Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$8,360.70

Service Code	MSDRG 443
Min. Negotiated Rate	$5,673.33
Max. Negotiated Rate	$8,360.70
Rate for Payer: Anthem Medicaid	$5,673.33
Rate for Payer: Anthem Medicare Advantage/PPO	$5,971.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,360.70
Rate for Payer: CareSource Just4Me Medicare	$8,062.11
Rate for Payer: Humana KY Medicaid	$5,673.33
Rate for Payer: Humana Medicare Advantage	$5,971.93
Rate for Payer: Kentucky WC Medicaid	$5,730.07
Rate for Payer: Molina Healthcare Benefit Exchange	$7,166.32
Rate for Payer: Molina Healthcare Medicaid	$5,786.80

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$10,004.30

Service Code	MSDRG 439
Min. Negotiated Rate	$6,788.63
Max. Negotiated Rate	$10,004.30
Rate for Payer: Anthem Medicaid	$6,788.63
Rate for Payer: Anthem Medicare Advantage/PPO	$7,145.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,004.30
Rate for Payer: CareSource Just4Me Medicare	$9,647.01
Rate for Payer: Humana KY Medicaid	$6,788.63
Rate for Payer: Humana Medicare Advantage	$7,145.93
Rate for Payer: Kentucky WC Medicaid	$6,856.52
Rate for Payer: Molina Healthcare Benefit Exchange	$8,575.12
Rate for Payer: Molina Healthcare Medicaid	$6,924.41

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$19,521.98

Service Code	MSDRG 438
Min. Negotiated Rate	$13,247.06
Max. Negotiated Rate	$19,521.98
Rate for Payer: Anthem Medicaid	$13,247.06
Rate for Payer: Anthem Medicare Advantage/PPO	$13,944.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,521.98
Rate for Payer: CareSource Just4Me Medicare	$18,824.76
Rate for Payer: Humana KY Medicaid	$13,247.06
Rate for Payer: Humana Medicare Advantage	$13,944.27
Rate for Payer: Kentucky WC Medicaid	$13,379.53
Rate for Payer: Molina Healthcare Benefit Exchange	$16,733.12
Rate for Payer: Molina Healthcare Medicaid	$13,512.00

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$7,201.40

Service Code	MSDRG 440
Min. Negotiated Rate	$4,886.67
Max. Negotiated Rate	$7,201.40
Rate for Payer: Anthem Medicaid	$4,886.67
Rate for Payer: Anthem Medicare Advantage/PPO	$5,143.86
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,201.40
Rate for Payer: CareSource Just4Me Medicare	$6,944.21
Rate for Payer: Humana KY Medicaid	$4,886.67
Rate for Payer: Humana Medicare Advantage	$5,143.86
Rate for Payer: Kentucky WC Medicaid	$4,935.53
Rate for Payer: Molina Healthcare Benefit Exchange	$6,172.63
Rate for Payer: Molina Healthcare Medicaid	$4,984.40

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$21,938.81

Service Code	MSDRG 883
Min. Negotiated Rate	$14,887.05
Max. Negotiated Rate	$21,938.81
Rate for Payer: Anthem Medicaid	$14,887.05
Rate for Payer: Anthem Medicare Advantage/PPO	$15,670.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,938.81
Rate for Payer: CareSource Just4Me Medicare	$21,155.28
Rate for Payer: Humana KY Medicaid	$14,887.05
Rate for Payer: Humana Medicare Advantage	$15,670.58
Rate for Payer: Kentucky WC Medicaid	$15,035.92
Rate for Payer: Molina Healthcare Benefit Exchange	$18,804.70
Rate for Payer: Molina Healthcare Medicaid	$15,184.79

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$12,713.61

Service Code	MSDRG 445
Min. Negotiated Rate	$8,627.09
Max. Negotiated Rate	$12,713.61
Rate for Payer: Anthem Medicaid	$8,627.09
Rate for Payer: Anthem Medicare Advantage/PPO	$9,081.15
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,713.61
Rate for Payer: CareSource Just4Me Medicare	$12,259.55
Rate for Payer: Humana KY Medicaid	$8,627.09
Rate for Payer: Humana Medicare Advantage	$9,081.15
Rate for Payer: Kentucky WC Medicaid	$8,713.36
Rate for Payer: Molina Healthcare Benefit Exchange	$10,897.38
Rate for Payer: Molina Healthcare Medicaid	$8,799.63

