Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: VACCINE ADMINISTRATION

Facility

$10.34

Service Code	EAPG 00459
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$10.34
Rate for Payer: Aetna CHP/Medicaid	$10.34
Rate for Payer: Humana OH Medicaid	$10.34

EAPG 3.18: VAGINAL DELIVERY PROCEDURES

Facility

$1,410.44

Service Code	EAPG 00195
Min. Negotiated Rate	$1,410.44
Max. Negotiated Rate	$1,410.44
Rate for Payer: Aetna CHP/Medicaid	$1,410.44
Rate for Payer: Humana OH Medicaid	$1,410.44

EAPG 3.18: VASCULAR ACCESS BY NEEDLE OR CATHETER

Facility

$134.45

Service Code	EAPG 00423
Min. Negotiated Rate	$134.45
Max. Negotiated Rate	$134.45
Rate for Payer: Aetna CHP/Medicaid	$134.45
Rate for Payer: Humana OH Medicaid	$134.45

EAPG 3.18: VENTILATION ASSISTANCE AND MANAGEMENT

Facility

$133.16

Service Code	EAPG 00067
Min. Negotiated Rate	$133.16
Max. Negotiated Rate	$133.16
Rate for Payer: Aetna CHP/Medicaid	$133.16
Rate for Payer: Humana OH Medicaid	$133.16

EAPG 3.18: VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO

Facility

$98.25

Service Code	EAPG 00561
Min. Negotiated Rate	$98.25
Max. Negotiated Rate	$98.25
Rate for Payer: Aetna CHP/Medicaid	$98.25
Rate for Payer: Humana OH Medicaid	$98.25

EAPG 3.18: VIRAL ILLNESS

Facility

$91.79

Service Code	EAPG 00808
Min. Negotiated Rate	$91.79
Max. Negotiated Rate	$91.79
Rate for Payer: Aetna CHP/Medicaid	$91.79
Rate for Payer: Humana OH Medicaid	$91.79

EAPG 3.18: VIRAL MENINGITIS

Facility

$103.42

Service Code	EAPG 00812
Min. Negotiated Rate	$103.42
Max. Negotiated Rate	$103.42
Rate for Payer: Aetna CHP/Medicaid	$103.42
Rate for Payer: Humana OH Medicaid	$103.42

EAR CARTILAGE GRAFT

Facility

$8,347.00

Service Code	HCPCS 21235
Hospital Charge Code	76100376
Hospital Revenue Code	761
Min. Negotiated Rate	$2,870.53
Max. Negotiated Rate	$8,013.12
Rate for Payer: Aetna Commercial	$6,427.19
Rate for Payer: Anthem Medicaid	$2,870.53
Rate for Payer: Anthem Medicare Advantage/PPO	$5,465.95
Rate for Payer: Anthem POS/PPO/Traditional	$6,510.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,652.33
Rate for Payer: CareSource Just4Me Medicare	$7,379.03
Rate for Payer: Cash Price	$4,173.50
Rate for Payer: Cash Price	$4,173.50
Rate for Payer: Cigna Commercial	$6,928.01
Rate for Payer: First Health Commercial	$7,929.65
Rate for Payer: Humana Commercial	$7,094.95
Rate for Payer: Humana KY Medicaid	$2,870.53
Rate for Payer: Humana Medicare Advantage	$5,465.95
Rate for Payer: Kentucky WC Medicaid	$2,899.75
Rate for Payer: Medical Mutual Of Ohio HMO	$6,844.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,160.09
Rate for Payer: Molina Healthcare Benefit Exchange	$6,559.14
Rate for Payer: Molina Healthcare Medicaid	$2,928.13
Rate for Payer: Ohio Health Choice Commercial	$7,345.36
Rate for Payer: Ohio Health Group HMO	$6,260.25
Rate for Payer: Ohio Health Group PPO Differential	$6,677.60
Rate for Payer: Ohio Health Group PPO No Differential	$7,261.89
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,759.43
Rate for Payer: PHCS Commercial	$8,013.12
Rate for Payer: United Healthcare All Payer	$7,345.36

