Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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 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: 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: 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 $300

Facility

$300.00

Hospital Charge Code	22200003
Hospital Revenue Code	222
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Anthem POS/PPO/Traditional	$234.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: First Health Commercial	$285.00
Rate for Payer: Humana Commercial	$255.00
Rate for Payer: Medical Mutual Of Ohio HMO	$246.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$221.40
Rate for Payer: Molina Healthcare Benefit Exchange	$90.00
Rate for Payer: Ohio Health Choice Commercial	$264.00
Rate for Payer: Ohio Health Group HMO	$225.00
Rate for Payer: Ohio Health Group PPO Differential	$240.00
Rate for Payer: Ohio Health Group PPO No Differential	$261.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$207.00
Rate for Payer: PHCS Commercial	$288.00
Rate for Payer: United Healthcare All Payer	$264.00

COSMETIC PROCEDURE $300

Facility

$300.00

Hospital Charge Code	22200003
Hospital Revenue Code	222
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Anthem Medicaid	$103.17
Rate for Payer: Anthem POS/PPO/Traditional	$234.00
Rate for Payer: Cash Price	$150.00
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: First Health Commercial	$285.00
Rate for Payer: Humana Commercial	$255.00
Rate for Payer: Humana KY Medicaid	$103.17
Rate for Payer: Kentucky WC Medicaid	$104.22
Rate for Payer: Medical Mutual Of Ohio HMO	$246.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$221.40
Rate for Payer: Molina Healthcare Benefit Exchange	$90.00
Rate for Payer: Molina Healthcare Medicaid	$105.24
Rate for Payer: Ohio Health Choice Commercial	$264.00
Rate for Payer: Ohio Health Group HMO	$225.00
Rate for Payer: Ohio Health Group PPO Differential	$240.00
Rate for Payer: Ohio Health Group PPO No Differential	$261.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$207.00
Rate for Payer: PHCS Commercial	$288.00
Rate for Payer: United Healthcare All Payer	$264.00

COSMETIC PROCEDURE $300

Professional

Both

$300.00

Hospital Charge Code	22200003
Hospital Revenue Code	222
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$210.00
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	$280.00
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 $400

Facility

$400.00

Hospital Charge Code	22200004
Hospital Revenue Code	222
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna Commercial	$308.00
Rate for Payer: Anthem Medicaid	$137.56
Rate for Payer: Anthem POS/PPO/Traditional	$312.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cigna Commercial	$332.00
Rate for Payer: First Health Commercial	$380.00
Rate for Payer: Humana Commercial	$340.00
Rate for Payer: Humana KY Medicaid	$137.56
Rate for Payer: Kentucky WC Medicaid	$138.96
Rate for Payer: Medical Mutual Of Ohio HMO	$328.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$295.20
Rate for Payer: Molina Healthcare Benefit Exchange	$120.00
Rate for Payer: Molina Healthcare Medicaid	$140.32
Rate for Payer: Ohio Health Choice Commercial	$352.00
Rate for Payer: Ohio Health Group HMO	$300.00
Rate for Payer: Ohio Health Group PPO Differential	$320.00
Rate for Payer: Ohio Health Group PPO No Differential	$348.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$276.00
Rate for Payer: PHCS Commercial	$384.00
Rate for Payer: United Healthcare All Payer	$352.00

COSMETIC PROCEDURE $400

Facility

$400.00

Hospital Charge Code	22200004
Hospital Revenue Code	222
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna Commercial	$308.00
Rate for Payer: Anthem POS/PPO/Traditional	$312.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cigna Commercial	$332.00
Rate for Payer: First Health Commercial	$380.00
Rate for Payer: Humana Commercial	$340.00
Rate for Payer: Medical Mutual Of Ohio HMO	$328.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$295.20
Rate for Payer: Molina Healthcare Benefit Exchange	$120.00
Rate for Payer: Ohio Health Choice Commercial	$352.00
Rate for Payer: Ohio Health Group HMO	$300.00
Rate for Payer: Ohio Health Group PPO Differential	$320.00
Rate for Payer: Ohio Health Group PPO No Differential	$348.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$276.00
Rate for Payer: PHCS Commercial	$384.00
Rate for Payer: United Healthcare All Payer	$352.00

