Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE)

Facility

$4,220.54

Service Code	CPT 55530
Hospital Revenue Code	360
Min. Negotiated Rate	$3,014.67
Max. Negotiated Rate	$4,220.54
Rate for Payer: Anthem Medicare Advantage/PPO	$3,014.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,220.54
Rate for Payer: CareSource Just4Me Medicare	$4,069.80
Rate for Payer: Humana Medicare Advantage	$3,014.67
Rate for Payer: Molina Healthcare Benefit Exchange	$3,617.60

EXCISION, OLECRANON BURSA

Facility

$7,291.00

Service Code	HCPCS 24105
Hospital Charge Code	76100508
Hospital Revenue Code	761
Min. Negotiated Rate	$947.83
Max. Negotiated Rate	$6,999.36
Rate for Payer: Aetna Commercial	$5,614.07
Rate for Payer: Anthem POS/PPO/Traditional	$5,686.98
Rate for Payer: Cash Price	$3,645.50
Rate for Payer: Cigna Commercial	$6,051.53
Rate for Payer: First Health Commercial	$6,926.45
Rate for Payer: Humana Commercial	$6,197.35
Rate for Payer: Medical Mutual Of Ohio HMO	$5,978.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,380.76
Rate for Payer: Molina Healthcare Benefit Exchange	$2,187.30
Rate for Payer: Ohio Health Choice Commercial	$6,416.08
Rate for Payer: Ohio Health Group HMO	$5,468.25
Rate for Payer: Ohio Health Group PPO Differential	$1,458.20
Rate for Payer: Ohio Health Group PPO No Differential	$947.83
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,260.21
Rate for Payer: PHCS Commercial	$6,999.36
Rate for Payer: United Healthcare All Payer	$6,416.08

EXCISION, OLECRANON BURSA

Facility

$3,918.70

Service Code	CPT 24105
Hospital Revenue Code	360
Min. Negotiated Rate	$2,799.07
Max. Negotiated Rate	$3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88

EXCISION, OLECRANON BURSA

Facility

$7,291.00

Service Code	HCPCS 24105
Hospital Charge Code	76100508
Hospital Revenue Code	761
Min. Negotiated Rate	$947.83
Max. Negotiated Rate	$6,999.36
Rate for Payer: Aetna Commercial	$5,614.07
Rate for Payer: Anthem Medicaid	$2,507.37
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Anthem POS/PPO/Traditional	$5,686.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Cash Price	$3,645.50
Rate for Payer: Cash Price	$3,645.50
Rate for Payer: Cigna Commercial	$6,051.53
Rate for Payer: First Health Commercial	$6,926.45
Rate for Payer: Humana Commercial	$6,197.35
Rate for Payer: Humana KY Medicaid	$2,507.37
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Kentucky WC Medicaid	$2,532.89
Rate for Payer: Medical Mutual Of Ohio HMO	$5,978.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$5,380.76
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88
Rate for Payer: Molina Healthcare Medicaid	$2,557.68
Rate for Payer: Ohio Health Choice Commercial	$6,416.08
Rate for Payer: Ohio Health Group HMO	$5,468.25
Rate for Payer: Ohio Health Group PPO Differential	$1,458.20
Rate for Payer: Ohio Health Group PPO No Differential	$947.83
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,260.21
Rate for Payer: PHCS Commercial	$6,999.36
Rate for Payer: United Healthcare All Payer	$6,416.08

EXCISION, OLECRANON BURSA

Facility

$3,918.70

Service Code	CPT 24105
Hospital Charge Code	76100508
Hospital Revenue Code	360
Min. Negotiated Rate	$2,799.07
Max. Negotiated Rate	$3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88