EAR CARTILAGE GRAFT

Facility

$8,347.00

Service Code	HCPCS 21235
Hospital Charge Code	76100376
Hospital Revenue Code	761
Min. Negotiated Rate	$2,504.10
Max. Negotiated Rate	$8,013.12
Rate for Payer: Aetna Commercial	$6,427.19
Rate for Payer: Anthem POS/PPO/Traditional	$6,510.66
Rate for Payer: Cash Price	$4,173.50
Rate for Payer: Cigna Commercial	$6,928.01
Rate for Payer: First Health Commercial	$7,929.65
Rate for Payer: Humana Commercial	$7,094.95
Rate for Payer: Medical Mutual Of Ohio HMO	$6,844.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,160.09
Rate for Payer: Molina Healthcare Benefit Exchange	$2,504.10
Rate for Payer: Ohio Health Choice Commercial	$7,345.36
Rate for Payer: Ohio Health Group HMO	$6,260.25
Rate for Payer: Ohio Health Group PPO Differential	$6,677.60
Rate for Payer: Ohio Health Group PPO No Differential	$7,261.89
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,759.43
Rate for Payer: PHCS Commercial	$8,013.12
Rate for Payer: United Healthcare All Payer	$7,345.36

EAR CARTILAGE GRAFT

Professional

Both

$8,347.00

Service Code	HCPCS 21235
Hospital Charge Code	76100376
Hospital Revenue Code	761
Min. Negotiated Rate	$300.07
Max. Negotiated Rate	$5,008.20
Rate for Payer: Aetna Commercial	$804.76
Rate for Payer: Ambetter Exchange	$536.04
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$300.07
Rate for Payer: Anthem Medicaid	$426.41
Rate for Payer: Buckeye Individual/Medicaid	$536.04
Rate for Payer: Buckeye Medicare Advantage	$536.04
Rate for Payer: CareSource Just4Me Medicare	$643.25
Rate for Payer: Cash Price	$4,173.50
Rate for Payer: Cash Price	$4,173.50
Rate for Payer: Cigna Commercial	$871.52
Rate for Payer: Healthspan PPO	$910.25
Rate for Payer: Humana Medicaid	$426.41
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$711.92
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$536.04
Rate for Payer: Molina Healthcare Benefit Exchange	$536.04
Rate for Payer: Molina Healthcare CHIP/Medicaid	$434.94
Rate for Payer: Molina Healthcare Passport	$426.41
Rate for Payer: Multiplan PHCS	$5,008.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$696.85
Rate for Payer: UHCCP Medicaid	$315.07
Rate for Payer: Wellcare CHIP/Medicaid	$430.67
Rate for Payer: Wellcare Medicare Advantage	$536.04

EAR CARTILAGE GRAFT(P

Professional

Both

$1,400.00

Service Code	HCPCS 21235
Hospital Charge Code	761P0376
Hospital Revenue Code	761
Min. Negotiated Rate	$300.07
Max. Negotiated Rate	$910.25
Rate for Payer: Aetna Commercial	$804.76
Rate for Payer: Ambetter Exchange	$536.04
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$300.07
Rate for Payer: Anthem Medicaid	$426.41
Rate for Payer: Buckeye Individual/Medicaid	$536.04
Rate for Payer: Buckeye Medicare Advantage	$536.04
Rate for Payer: CareSource Just4Me Medicare	$643.25
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cigna Commercial	$871.52
Rate for Payer: Healthspan PPO	$910.25
Rate for Payer: Humana Medicaid	$426.41
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$711.92
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$536.04
Rate for Payer: Molina Healthcare Benefit Exchange	$536.04
Rate for Payer: Molina Healthcare CHIP/Medicaid	$434.94
Rate for Payer: Molina Healthcare Passport	$426.41
Rate for Payer: Multiplan PHCS	$840.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$696.85
Rate for Payer: UHCCP Medicaid	$315.07
Rate for Payer: Wellcare CHIP/Medicaid	$430.67
Rate for Payer: Wellcare Medicare Advantage	$536.04