COSMETIC PROCEDURE $500

Facility

$500.00

Hospital Charge Code	22200005
Hospital Revenue Code	222
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$385.00
Rate for Payer: Anthem Medicaid	$171.95
Rate for Payer: Anthem POS/PPO/Traditional	$390.00
Rate for Payer: Cash Price	$250.00
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: First Health Commercial	$475.00
Rate for Payer: Humana Commercial	$425.00
Rate for Payer: Humana KY Medicaid	$171.95
Rate for Payer: Kentucky WC Medicaid	$173.70
Rate for Payer: Medical Mutual Of Ohio HMO	$410.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$369.00
Rate for Payer: Molina Healthcare Benefit Exchange	$150.00
Rate for Payer: Molina Healthcare Medicaid	$175.40
Rate for Payer: Ohio Health Choice Commercial	$440.00
Rate for Payer: Ohio Health Group HMO	$375.00
Rate for Payer: Ohio Health Group PPO Differential	$400.00
Rate for Payer: Ohio Health Group PPO No Differential	$435.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$345.00
Rate for Payer: PHCS Commercial	$480.00
Rate for Payer: United Healthcare All Payer	$440.00

COSMETIC PROCEDURE $500

Professional

Both

$500.00

Hospital Charge Code	22200005
Hospital Revenue Code	222
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$350.00
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 $500

Facility

$500.00

Hospital Charge Code	22200005
Hospital Revenue Code	222
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$385.00
Rate for Payer: Anthem POS/PPO/Traditional	$390.00
Rate for Payer: Cash Price	$250.00
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: First Health Commercial	$475.00
Rate for Payer: Humana Commercial	$425.00
Rate for Payer: Medical Mutual Of Ohio HMO	$410.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$369.00
Rate for Payer: Molina Healthcare Benefit Exchange	$150.00
Rate for Payer: Ohio Health Choice Commercial	$440.00
Rate for Payer: Ohio Health Group HMO	$375.00
Rate for Payer: Ohio Health Group PPO Differential	$400.00
Rate for Payer: Ohio Health Group PPO No Differential	$435.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$345.00
Rate for Payer: PHCS Commercial	$480.00
Rate for Payer: United Healthcare All Payer	$440.00

COSMETIC PROCEDURE $600

Professional

Both

$600.00

Hospital Charge Code	22200006
Hospital Revenue Code	222
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$420.00
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 $600

Facility

$600.00

Hospital Charge Code	22200006
Hospital Revenue Code	222
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$576.00
Rate for Payer: Aetna Commercial	$462.00
Rate for Payer: Anthem POS/PPO/Traditional	$468.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cigna Commercial	$498.00
Rate for Payer: First Health Commercial	$570.00
Rate for Payer: Humana Commercial	$510.00
Rate for Payer: Medical Mutual Of Ohio HMO	$492.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$442.80
Rate for Payer: Molina Healthcare Benefit Exchange	$180.00
Rate for Payer: Ohio Health Choice Commercial	$528.00
Rate for Payer: Ohio Health Group HMO	$450.00
Rate for Payer: Ohio Health Group PPO Differential	$480.00
Rate for Payer: Ohio Health Group PPO No Differential	$522.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$414.00
Rate for Payer: PHCS Commercial	$576.00
Rate for Payer: United Healthcare All Payer	$528.00

