Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,962.83

Service Code	CPT 21931
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,962.83

Service Code	CPT 21930
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 21933
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, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 21014
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, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER

Facility

$1,962.83

Service Code	CPT 21012
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 28039
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, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,962.83

Service Code	CPT 25071
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,962.83

Service Code	CPT 25075
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 27632
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, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 21552
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, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,962.83

Service Code	CPT 21555
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 21554
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, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$3,440.07

Service Code	CPT 21556
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, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 27043
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, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$3,440.07

Service Code	CPT 27047
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, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,962.83

Service Code	CPT 23071
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$3,440.07

Service Code	CPT 23076
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, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 27337
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, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,962.83

Service Code	CPT 27327
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 27339
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, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 24071
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, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,962.83

Service Code	CPT 24075
Hospital Revenue Code	360
Min. Negotiated Rate	$1,402.02
Max. Negotiated Rate	$1,962.83
Rate for Payer: Anthem Medicare Advantage/PPO	$1,402.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,962.83
Rate for Payer: CareSource Just4Me Medicare	$1,892.73
Rate for Payer: Humana Medicare Advantage	$1,402.02
Rate for Payer: Molina Healthcare Benefit Exchange	$1,682.42

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$3,440.07

Service Code	CPT 24073
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 VAG CUFF ENDOMETRIOMA

Professional

Both

$2,500.00

Service Code	HCPCS 58999
Hospital Charge Code	761P2267
Hospital Revenue Code	761
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2,500.00
Rate for Payer: Anthem Medicaid	$570.00
Rate for Payer: Buckeye Medicare Advantage	$2,500.00
Rate for Payer: Cash Price	$1,250.00
Rate for Payer: Cash Price	$1,250.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$570.00
Rate for Payer: Molina Healthcare CHIP/Medicaid	$581.40
Rate for Payer: Molina Healthcare Passport	$570.00
Rate for Payer: Multiplan PHCS	$1,500.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,750.00
Rate for Payer: UHCCP Medicaid	$875.00
Rate for Payer: Wellcare CHIP/Medicaid	$575.70

EXCISION VAG CUFF ENDOMETRIOMA

Professional

Both

$2,500.00

Service Code	HCPCS 58999
Hospital Charge Code	76102267
Hospital Revenue Code	761
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2,500.00
Rate for Payer: Anthem Medicaid	$570.00
Rate for Payer: Buckeye Medicare Advantage	$2,500.00
Rate for Payer: Cash Price	$1,250.00
Rate for Payer: Cash Price	$1,250.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Humana Medicaid	$570.00
Rate for Payer: Molina Healthcare CHIP/Medicaid	$581.40
Rate for Payer: Molina Healthcare Passport	$570.00
Rate for Payer: Multiplan PHCS	$1,500.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,750.00
Rate for Payer: UHCCP Medicaid	$875.00
Rate for Payer: Wellcare CHIP/Medicaid	$575.70

Know your out-of-pocket cost for care.

All Charges