EAR CARTILAGE GRAFT(T

Facility

$6,947.00

Service Code	HCPCS 21235
Hospital Charge Code	761T0376
Hospital Revenue Code	761
Min. Negotiated Rate	$2,389.07
Max. Negotiated Rate	$7,652.33
Rate for Payer: Aetna Commercial	$5,349.19
Rate for Payer: Anthem Medicaid	$2,389.07
Rate for Payer: Anthem Medicare Advantage/PPO	$5,465.95
Rate for Payer: Anthem POS/PPO/Traditional	$5,418.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,652.33
Rate for Payer: CareSource Just4Me Medicare	$7,379.03
Rate for Payer: Cash Price	$3,473.50
Rate for Payer: Cash Price	$3,473.50
Rate for Payer: Cigna Commercial	$5,766.01
Rate for Payer: First Health Commercial	$6,599.65
Rate for Payer: Humana Commercial	$5,904.95
Rate for Payer: Humana KY Medicaid	$2,389.07
Rate for Payer: Humana Medicare Advantage	$5,465.95
Rate for Payer: Kentucky WC Medicaid	$2,413.39
Rate for Payer: Medical Mutual Of Ohio HMO	$5,696.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,126.89
Rate for Payer: Molina Healthcare Benefit Exchange	$6,559.14
Rate for Payer: Molina Healthcare Medicaid	$2,437.01
Rate for Payer: Ohio Health Choice Commercial	$6,113.36
Rate for Payer: Ohio Health Group HMO	$5,210.25
Rate for Payer: Ohio Health Group PPO Differential	$5,557.60
Rate for Payer: Ohio Health Group PPO No Differential	$6,043.89
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,793.43
Rate for Payer: PHCS Commercial	$6,669.12
Rate for Payer: United Healthcare All Payer	$6,113.36

EAR CARTILAGE GRAFT(T

Facility

$6,947.00

Service Code	HCPCS 21235
Hospital Charge Code	761T0376
Hospital Revenue Code	761
Min. Negotiated Rate	$2,084.10
Max. Negotiated Rate	$6,669.12
Rate for Payer: Aetna Commercial	$5,349.19
Rate for Payer: Anthem POS/PPO/Traditional	$5,418.66
Rate for Payer: Cash Price	$3,473.50
Rate for Payer: Cigna Commercial	$5,766.01
Rate for Payer: First Health Commercial	$6,599.65
Rate for Payer: Humana Commercial	$5,904.95
Rate for Payer: Medical Mutual Of Ohio HMO	$5,696.54
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,126.89
Rate for Payer: Molina Healthcare Benefit Exchange	$2,084.10
Rate for Payer: Ohio Health Choice Commercial	$6,113.36
Rate for Payer: Ohio Health Group HMO	$5,210.25
Rate for Payer: Ohio Health Group PPO Differential	$5,557.60
Rate for Payer: Ohio Health Group PPO No Differential	$6,043.89
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,793.43
Rate for Payer: PHCS Commercial	$6,669.12
Rate for Payer: United Healthcare All Payer	$6,113.36

EAR LOBE REPAIR

Facility

$300.00

Hospital Charge Code	22200019
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

EAR LOBE REPAIR

Facility

$300.00

Hospital Charge Code	22200019
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

EAR LOBE REPAIR

Professional

Both

$300.00

Hospital Charge Code	22200019
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

EAR MOLD

Facility

$110.00

Service Code	HCPCS V5264
Hospital Charge Code	47000035
Hospital Revenue Code	470
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$105.60
Rate for Payer: Aetna Commercial	$84.70
Rate for Payer: Anthem POS/PPO/Traditional	$85.80
Rate for Payer: Cash Price	$55.00
Rate for Payer: Cigna Commercial	$91.30
Rate for Payer: First Health Commercial	$104.50
Rate for Payer: Humana Commercial	$93.50
Rate for Payer: Medical Mutual Of Ohio HMO	$90.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$81.18
Rate for Payer: Molina Healthcare Benefit Exchange	$33.00
Rate for Payer: Ohio Health Choice Commercial	$96.80
Rate for Payer: Ohio Health Group HMO	$82.50
Rate for Payer: Ohio Health Group PPO Differential	$88.00
Rate for Payer: Ohio Health Group PPO No Differential	$95.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$75.90
Rate for Payer: PHCS Commercial	$105.60
Rate for Payer: United Healthcare All Payer	$96.80

