Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION, OLECRANON BURSA

Facility

$7,291.00

Service Code	HCPCS 24105
Hospital Charge Code	76100508
Hospital Revenue Code	761
Min. Negotiated Rate	$2,187.30
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	$5,832.80
Rate for Payer: Ohio Health Group PPO No Differential	$6,343.17
Rate for Payer: Ohio Health Group PPO SOMC Employees	$5,030.79
Rate for Payer: PHCS Commercial	$6,999.36
Rate for Payer: United Healthcare All Payer	$6,416.08

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	$527.38
Rate for Payer: Aetna Commercial	$477.40
Rate for Payer: Ambetter Exchange	$344.72
Rate for Payer: Anthem Medicaid	$217.08
Rate for Payer: Buckeye Individual/Medicaid	$344.72
Rate for Payer: Buckeye Medicare Advantage	$344.72
Rate for Payer: CareSource Just4Me Medicare	$413.66
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: Medical Mutual Of Ohio Medicare Advantage	$344.72
Rate for Payer: Molina Healthcare Benefit Exchange	$344.72
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	$448.14
Rate for Payer: UHCCP Medicaid	$280.00
Rate for Payer: Wellcare CHIP/Medicaid	$219.25
Rate for Payer: Wellcare Medicare Advantage	$344.72

EXCISION, OLECRANON BURSA(T

Facility

$6,491.00

Service Code	HCPCS 24105
Hospital Charge Code	761T0508
Hospital Revenue Code	761
Min. Negotiated Rate	$2,232.25
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	$2,997.95
Rate for Payer: Anthem POS/PPO/Traditional	$5,062.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
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	$2,997.95
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	$3,597.54
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	$5,192.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,647.17
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,478.79
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	$1,947.30
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	$5,192.80
Rate for Payer: Ohio Health Group PPO No Differential	$5,647.17
Rate for Payer: Ohio Health Group PPO SOMC Employees	$4,478.79
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

$9,240.92

Service Code	CPT 23156
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

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

Facility

$4,197.13

Service Code	CPT 28104
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

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

Facility

$4,197.13

Service Code	CPT 27635
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

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

Facility

$9,240.92

Service Code	CPT 27638
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

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

Facility

$4,195.14

Service Code	CPT 30117
Hospital Revenue Code	360
Min. Negotiated Rate	$2,996.53
Max. Negotiated Rate	$4,195.14
Rate for Payer: Anthem Medicare Advantage/PPO	$2,996.53
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,195.14
Rate for Payer: CareSource Just4Me Medicare	$4,045.32
Rate for Payer: Humana Medicare Advantage	$2,996.53
Rate for Payer: Molina Healthcare Benefit Exchange	$3,595.84

EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD

Facility

$4,195.14

Service Code	CPT 42808
Hospital Revenue Code	360
Min. Negotiated Rate	$2,996.53
Max. Negotiated Rate	$4,195.14
Rate for Payer: Anthem Medicare Advantage/PPO	$2,996.53
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,195.14
Rate for Payer: CareSource Just4Me Medicare	$4,045.32
Rate for Payer: Humana Medicare Advantage	$2,996.53
Rate for Payer: Molina Healthcare Benefit Exchange	$3,595.84

EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT

Facility

$3,017.85

Service Code	CPT 65426
Hospital Revenue Code	360
Min. Negotiated Rate	$2,155.61
Max. Negotiated Rate	$3,017.85
Rate for Payer: Anthem Medicare Advantage/PPO	$2,155.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,017.85
Rate for Payer: CareSource Just4Me Medicare	$2,910.07
Rate for Payer: Humana Medicare Advantage	$2,155.61
Rate for Payer: Molina Healthcare Benefit Exchange	$2,586.73

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

$910.14

Service Code	CPT 11442
Hospital Revenue Code	360
Min. Negotiated Rate	$650.10
Max. Negotiated Rate	$910.14
Rate for Payer: Anthem Medicare Advantage/PPO	$650.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$910.14
Rate for Payer: CareSource Just4Me Medicare	$877.63
Rate for Payer: Humana Medicare Advantage	$650.10
Rate for Payer: Molina Healthcare Benefit Exchange	$780.12