EXCISION, OLECRANON BURSA

Professional

Both

$7,291.00

Service Code	HCPCS 24105
Hospital Charge Code	76100508
Hospital Revenue Code	761
Min. Negotiated Rate	$217.08
Max. Negotiated Rate	$7,291.00
Rate for Payer: Aetna Commercial	$477.40
Rate for Payer: Anthem Medicaid	$217.08
Rate for Payer: Buckeye Medicare Advantage	$7,291.00
Rate for Payer: Cash Price	$3,645.50
Rate for Payer: Cash Price	$3,645.50
Rate for Payer: Cigna Commercial	$527.38
Rate for Payer: Healthspan PPO	$432.42
Rate for Payer: Humana Medicaid	$217.08
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$418.25
Rate for Payer: Molina Healthcare CHIP/Medicaid	$221.42
Rate for Payer: Molina Healthcare Passport	$217.08
Rate for Payer: Multiplan PHCS	$4,374.60
Rate for Payer: Ohio Health Choice Preferred Health Choice	$5,103.70
Rate for Payer: UHCCP Medicaid	$2,551.85
Rate for Payer: Wellcare CHIP/Medicaid	$219.25

EXCISION, OLECRANON BURSA(P

Professional

Both

$800.00

Service Code	HCPCS 24105
Hospital Charge Code	761P0508
Hospital Revenue Code	761
Min. Negotiated Rate	$217.08
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$477.40
Rate for Payer: Anthem Medicaid	$217.08
Rate for Payer: Buckeye Medicare Advantage	$800.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cigna Commercial	$527.38
Rate for Payer: Healthspan PPO	$432.42
Rate for Payer: Humana Medicaid	$217.08
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$418.25
Rate for Payer: Molina Healthcare CHIP/Medicaid	$221.42
Rate for Payer: Molina Healthcare Passport	$217.08
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
Rate for Payer: Wellcare CHIP/Medicaid	$219.25

EXCISION, OLECRANON BURSA(T

Facility

$6,491.00

Service Code	HCPCS 24105
Hospital Charge Code	761T0508
Hospital Revenue Code	761
Min. Negotiated Rate	$843.83
Max. Negotiated Rate	$6,231.36
Rate for Payer: Aetna Commercial	$4,998.07
Rate for Payer: Anthem Medicaid	$2,232.25
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Anthem POS/PPO/Traditional	$5,062.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Cash Price	$3,245.50
Rate for Payer: Cash Price	$3,245.50
Rate for Payer: Cigna Commercial	$5,387.53
Rate for Payer: First Health Commercial	$6,166.45
Rate for Payer: Humana Commercial	$5,517.35
Rate for Payer: Humana KY Medicaid	$2,232.25
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Kentucky WC Medicaid	$2,254.97
Rate for Payer: Medical Mutual Of Ohio HMO	$5,322.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,790.36
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88
Rate for Payer: Molina Healthcare Medicaid	$2,277.04
Rate for Payer: Ohio Health Choice Commercial	$5,712.08
Rate for Payer: Ohio Health Group HMO	$4,868.25
Rate for Payer: Ohio Health Group PPO Differential	$1,298.20
Rate for Payer: Ohio Health Group PPO No Differential	$843.83
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,012.21
Rate for Payer: PHCS Commercial	$6,231.36
Rate for Payer: United Healthcare All Payer	$5,712.08

EXCISION, OLECRANON BURSA(T

Facility

$6,491.00

Service Code	HCPCS 24105
Hospital Charge Code	761T0508
Hospital Revenue Code	761
Min. Negotiated Rate	$843.83
Max. Negotiated Rate	$6,231.36
Rate for Payer: Aetna Commercial	$4,998.07
Rate for Payer: Anthem POS/PPO/Traditional	$5,062.98
Rate for Payer: Cash Price	$3,245.50
Rate for Payer: Cigna Commercial	$5,387.53
Rate for Payer: First Health Commercial	$6,166.45
Rate for Payer: Humana Commercial	$5,517.35
Rate for Payer: Medical Mutual Of Ohio HMO	$5,322.62
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,790.36
Rate for Payer: Molina Healthcare Benefit Exchange	$1,947.30
Rate for Payer: Ohio Health Choice Commercial	$5,712.08
Rate for Payer: Ohio Health Group HMO	$4,868.25
Rate for Payer: Ohio Health Group PPO Differential	$1,298.20
Rate for Payer: Ohio Health Group PPO No Differential	$843.83
Rate for Payer: Ohio Health Group PPO SOMC Employees	$2,012.21
Rate for Payer: PHCS Commercial	$6,231.36
Rate for Payer: United Healthcare All Payer	$5,712.08