EAR MOLD

Facility

$110.00

Service Code	HCPCS V5264
Hospital Charge Code	47000035
Hospital Revenue Code	470
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$105.60
Rate for Payer: Aetna Commercial	$84.70
Rate for Payer: Anthem Medicaid	$37.83
Rate for Payer: Anthem POS/PPO/Traditional	$85.80
Rate for Payer: Cash Price	$55.00
Rate for Payer: Cigna Commercial	$91.30
Rate for Payer: First Health Commercial	$104.50
Rate for Payer: Humana Commercial	$93.50
Rate for Payer: Humana KY Medicaid	$37.83
Rate for Payer: Kentucky WC Medicaid	$38.21
Rate for Payer: Medical Mutual Of Ohio HMO	$90.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$81.18
Rate for Payer: Molina Healthcare Benefit Exchange	$33.00
Rate for Payer: Molina Healthcare Medicaid	$38.59
Rate for Payer: Ohio Health Choice Commercial	$96.80
Rate for Payer: Ohio Health Group HMO	$82.50
Rate for Payer: Ohio Health Group PPO Differential	$88.00
Rate for Payer: Ohio Health Group PPO No Differential	$95.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$75.90
Rate for Payer: PHCS Commercial	$105.60
Rate for Payer: United Healthcare All Payer	$96.80

EAR MOLD(P

Professional

Both

$30.00

Service Code	HCPCS V5264
Hospital Charge Code	470P0035
Hospital Revenue Code	470
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$70.90
Rate for Payer: Aetna Commercial	$59.23
Rate for Payer: Cash Price	$15.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$70.90
Rate for Payer: Multiplan PHCS	$18.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$21.00
Rate for Payer: UHCCP Medicaid	$10.50

EAR MOLD SP

Professional

Both

$77.00

Hospital Charge Code	47000102
Hospital Revenue Code	222
Min. Negotiated Rate	$26.95
Max. Negotiated Rate	$53.90
Rate for Payer: Cash Price	$38.50
Rate for Payer: Multiplan PHCS	$46.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$53.90
Rate for Payer: UHCCP Medicaid	$26.95

EAR MOLD(T

Facility

$82.00

Service Code	HCPCS V5264
Hospital Charge Code	470T0035
Hospital Revenue Code	470
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$78.72
Rate for Payer: Aetna Commercial	$63.14
Rate for Payer: Anthem Medicaid	$28.20
Rate for Payer: Anthem POS/PPO/Traditional	$63.96
Rate for Payer: Cash Price	$41.00
Rate for Payer: Cigna Commercial	$68.06
Rate for Payer: First Health Commercial	$77.90
Rate for Payer: Humana Commercial	$69.70
Rate for Payer: Humana KY Medicaid	$28.20
Rate for Payer: Kentucky WC Medicaid	$28.49
Rate for Payer: Medical Mutual Of Ohio HMO	$67.24
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$60.52
Rate for Payer: Molina Healthcare Benefit Exchange	$24.60
Rate for Payer: Molina Healthcare Medicaid	$28.77
Rate for Payer: Ohio Health Choice Commercial	$72.16
Rate for Payer: Ohio Health Group HMO	$61.50
Rate for Payer: Ohio Health Group PPO Differential	$65.60
Rate for Payer: Ohio Health Group PPO No Differential	$71.34
Rate for Payer: Ohio Health Group PPO SOMC Employees	$56.58
Rate for Payer: PHCS Commercial	$78.72
Rate for Payer: United Healthcare All Payer	$72.16

EAR MOLD(T

Facility

$82.00

Service Code	HCPCS V5264
Hospital Charge Code	470T0035
Hospital Revenue Code	470
Min. Negotiated Rate	$24.60
Max. Negotiated Rate	$78.72
Rate for Payer: Aetna Commercial	$63.14
Rate for Payer: Anthem POS/PPO/Traditional	$63.96
Rate for Payer: Cash Price	$41.00
Rate for Payer: Cigna Commercial	$68.06
Rate for Payer: First Health Commercial	$77.90
Rate for Payer: Humana Commercial	$69.70
Rate for Payer: Medical Mutual Of Ohio HMO	$67.24
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$60.52
Rate for Payer: Molina Healthcare Benefit Exchange	$24.60
Rate for Payer: Ohio Health Choice Commercial	$72.16
Rate for Payer: Ohio Health Group HMO	$61.50
Rate for Payer: Ohio Health Group PPO Differential	$65.60
Rate for Payer: Ohio Health Group PPO No Differential	$71.34
Rate for Payer: Ohio Health Group PPO SOMC Employees	$56.58
Rate for Payer: PHCS Commercial	$78.72
Rate for Payer: United Healthcare All Payer	$72.16

