.00
Rate for Payer: United Healthcare All Payer	$88.00

COSMETIC PROCEDURE $100

Facility

$100.00

Hospital Charge Code	22200001
Hospital Revenue Code	222
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$77.00
Rate for Payer: Anthem POS/PPO/Traditional	$78.00
Rate for Payer: Cash Price	$50.00
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: First Health Commercial	$95.00
Rate for Payer: Humana Commercial	$85.00
Rate for Payer: Medical Mutual Of Ohio HMO	$82.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$73.80
Rate for Payer: Molina Healthcare Benefit Exchange	$30.00
Rate for Payer: Ohio Health Choice Commercial	$88.00
Rate for Payer: Ohio Health Group HMO	$75.00
Rate for Payer: Ohio Health Group PPO Differential	$80.00
Rate for Payer: Ohio Health Group PPO No Differential	$87.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$69.00
Rate for Payer: PHCS Commercial	$96.00
Rate for Payer: United Healthcare All Payer	$88.00

COSMETIC PROCEDURE $200

Facility

$200.00

Hospital Charge Code	22200002
Hospital Revenue Code	222
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$154.00
Rate for Payer: Anthem Medicaid	$68.78
Rate for Payer: Anthem POS/PPO/Traditional	$156.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: First Health Commercial	$190.00
Rate for Payer: Humana Commercial	$170.00
Rate for Payer: Humana KY Medicaid	$68.78
Rate for Payer: Kentucky WC Medicaid	$69.48
Rate for Payer: Medical Mutual Of Ohio HMO	$164.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$147.60
Rate for Payer: Molina Healthcare Benefit Exchange	$60.00
Rate for Payer: Molina Healthcare Medicaid	$70.16
Rate for Payer: Ohio Health Choice Commercial	$176.00
Rate for Payer: Ohio Health Group HMO	$150.00
Rate for Payer: Ohio Health Group PPO Differential	$160.00
Rate for Payer: Ohio Health Group PPO No Differential	$174.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$138.00
Rate for Payer: PHCS Commercial	$192.00
Rate for Payer: United Healthcare All Payer	$176.00

COSMETIC PROCEDURE $200

Professional

Both

$200.00

Hospital Charge Code	22200002
Hospital Revenue Code	222
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$140.00
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

Know your out-of-pocket cost for care.

All Charges