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$19,105.49

Service Code	MSDRG 444
Min. Negotiated Rate	$12,964.44
Max. Negotiated Rate	$19,105.49
Rate for Payer: Anthem Medicaid	$12,964.44
Rate for Payer: Anthem Medicare Advantage/PPO	$13,646.78
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,105.49
Rate for Payer: CareSource Just4Me Medicare	$18,423.15
Rate for Payer: Humana KY Medicaid	$12,964.44
Rate for Payer: Humana Medicare Advantage	$13,646.78
Rate for Payer: Kentucky WC Medicaid	$13,094.09
Rate for Payer: Molina Healthcare Benefit Exchange	$16,376.14
Rate for Payer: Molina Healthcare Medicaid	$13,223.73

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$9,376.12

Service Code	MSDRG 446
Min. Negotiated Rate	$6,362.37
Max. Negotiated Rate	$9,376.12
Rate for Payer: Anthem Medicaid	$6,362.37
Rate for Payer: Anthem Medicare Advantage/PPO	$6,697.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,376.12
Rate for Payer: CareSource Just4Me Medicare	$9,041.26
Rate for Payer: Humana KY Medicaid	$6,362.37
Rate for Payer: Humana Medicare Advantage	$6,697.23
Rate for Payer: Kentucky WC Medicaid	$6,425.99
Rate for Payer: Molina Healthcare Benefit Exchange	$8,036.68
Rate for Payer: Molina Healthcare Medicaid	$6,489.62

DISPENSE FEE BINAURAL SP

Professional

Both

$541.00

Hospital Charge Code	47000106
Hospital Revenue Code	222
Min. Negotiated Rate	$189.35
Max. Negotiated Rate	$541.00
Rate for Payer: Buckeye Medicare Advantage	$541.00
Rate for Payer: Cash Price	$270.50
Rate for Payer: Multiplan PHCS	$324.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$378.70
Rate for Payer: UHCCP Medicaid	$189.35

DISPENSE FEE BINAURAL SP

Professional

Both

$269.00

Hospital Charge Code	47000117
Hospital Revenue Code	222
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$269.00
Rate for Payer: Buckeye Medicare Advantage	$269.00
Rate for Payer: Cash Price	$134.50
Rate for Payer: Multiplan PHCS	$161.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.30
Rate for Payer: UHCCP Medicaid	$94.15

DISPENSE FEE HEAR AID SP

Professional

Both

$269.00

Hospital Charge Code	47000116
Hospital Revenue Code	222
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$269.00
Rate for Payer: Buckeye Medicare Advantage	$269.00
Rate for Payer: Cash Price	$134.50
Rate for Payer: Multiplan PHCS	$161.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.30
Rate for Payer: UHCCP Medicaid	$94.15

DISPENSE FEE MONAURAL SP

Professional

Both

$269.00

Hospital Charge Code	47000107
Hospital Revenue Code	222
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$269.00
Rate for Payer: Buckeye Medicare Advantage	$269.00
Rate for Payer: Cash Price	$134.50
Rate for Payer: Multiplan PHCS	$161.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.30
Rate for Payer: UHCCP Medicaid	$94.15

DISPENS FEE BINAURAL

Facility

$564.00

Service Code	HCPCS V5160
Hospital Charge Code	47000047
Hospital Revenue Code	292
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$541.44
Rate for Payer: Aetna Commercial	$434.28
Rate for Payer: Anthem Medicaid	$193.96
Rate for Payer: Anthem POS/PPO/Traditional	$439.92
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cigna Commercial	$468.12
Rate for Payer: First Health Commercial	$535.80
Rate for Payer: Humana Commercial	$479.40
Rate for Payer: Humana KY Medicaid	$193.96
Rate for Payer: Kentucky WC Medicaid	$195.93
Rate for Payer: Medical Mutual Of Ohio HMO	$462.48
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$416.23
Rate for Payer: Molina Healthcare Benefit Exchange	$169.20
Rate for Payer: Molina Healthcare Medicaid	$197.85
Rate for Payer: Ohio Health Choice Commercial	$496.32
Rate for Payer: Ohio Health Group HMO	$423.00
Rate for Payer: Ohio Health Group PPO Differential	$112.80
Rate for Payer: Ohio Health Group PPO No Differential	$73.32
Rate for Payer: Ohio Health Group PPO SOMC Employees	$174.84
Rate for Payer: PHCS Commercial	$541.44
Rate for Payer: United Healthcare All Payer	$496.32