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

$3,702.27

Service Code	CPT 11446
Hospital Revenue Code	360
Min. Negotiated Rate	$2,644.48
Max. Negotiated Rate	$3,702.27
Rate for Payer: Anthem Medicare Advantage/PPO	$2,644.48
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,702.27
Rate for Payer: CareSource Just4Me Medicare	$3,570.05
Rate for Payer: Humana Medicare Advantage	$2,644.48
Rate for Payer: Molina Healthcare Benefit Exchange	$3,173.38

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	$1,648.84
Rate for Payer: Aetna Commercial	$1,648.84
Rate for Payer: Ambetter Exchange	$1,002.06
Rate for Payer: Anthem Medicaid	$853.94
Rate for Payer: Buckeye Individual/Medicaid	$1,002.06
Rate for Payer: Buckeye Medicare Advantage	$1,002.06
Rate for Payer: CareSource Just4Me Medicare	$1,202.47
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: Medical Mutual Of Ohio Medicare Advantage	$1,002.06
Rate for Payer: Molina Healthcare Benefit Exchange	$1,002.06
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	$1,302.68
Rate for Payer: UHCCP Medicaid	$735.00
Rate for Payer: Wellcare CHIP/Medicaid	$862.48
Rate for Payer: Wellcare Medicare Advantage	$1,002.06

EXCISION PARTOID TUMOR OR GLAN

Facility

$2,100.00

Service Code	HCPCS 42415
Hospital Charge Code	76101689
Hospital Revenue Code	761
Min. Negotiated Rate	$630.00
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	$1,680.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,827.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,449.00
Rate for Payer: PHCS Commercial	$2,016.00
Rate for Payer: United Healthcare All Payer	$1,848.00

EXCISION PARTOID TUMOR OR GLAN

Facility

$2,100.00

Service Code	HCPCS 42415
Hospital Charge Code	76101689
Hospital Revenue Code	761
Min. Negotiated Rate	$722.19
Max. Negotiated Rate	$7,652.33
Rate for Payer: Aetna Commercial	$1,617.00
Rate for Payer: Anthem Medicaid	$722.19
Rate for Payer: Anthem Medicare Advantage/PPO	$5,465.95
Rate for Payer: Anthem POS/PPO/Traditional	$1,638.00
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	$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	$5,465.95
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	$6,559.14
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	$1,680.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,827.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,449.00
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	$1,648.84
Rate for Payer: Aetna Commercial	$1,648.84
Rate for Payer: Ambetter Exchange	$1,002.06
Rate for Payer: Anthem Medicaid	$853.94
Rate for Payer: Buckeye Individual/Medicaid	$1,002.06
Rate for Payer: Buckeye Medicare Advantage	$1,002.06
Rate for Payer: CareSource Just4Me Medicare	$1,202.47
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: Medical Mutual Of Ohio Medicare Advantage	$1,002.06
Rate for Payer: Molina Healthcare Benefit Exchange	$1,002.06
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	$1,302.68
Rate for Payer: UHCCP Medicaid	$735.00
Rate for Payer: Wellcare CHIP/Medicaid	$862.48
Rate for Payer: Wellcare Medicare Advantage	$1,002.06

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	$696.00
Rate for Payer: Aetna Commercial	$521.29
Rate for Payer: Ambetter Exchange	$359.13
Rate for Payer: Anthem Medicaid	$233.36
Rate for Payer: Buckeye Individual/Medicaid	$359.13
Rate for Payer: Buckeye Medicare Advantage	$359.13
Rate for Payer: CareSource Just4Me Medicare	$430.96
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: Medical Mutual Of Ohio Medicare Advantage	$359.13
Rate for Payer: Molina Healthcare Benefit Exchange	$359.13
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	$466.87
Rate for Payer: UHCCP Medicaid	$406.00
Rate for Payer: Wellcare CHIP/Medicaid	$235.69
Rate for Payer: Wellcare Medicare Advantage	$359.13

EXCISION, PREPATELLAR BURSA

Facility

$4,197.13

Service Code	CPT 27340
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

EXCISION, PREPATELLAR BURSA

Facility

$4,197.13

Service Code	CPT 27340
Hospital Charge Code	76100820
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