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF PROXIMAL HUMERUS; WITH ALLOGRAFT

Facility

$8,661.10

Service Code	CPT 23156
Hospital Revenue Code	360
Min. Negotiated Rate	$6,186.50
Max. Negotiated Rate	$8,661.10
Rate for Payer: Anthem Medicare Advantage/PPO	$6,186.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,661.10
Rate for Payer: CareSource Just4Me Medicare	$8,351.78
Rate for Payer: Humana Medicare Advantage	$6,186.50
Rate for Payer: Molina Healthcare Benefit Exchange	$7,423.80

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALCANEUS;

Facility

$3,918.70

Service Code	CPT 28104
Hospital Revenue Code	360
Min. Negotiated Rate	$2,799.07
Max. Negotiated Rate	$3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;

Facility

$3,918.70

Service Code	CPT 27635
Hospital Revenue Code	360
Min. Negotiated Rate	$2,799.07
Max. Negotiated Rate	$3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH ALLOGRAFT

Facility

$8,661.10

Service Code	CPT 27638
Hospital Revenue Code	360
Min. Negotiated Rate	$6,186.50
Max. Negotiated Rate	$8,661.10
Rate for Payer: Anthem Medicare Advantage/PPO	$6,186.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,661.10
Rate for Payer: CareSource Just4Me Medicare	$8,351.78
Rate for Payer: Humana Medicare Advantage	$6,186.50
Rate for Payer: Molina Healthcare Benefit Exchange	$7,423.80

EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH

Facility

$3,897.84

Service Code	CPT 30117
Hospital Revenue Code	360
Min. Negotiated Rate	$2,784.17
Max. Negotiated Rate	$3,897.84
Rate for Payer: Anthem Medicare Advantage/PPO	$2,784.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,897.84
Rate for Payer: CareSource Just4Me Medicare	$3,758.63
Rate for Payer: Humana Medicare Advantage	$2,784.17
Rate for Payer: Molina Healthcare Benefit Exchange	$3,341.00

EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD

Facility

$3,897.84

Service Code	CPT 42808
Hospital Revenue Code	360
Min. Negotiated Rate	$2,784.17
Max. Negotiated Rate	$3,897.84
Rate for Payer: Anthem Medicare Advantage/PPO	$2,784.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,897.84
Rate for Payer: CareSource Just4Me Medicare	$3,758.63
Rate for Payer: Humana Medicare Advantage	$2,784.17
Rate for Payer: Molina Healthcare Benefit Exchange	$3,341.00

EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT

Facility

$2,829.05

Service Code	CPT 65426
Hospital Revenue Code	360
Min. Negotiated Rate	$2,020.75
Max. Negotiated Rate	$2,829.05
Rate for Payer: Anthem Medicare Advantage/PPO	$2,020.75
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,829.05
Rate for Payer: CareSource Just4Me Medicare	$2,728.01
Rate for Payer: Humana Medicare Advantage	$2,020.75
Rate for Payer: Molina Healthcare Benefit Exchange	$2,424.90

EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

$851.79

Service Code	CPT 11442
Hospital Revenue Code	360
Min. Negotiated Rate	$608.42
Max. Negotiated Rate	$851.79
Rate for Payer: Anthem Medicare Advantage/PPO	$608.42
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$851.79
Rate for Payer: CareSource Just4Me Medicare	$821.37
Rate for Payer: Humana Medicare Advantage	$608.42
Rate for Payer: Molina Healthcare Benefit Exchange	$730.10

EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM

Facility

$3,440.07

Service Code	CPT 11446
Hospital Revenue Code	360
Min. Negotiated Rate	$2,457.19
Max. Negotiated Rate	$3,440.07
Rate for Payer: Anthem Medicare Advantage/PPO	$2,457.19
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,440.07
Rate for Payer: CareSource Just4Me Medicare	$3,317.21
Rate for Payer: Humana Medicare Advantage	$2,457.19
Rate for Payer: Molina Healthcare Benefit Exchange	$2,948.63

EXCISION PARTOID TUMOR OR GLAN

Professional

Both

$2,100.00

Service Code	HCPCS 42415
Hospital Charge Code	761P1689
Hospital Revenue Code	761
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,648.84
Rate for Payer: Anthem Medicaid	$853.94
Rate for Payer: Buckeye Medicare Advantage	$2,100.00
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cigna Commercial	$1,635.36
Rate for Payer: Healthspan PPO	$1,390.50
Rate for Payer: Humana Medicaid	$853.94
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$1,445.30
Rate for Payer: Molina Healthcare CHIP/Medicaid	$871.02
Rate for Payer: Molina Healthcare Passport	$853.94
Rate for Payer: Multiplan PHCS	$1,260.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,470.00
Rate for Payer: UHCCP Medicaid	$735.00
Rate for Payer: Wellcare CHIP/Medicaid	$862.48

EXCISION PARTOID TUMOR OR GLAN

Facility

$2,100.00

Service Code	HCPCS 42415
Hospital Charge Code	76101689
Hospital Revenue Code	761
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$2,016.00
Rate for Payer: Aetna Commercial	$1,617.00
Rate for Payer: Anthem POS/PPO/Traditional	$1,638.00
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cigna Commercial	$1,743.00
Rate for Payer: First Health Commercial	$1,995.00
Rate for Payer: Humana Commercial	$1,785.00
Rate for Payer: Medical Mutual Of Ohio HMO	$1,722.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,549.80
Rate for Payer: Molina Healthcare Benefit Exchange	$630.00
Rate for Payer: Ohio Health Choice Commercial	$1,848.00
Rate for Payer: Ohio Health Group HMO	$1,575.00
Rate for Payer: Ohio Health Group PPO Differential	$420.00
Rate for Payer: Ohio Health Group PPO No Differential	$273.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$651.00
Rate for Payer: PHCS Commercial	$2,016.00
Rate for Payer: United Healthcare All Payer	$1,848.00

EXCISION PARTOID TUMOR OR GLAN

Professional

Both

$2,100.00

Service Code	HCPCS 42415
Hospital Charge Code	76101689
Hospital Revenue Code	761
Min. Negotiated Rate	$735.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,648.84
Rate for Payer: Anthem Medicaid	$853.94
Rate for Payer: Buckeye Medicare Advantage	$2,100.00
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cigna Commercial	$1,635.36
Rate for Payer: Healthspan PPO	$1,390.50
Rate for Payer: Humana Medicaid	$853.94
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$1,445.30
Rate for Payer: Molina Healthcare CHIP/Medicaid	$871.02
Rate for Payer: Molina Healthcare Passport	$853.94
Rate for Payer: Multiplan PHCS	$1,260.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,470.00
Rate for Payer: UHCCP Medicaid	$735.00
Rate for Payer: Wellcare CHIP/Medicaid	$862.48