DISPENS FEE BINAURAL

Facility

$564.00

Service Code	HCPCS V5160
Hospital Charge Code	47000047
Hospital Revenue Code	292
Min. Negotiated Rate	$73.32
Max. Negotiated Rate	$541.44
Rate for Payer: Aetna Commercial	$434.28
Rate for Payer: Anthem POS/PPO/Traditional	$439.92
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cigna Commercial	$468.12
Rate for Payer: First Health Commercial	$535.80
Rate for Payer: Humana Commercial	$479.40
Rate for Payer: Medical Mutual Of Ohio HMO	$462.48
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$416.23
Rate for Payer: Molina Healthcare Benefit Exchange	$169.20
Rate for Payer: Ohio Health Choice Commercial	$496.32
Rate for Payer: Ohio Health Group HMO	$423.00
Rate for Payer: Ohio Health Group PPO Differential	$112.80
Rate for Payer: Ohio Health Group PPO No Differential	$73.32
Rate for Payer: Ohio Health Group PPO SOMC Employees	$174.84
Rate for Payer: PHCS Commercial	$541.44
Rate for Payer: United Healthcare All Payer	$496.32

DISPENS FEE HEAR-AID BICROS

Professional

Both

$269.00

Hospital Charge Code	27000046
Hospital Revenue Code	292
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$269.00
Rate for Payer: Buckeye Medicare Advantage	$269.00
Rate for Payer: Cash Price	$134.50
Rate for Payer: Multiplan PHCS	$161.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.30
Rate for Payer: UHCCP Medicaid	$94.15

DISPENS FEE HEAR-AID BICROS

Facility

$269.00

Service Code	HCPCS V5200
Hospital Charge Code	27000046
Hospital Revenue Code	292
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$258.24
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Anthem Medicaid	$92.51
Rate for Payer: Anthem POS/PPO/Traditional	$209.82
Rate for Payer: Cash Price	$134.50
Rate for Payer: Cigna Commercial	$223.27
Rate for Payer: First Health Commercial	$255.55
Rate for Payer: Humana Commercial	$228.65
Rate for Payer: Humana KY Medicaid	$92.51
Rate for Payer: Kentucky WC Medicaid	$93.45
Rate for Payer: Medical Mutual Of Ohio HMO	$220.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$198.52
Rate for Payer: Molina Healthcare Benefit Exchange	$80.70
Rate for Payer: Molina Healthcare Medicaid	$94.37
Rate for Payer: Ohio Health Choice Commercial	$236.72
Rate for Payer: Ohio Health Group HMO	$201.75
Rate for Payer: Ohio Health Group PPO Differential	$53.80
Rate for Payer: Ohio Health Group PPO No Differential	$34.97
Rate for Payer: Ohio Health Group PPO SOMC Employees	$83.39
Rate for Payer: PHCS Commercial	$258.24
Rate for Payer: United Healthcare All Payer	$236.72

DISPENS FEE HEAR-AID BICROS

Facility

$269.00

Service Code	HCPCS V5200
Hospital Charge Code	27000046
Hospital Revenue Code	292
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$258.24
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Anthem POS/PPO/Traditional	$209.82
Rate for Payer: Cash Price	$134.50
Rate for Payer: Cigna Commercial	$223.27
Rate for Payer: First Health Commercial	$255.55
Rate for Payer: Humana Commercial	$228.65
Rate for Payer: Medical Mutual Of Ohio HMO	$220.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$198.52
Rate for Payer: Molina Healthcare Benefit Exchange	$80.70
Rate for Payer: Ohio Health Choice Commercial	$236.72
Rate for Payer: Ohio Health Group HMO	$201.75
Rate for Payer: Ohio Health Group PPO Differential	$53.80
Rate for Payer: Ohio Health Group PPO No Differential	$34.97
Rate for Payer: Ohio Health Group PPO SOMC Employees	$83.39
Rate for Payer: PHCS Commercial	$258.24
Rate for Payer: United Healthcare All Payer	$236.72

DISPENS FEE HEAR-AID CROS

Professional

Both

$269.00

Hospital Charge Code	27000234
Hospital Revenue Code	292
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$269.00
Rate for Payer: Buckeye Medicare Advantage	$269.00
Rate for Payer: Cash Price	$134.50
Rate for Payer: Multiplan PHCS	$161.40
Rate for Payer: Ohio Health Choice Preferred Health Choice	$188.30
Rate for Payer: UHCCP Medicaid	$94.15