COSMETIC PROCEDURE $600

Facility

$600.00

Hospital Charge Code	22200006
Hospital Revenue Code	222
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$576.00
Rate for Payer: Aetna Commercial	$462.00
Rate for Payer: Anthem Medicaid	$206.34
Rate for Payer: Anthem POS/PPO/Traditional	$468.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cigna Commercial	$498.00
Rate for Payer: First Health Commercial	$570.00
Rate for Payer: Humana Commercial	$510.00
Rate for Payer: Humana KY Medicaid	$206.34
Rate for Payer: Kentucky WC Medicaid	$208.44
Rate for Payer: Medical Mutual Of Ohio HMO	$492.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$442.80
Rate for Payer: Molina Healthcare Benefit Exchange	$180.00
Rate for Payer: Molina Healthcare Medicaid	$210.48
Rate for Payer: Ohio Health Choice Commercial	$528.00
Rate for Payer: Ohio Health Group HMO	$450.00
Rate for Payer: Ohio Health Group PPO Differential	$480.00
Rate for Payer: Ohio Health Group PPO No Differential	$522.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$414.00
Rate for Payer: PHCS Commercial	$576.00
Rate for Payer: United Healthcare All Payer	$528.00

COSMETIC PROCEDURE $700

Facility

$700.00

Hospital Charge Code	22200007
Hospital Revenue Code	222
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$539.00
Rate for Payer: Anthem Medicaid	$240.73
Rate for Payer: Anthem POS/PPO/Traditional	$546.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Cigna Commercial	$581.00
Rate for Payer: First Health Commercial	$665.00
Rate for Payer: Humana Commercial	$595.00
Rate for Payer: Humana KY Medicaid	$240.73
Rate for Payer: Kentucky WC Medicaid	$243.18
Rate for Payer: Medical Mutual Of Ohio HMO	$574.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$516.60
Rate for Payer: Molina Healthcare Benefit Exchange	$210.00
Rate for Payer: Molina Healthcare Medicaid	$245.56
Rate for Payer: Ohio Health Choice Commercial	$616.00
Rate for Payer: Ohio Health Group HMO	$525.00
Rate for Payer: Ohio Health Group PPO Differential	$560.00
Rate for Payer: Ohio Health Group PPO No Differential	$609.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$483.00
Rate for Payer: PHCS Commercial	$672.00
Rate for Payer: United Healthcare All Payer	$616.00

COSMETIC PROCEDURE $700

Professional

Both

$700.00

Hospital Charge Code	22200007
Hospital Revenue Code	222
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$490.00
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 $700

Facility

$700.00

Hospital Charge Code	22200007
Hospital Revenue Code	222
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$539.00
Rate for Payer: Anthem POS/PPO/Traditional	$546.00
Rate for Payer: Cash Price	$350.00
Rate for Payer: Cigna Commercial	$581.00
Rate for Payer: First Health Commercial	$665.00
Rate for Payer: Humana Commercial	$595.00
Rate for Payer: Medical Mutual Of Ohio HMO	$574.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$516.60
Rate for Payer: Molina Healthcare Benefit Exchange	$210.00
Rate for Payer: Ohio Health Choice Commercial	$616.00
Rate for Payer: Ohio Health Group HMO	$525.00
Rate for Payer: Ohio Health Group PPO Differential	$560.00
Rate for Payer: Ohio Health Group PPO No Differential	$609.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$483.00
Rate for Payer: PHCS Commercial	$672.00
Rate for Payer: United Healthcare All Payer	$616.00

COSMETIC PROCEDURE $800

Facility

$800.00

Hospital Charge Code	22200008
Hospital Revenue Code	222
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$616.00
Rate for Payer: Anthem POS/PPO/Traditional	$624.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: First Health Commercial	$760.00
Rate for Payer: Humana Commercial	$680.00
Rate for Payer: Medical Mutual Of Ohio HMO	$656.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$590.40
Rate for Payer: Molina Healthcare Benefit Exchange	$240.00
Rate for Payer: Ohio Health Choice Commercial	$704.00
Rate for Payer: Ohio Health Group HMO	$600.00
Rate for Payer: Ohio Health Group PPO Differential	$640.00
Rate for Payer: Ohio Health Group PPO No Differential	$696.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$552.00
Rate for Payer: PHCS Commercial	$768.00
Rate for Payer: United Healthcare All Payer	$704.00