EXCISION PARTOID TUMOR OR GLAN

Facility

$2,100.00

Service Code	HCPCS 42415
Hospital Charge Code	76101689
Hospital Revenue Code	761
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$7,089.80
Rate for Payer: Aetna Commercial	$1,617.00
Rate for Payer: Anthem Medicaid	$722.19
Rate for Payer: Anthem Medicare Advantage/PPO	$5,064.14
Rate for Payer: Anthem POS/PPO/Traditional	$1,638.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,089.80
Rate for Payer: CareSource Just4Me Medicare	$6,836.59
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cash Price	$1,050.00
Rate for Payer: Cigna Commercial	$1,743.00
Rate for Payer: First Health Commercial	$1,995.00
Rate for Payer: Humana Commercial	$1,785.00
Rate for Payer: Humana KY Medicaid	$722.19
Rate for Payer: Humana Medicare Advantage	$5,064.14
Rate for Payer: Kentucky WC Medicaid	$729.54
Rate for Payer: Medical Mutual Of Ohio HMO	$1,722.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,549.80
Rate for Payer: Molina Healthcare Benefit Exchange	$6,076.97
Rate for Payer: Molina Healthcare Medicaid	$736.68
Rate for Payer: Ohio Health Choice Commercial	$1,848.00
Rate for Payer: Ohio Health Group HMO	$1,575.00
Rate for Payer: Ohio Health Group PPO Differential	$420.00
Rate for Payer: Ohio Health Group PPO No Differential	$273.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$651.00
Rate for Payer: PHCS Commercial	$2,016.00
Rate for Payer: United Healthcare All Payer	$1,848.00

EXCISION, PREPATELLAR BURSA

Facility

$3,918.70

Service Code	CPT 27340
Hospital Revenue Code	360
Min. Negotiated Rate	$2,799.07
Max. Negotiated Rate	$3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88

EXCISION, PREPATELLAR BURSA

Facility

$1,160.00

Service Code	HCPCS 27340
Hospital Charge Code	76100820
Hospital Revenue Code	761
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$3,918.70
Rate for Payer: Aetna Commercial	$893.20
Rate for Payer: Anthem Medicaid	$398.92
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Anthem POS/PPO/Traditional	$904.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Cash Price	$580.00
Rate for Payer: Cash Price	$580.00
Rate for Payer: Cigna Commercial	$962.80
Rate for Payer: First Health Commercial	$1,102.00
Rate for Payer: Humana Commercial	$986.00
Rate for Payer: Humana KY Medicaid	$398.92
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Kentucky WC Medicaid	$402.98
Rate for Payer: Medical Mutual Of Ohio HMO	$951.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$856.08
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88
Rate for Payer: Molina Healthcare Medicaid	$406.93
Rate for Payer: Ohio Health Choice Commercial	$1,020.80
Rate for Payer: Ohio Health Group HMO	$870.00
Rate for Payer: Ohio Health Group PPO Differential	$232.00
Rate for Payer: Ohio Health Group PPO No Differential	$150.80
Rate for Payer: Ohio Health Group PPO SOMC Employees	$359.60
Rate for Payer: PHCS Commercial	$1,113.60
Rate for Payer: United Healthcare All Payer	$1,020.80

EXCISION, PREPATELLAR BURSA

Professional

Both

$1,160.00

Service Code	HCPCS 27340
Hospital Charge Code	76100820
Hospital Revenue Code	761
Min. Negotiated Rate	$233.36
Max. Negotiated Rate	$1,160.00
Rate for Payer: Aetna Commercial	$521.29
Rate for Payer: Anthem Medicaid	$233.36
Rate for Payer: Buckeye Medicare Advantage	$1,160.00
Rate for Payer: Cash Price	$580.00
Rate for Payer: Cash Price	$580.00
Rate for Payer: Cigna Commercial	$575.88
Rate for Payer: Healthspan PPO	$472.18
Rate for Payer: Humana Medicaid	$233.36
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$449.86
Rate for Payer: Molina Healthcare CHIP/Medicaid	$238.03
Rate for Payer: Molina Healthcare Passport	$233.36
Rate for Payer: Multiplan PHCS	$696.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$812.00
Rate for Payer: UHCCP Medicaid	$406.00
Rate for Payer: Wellcare CHIP/Medicaid	$235.69

Know your out-of-pocket cost for care.

All Charges