DISPENS FEE HEAR-AID CROS

Facility

$269.00

Service Code	HCPCS V5240
Hospital Charge Code	27000234
Hospital Revenue Code	292
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$258.24
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Anthem Medicaid	$92.51
Rate for Payer: Anthem POS/PPO/Traditional	$209.82
Rate for Payer: Cash Price	$134.50
Rate for Payer: Cigna Commercial	$223.27
Rate for Payer: First Health Commercial	$255.55
Rate for Payer: Humana Commercial	$228.65
Rate for Payer: Humana KY Medicaid	$92.51
Rate for Payer: Kentucky WC Medicaid	$93.45
Rate for Payer: Medical Mutual Of Ohio HMO	$220.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$198.52
Rate for Payer: Molina Healthcare Benefit Exchange	$80.70
Rate for Payer: Molina Healthcare Medicaid	$94.37
Rate for Payer: Ohio Health Choice Commercial	$236.72
Rate for Payer: Ohio Health Group HMO	$201.75
Rate for Payer: Ohio Health Group PPO Differential	$53.80
Rate for Payer: Ohio Health Group PPO No Differential	$34.97
Rate for Payer: Ohio Health Group PPO SOMC Employees	$83.39
Rate for Payer: PHCS Commercial	$258.24
Rate for Payer: United Healthcare All Payer	$236.72

DISPENS FEE HEAR-AID CROS

Facility

$269.00

Service Code	HCPCS V5240
Hospital Charge Code	27000234
Hospital Revenue Code	292
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$258.24
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Anthem POS/PPO/Traditional	$209.82
Rate for Payer: Cash Price	$134.50
Rate for Payer: Cigna Commercial	$223.27
Rate for Payer: First Health Commercial	$255.55
Rate for Payer: Humana Commercial	$228.65
Rate for Payer: Medical Mutual Of Ohio HMO	$220.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$198.52
Rate for Payer: Molina Healthcare Benefit Exchange	$80.70
Rate for Payer: Ohio Health Choice Commercial	$236.72
Rate for Payer: Ohio Health Group HMO	$201.75
Rate for Payer: Ohio Health Group PPO Differential	$53.80
Rate for Payer: Ohio Health Group PPO No Differential	$34.97
Rate for Payer: Ohio Health Group PPO SOMC Employees	$83.39
Rate for Payer: PHCS Commercial	$258.24
Rate for Payer: United Healthcare All Payer	$236.72

DISPENS FEE MONAURAL

Facility

$269.00

Service Code	HCPCS V5241
Hospital Charge Code	27000235
Hospital Revenue Code	292
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$258.24
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Anthem Medicaid	$92.51
Rate for Payer: Anthem POS/PPO/Traditional	$209.82
Rate for Payer: Cash Price	$134.50
Rate for Payer: Cigna Commercial	$223.27
Rate for Payer: First Health Commercial	$255.55
Rate for Payer: Humana Commercial	$228.65
Rate for Payer: Humana KY Medicaid	$92.51
Rate for Payer: Kentucky WC Medicaid	$93.45
Rate for Payer: Medical Mutual Of Ohio HMO	$220.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$198.52
Rate for Payer: Molina Healthcare Benefit Exchange	$80.70
Rate for Payer: Molina Healthcare Medicaid	$94.37
Rate for Payer: Ohio Health Choice Commercial	$236.72
Rate for Payer: Ohio Health Group HMO	$201.75
Rate for Payer: Ohio Health Group PPO Differential	$53.80
Rate for Payer: Ohio Health Group PPO No Differential	$34.97
Rate for Payer: Ohio Health Group PPO SOMC Employees	$83.39
Rate for Payer: PHCS Commercial	$258.24
Rate for Payer: United Healthcare All Payer	$236.72

DISPENS FEE MONAURAL

Facility

$269.00

Service Code	HCPCS V5241
Hospital Charge Code	27000235
Hospital Revenue Code	292
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$258.24
Rate for Payer: Aetna Commercial	$207.13
Rate for Payer: Anthem POS/PPO/Traditional	$209.82
Rate for Payer: Cash Price	$134.50
Rate for Payer: Cigna Commercial	$223.27
Rate for Payer: First Health Commercial	$255.55
Rate for Payer: Humana Commercial	$228.65
Rate for Payer: Medical Mutual Of Ohio HMO	$220.58
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$198.52
Rate for Payer: Molina Healthcare Benefit Exchange	$80.70
Rate for Payer: Ohio Health Choice Commercial	$236.72
Rate for Payer: Ohio Health Group HMO	$201.75
Rate for Payer: Ohio Health Group PPO Differential	$53.80
Rate for Payer: Ohio Health Group PPO No Differential	$34.97
Rate for Payer: Ohio Health Group PPO SOMC Employees	$83.39
Rate for Payer: PHCS Commercial	$258.24
Rate for Payer: United Healthcare All Payer	$236.72