EAR PROTECTOR EVALUATION

Facility

$70.00

Service Code	HCPCS 92596
Hospital Charge Code	47000123
Hospital Revenue Code	470
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna Commercial	$53.90
Rate for Payer: Anthem POS/PPO/Traditional	$54.60
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cigna Commercial	$58.10
Rate for Payer: First Health Commercial	$66.50
Rate for Payer: Humana Commercial	$59.50
Rate for Payer: Medical Mutual Of Ohio HMO	$57.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$51.66
Rate for Payer: Molina Healthcare Benefit Exchange	$21.00
Rate for Payer: Ohio Health Choice Commercial	$61.60
Rate for Payer: Ohio Health Group HMO	$52.50
Rate for Payer: Ohio Health Group PPO Differential	$56.00
Rate for Payer: Ohio Health Group PPO No Differential	$60.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$48.30
Rate for Payer: PHCS Commercial	$67.20
Rate for Payer: United Healthcare All Payer	$61.60

EAR PROTECTOR EVALUATION

Facility

$70.00

Service Code	HCPCS 92596
Hospital Charge Code	47000123
Hospital Revenue Code	470
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$67.20
Rate for Payer: Aetna Commercial	$53.90
Rate for Payer: Anthem Medicaid	$24.07
Rate for Payer: Anthem Medicare Advantage/PPO	$36.27
Rate for Payer: Anthem POS/PPO/Traditional	$54.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$50.78
Rate for Payer: CareSource Just4Me Medicare	$48.96
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cash Price	$35.00
Rate for Payer: Cigna Commercial	$58.10
Rate for Payer: First Health Commercial	$66.50
Rate for Payer: Humana Commercial	$59.50
Rate for Payer: Humana KY Medicaid	$24.07
Rate for Payer: Humana Medicare Advantage	$36.27
Rate for Payer: Kentucky WC Medicaid	$24.32
Rate for Payer: Medical Mutual Of Ohio HMO	$57.40
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$51.66
Rate for Payer: Molina Healthcare Benefit Exchange	$43.52
Rate for Payer: Molina Healthcare Medicaid	$24.56
Rate for Payer: Ohio Health Choice Commercial	$61.60
Rate for Payer: Ohio Health Group HMO	$52.50
Rate for Payer: Ohio Health Group PPO Differential	$56.00
Rate for Payer: Ohio Health Group PPO No Differential	$60.90
Rate for Payer: Ohio Health Group PPO SOMC Employees	$48.30
Rate for Payer: PHCS Commercial	$67.20
Rate for Payer: United Healthcare All Payer	$61.60

EAR WAX REMOVAL

Professional

Both

$211.00

Service Code	HCPCS 69210
Hospital Charge Code	76102413
Hospital Revenue Code	761
Min. Negotiated Rate	$16.79
Max. Negotiated Rate	$126.60
Rate for Payer: Aetna Commercial	$48.94
Rate for Payer: Ambetter Exchange	$30.32
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional	$16.79
Rate for Payer: Anthem Medicaid	$24.55
Rate for Payer: Buckeye Individual/Medicaid	$30.32
Rate for Payer: Buckeye Medicare Advantage	$30.32
Rate for Payer: CareSource Just4Me Medicare	$36.38
Rate for Payer: Cash Price	$105.50
Rate for Payer: Cash Price	$105.50
Rate for Payer: Cigna Commercial	$70.74
Rate for Payer: Healthspan PPO	$62.41
Rate for Payer: Humana Medicaid	$24.55
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$41.85
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$30.32
Rate for Payer: Molina Healthcare Benefit Exchange	$30.32
Rate for Payer: Molina Healthcare CHIP/Medicaid	$25.04
Rate for Payer: Molina Healthcare Passport	$24.55
Rate for Payer: Multiplan PHCS	$126.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$39.42
Rate for Payer: UHCCP Medicaid	$17.63
Rate for Payer: Wellcare CHIP/Medicaid	$24.80
Rate for Payer: Wellcare Medicare Advantage	$30.32

Know your out-of-pocket cost for care.

All Charges