COSMETIC PROCEDURE $800

Facility

$800.00

Hospital Charge Code	22200008
Hospital Revenue Code	222
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$616.00
Rate for Payer: Anthem Medicaid	$275.12
Rate for Payer: Anthem POS/PPO/Traditional	$624.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$664.00
Rate for Payer: First Health Commercial	$760.00
Rate for Payer: Humana Commercial	$680.00
Rate for Payer: Humana KY Medicaid	$275.12
Rate for Payer: Kentucky WC Medicaid	$277.92
Rate for Payer: Medical Mutual Of Ohio HMO	$656.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$590.40
Rate for Payer: Molina Healthcare Benefit Exchange	$240.00
Rate for Payer: Molina Healthcare Medicaid	$280.64
Rate for Payer: Ohio Health Choice Commercial	$704.00
Rate for Payer: Ohio Health Group HMO	$600.00
Rate for Payer: Ohio Health Group PPO Differential	$640.00
Rate for Payer: Ohio Health Group PPO No Differential	$696.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$552.00
Rate for Payer: PHCS Commercial	$768.00
Rate for Payer: United Healthcare All Payer	$704.00

COSMETIC PROCEDURE $800

Professional

Both

$800.00

Hospital Charge Code	22200008
Hospital Revenue Code	222
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$560.00
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

Facility

$900.00

Hospital Charge Code	22200009
Hospital Revenue Code	222
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$864.00
Rate for Payer: Aetna Commercial	$693.00
Rate for Payer: Anthem Medicaid	$309.51
Rate for Payer: Anthem POS/PPO/Traditional	$702.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial	$747.00
Rate for Payer: First Health Commercial	$855.00
Rate for Payer: Humana Commercial	$765.00
Rate for Payer: Humana KY Medicaid	$309.51
Rate for Payer: Kentucky WC Medicaid	$312.66
Rate for Payer: Medical Mutual Of Ohio HMO	$738.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$664.20
Rate for Payer: Molina Healthcare Benefit Exchange	$270.00
Rate for Payer: Molina Healthcare Medicaid	$315.72
Rate for Payer: Ohio Health Choice Commercial	$792.00
Rate for Payer: Ohio Health Group HMO	$675.00
Rate for Payer: Ohio Health Group PPO Differential	$720.00
Rate for Payer: Ohio Health Group PPO No Differential	$783.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$621.00
Rate for Payer: PHCS Commercial	$864.00
Rate for Payer: United Healthcare All Payer	$792.00

COSMETIC PROCEDURE $900

Facility

$900.00

Hospital Charge Code	22200009
Hospital Revenue Code	222
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$864.00
Rate for Payer: Aetna Commercial	$693.00
Rate for Payer: Anthem POS/PPO/Traditional	$702.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial	$747.00
Rate for Payer: First Health Commercial	$855.00
Rate for Payer: Humana Commercial	$765.00
Rate for Payer: Medical Mutual Of Ohio HMO	$738.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$664.20
Rate for Payer: Molina Healthcare Benefit Exchange	$270.00
Rate for Payer: Ohio Health Choice Commercial	$792.00
Rate for Payer: Ohio Health Group HMO	$675.00
Rate for Payer: Ohio Health Group PPO Differential	$720.00
Rate for Payer: Ohio Health Group PPO No Differential	$783.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$621.00
Rate for Payer: PHCS Commercial	$864.00
Rate for Payer: United Healthcare All Payer	$792.00

COSMETIC PROCEDURE $900

Professional

Both

$900.00

Hospital Charge Code	22200009
Hospital Revenue Code	222
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$630.00
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 MAMMO W/IMPLANT

Professional

Both

$1,750.00

Hospital Charge Code	22200690
Hospital Revenue Code	222
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$1,225.00
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	$612.50
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

COSM MAMMO W/O LIP 120 M

Professional

Both

$1,750.00

Hospital Charge Code	22200082
Hospital Revenue Code	222
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$1,225.00
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

Know your out-of-pocket cost for care.

All Charges