DISPOSABLE KIT FOR DX KNOTLESS

Facility

$9,187.50

Service Code	HCPCS C1713
Hospital Charge Code	27000005
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.38
Max. Negotiated Rate	$8,820.00
Rate for Payer: Aetna Commercial	$7,074.38
Rate for Payer: Anthem Medicaid	$3,159.58
Rate for Payer: Anthem POS/PPO/Traditional	$7,166.25
Rate for Payer: Cash Price	$4,593.75
Rate for Payer: Cigna Commercial	$7,625.62
Rate for Payer: First Health Commercial	$8,728.12
Rate for Payer: Humana Commercial	$7,809.38
Rate for Payer: Humana KY Medicaid	$3,159.58
Rate for Payer: Kentucky WC Medicaid	$3,191.74
Rate for Payer: Medical Mutual Of Ohio HMO	$7,533.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,780.38
Rate for Payer: Molina Healthcare Benefit Exchange	$2,756.25
Rate for Payer: Molina Healthcare Medicaid	$3,222.98
Rate for Payer: Ohio Health Choice Commercial	$8,085.00
Rate for Payer: Ohio Health Group HMO	$6,890.62
Rate for Payer: Ohio Health Group PPO Differential	$1,837.50
Rate for Payer: Ohio Health Group PPO No Differential	$1,194.38
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,848.12
Rate for Payer: PHCS Commercial	$8,820.00
Rate for Payer: United Healthcare All Payer	$8,085.00

DISPOSABLE KIT FOR DX KNOTLESS

Facility

$9,187.50

Service Code	HCPCS C1713
Hospital Charge Code	27000005
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.38
Max. Negotiated Rate	$8,820.00
Rate for Payer: Aetna Commercial	$7,074.38
Rate for Payer: Anthem POS/PPO/Traditional	$7,166.25
Rate for Payer: Cash Price	$4,593.75
Rate for Payer: Cigna Commercial	$7,625.62
Rate for Payer: First Health Commercial	$8,728.12
Rate for Payer: Humana Commercial	$7,809.38
Rate for Payer: Medical Mutual Of Ohio HMO	$7,533.75
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,780.38
Rate for Payer: Molina Healthcare Benefit Exchange	$2,756.25
Rate for Payer: Ohio Health Choice Commercial	$8,085.00
Rate for Payer: Ohio Health Group HMO	$6,890.62
Rate for Payer: Ohio Health Group PPO Differential	$1,837.50
Rate for Payer: Ohio Health Group PPO No Differential	$1,194.38
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,848.12
Rate for Payer: PHCS Commercial	$8,820.00
Rate for Payer: United Healthcare All Payer	$8,085.00

DISPOSABLE KIT NANO SWIVELOCK

Facility

$3,232.50

Hospital Charge Code	27000242
Hospital Revenue Code	272
Min. Negotiated Rate	$420.22
Max. Negotiated Rate	$3,103.20
Rate for Payer: Aetna Commercial	$2,489.02
Rate for Payer: Anthem Medicaid	$1,111.66
Rate for Payer: Anthem POS/PPO/Traditional	$2,521.35
Rate for Payer: Cash Price	$1,616.25
Rate for Payer: Cigna Commercial	$2,682.98
Rate for Payer: First Health Commercial	$3,070.88
Rate for Payer: Humana Commercial	$2,747.62
Rate for Payer: Humana KY Medicaid	$1,111.66
Rate for Payer: Kentucky WC Medicaid	$1,122.97
Rate for Payer: Medical Mutual Of Ohio HMO	$2,650.65
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$2,385.58
Rate for Payer: Molina Healthcare Benefit Exchange	$969.75
Rate for Payer: Molina Healthcare Medicaid	$1,133.96
Rate for Payer: Ohio Health Choice Commercial	$2,844.60
Rate for Payer: Ohio Health Group HMO	$2,424.38
Rate for Payer: Ohio Health Group PPO Differential	$646.50
Rate for Payer: Ohio Health Group PPO No Differential	$420.22
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,002.08
Rate for Payer: PHCS Commercial	$3,103.20
Rate for Payer: United Healthcare All Payer	$2,844.60

Know your out-of-pocket cost for care.

All Charges