EXCISION, PREPATELLAR BURSA

Facility

$1,160.00

Service Code	HCPCS 27340
Hospital Charge Code	76100820
Hospital Revenue Code	761
Min. Negotiated Rate	$398.92
Max. Negotiated Rate	$4,197.13
Rate for Payer: Aetna Commercial	$893.20
Rate for Payer: Anthem Medicaid	$398.92
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Anthem POS/PPO/Traditional	$904.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
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	$2,997.95
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	$3,597.54
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	$928.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,009.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$800.40
Rate for Payer: PHCS Commercial	$1,113.60
Rate for Payer: United Healthcare All Payer	$1,020.80

EXCISION, PREPATELLAR BURSA

Facility

$1,160.00

Service Code	HCPCS 27340
Hospital Charge Code	76100820
Hospital Revenue Code	761
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$1,113.60
Rate for Payer: Aetna Commercial	$893.20
Rate for Payer: Anthem POS/PPO/Traditional	$904.80
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: 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	$348.00
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	$928.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,009.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$800.40
Rate for Payer: PHCS Commercial	$1,113.60
Rate for Payer: United Healthcare All Payer	$1,020.80

EXCISION, PREPATELLAR BURSA(P

Professional

Both

$1,160.00

Service Code	HCPCS 27340
Hospital Charge Code	761P0820
Hospital Revenue Code	761
Min. Negotiated Rate	$233.36
Max. Negotiated Rate	$696.00
Rate for Payer: Aetna Commercial	$521.29
Rate for Payer: Ambetter Exchange	$359.13
Rate for Payer: Anthem Medicaid	$233.36
Rate for Payer: Buckeye Individual/Medicaid	$359.13
Rate for Payer: Buckeye Medicare Advantage	$359.13
Rate for Payer: CareSource Just4Me Medicare	$430.96
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: Medical Mutual Of Ohio Medicare Advantage	$359.13
Rate for Payer: Molina Healthcare Benefit Exchange	$359.13
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	$466.87
Rate for Payer: UHCCP Medicaid	$406.00
Rate for Payer: Wellcare CHIP/Medicaid	$235.69
Rate for Payer: Wellcare Medicare Advantage	$359.13

EXCISION - PRESSURE ULCER

Professional

Both

$5,435.43

Service Code	HCPCS 15950
Hospital Charge Code	76100239
Hospital Revenue Code	761
Min. Negotiated Rate	$294.07
Max. Negotiated Rate	$3,261.26
Rate for Payer: Aetna Commercial	$820.76
Rate for Payer: Ambetter Exchange	$599.71
Rate for Payer: Anthem Medicaid	$294.07
Rate for Payer: Buckeye Individual/Medicaid	$599.71
Rate for Payer: Buckeye Medicare Advantage	$599.71
Rate for Payer: CareSource Just4Me Medicare	$719.65
Rate for Payer: Cash Price	$2,717.72
Rate for Payer: Cash Price	$2,717.72
Rate for Payer: Cigna Commercial	$777.59
Rate for Payer: Healthspan PPO	$656.27
Rate for Payer: Humana Medicaid	$294.07
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$709.02
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$599.71
Rate for Payer: Molina Healthcare Benefit Exchange	$599.71
Rate for Payer: Molina Healthcare CHIP/Medicaid	$299.95
Rate for Payer: Molina Healthcare Passport	$294.07
Rate for Payer: Multiplan PHCS	$3,261.26
Rate for Payer: Ohio Health Choice Preferred Health Choice	$779.62
Rate for Payer: UHCCP Medicaid	$1,902.40
Rate for Payer: Wellcare CHIP/Medicaid	$297.01
Rate for Payer: Wellcare Medicare Advantage	$599.71

EXCISION - PRESSURE ULCER

Facility

$5,435.43

Service Code	HCPCS 15950
Hospital Charge Code	76100239
Hospital Revenue Code	761
Min. Negotiated Rate	$1,630.63
Max. Negotiated Rate	$5,218.01
Rate for Payer: Aetna Commercial	$4,185.28
Rate for Payer: Anthem POS/PPO/Traditional	$4,239.64
Rate for Payer: Cash Price	$2,717.72
Rate for Payer: Cigna Commercial	$4,511.41
Rate for Payer: First Health Commercial	$5,163.66
Rate for Payer: Humana Commercial	$4,620.12
Rate for Payer: Medical Mutual Of Ohio HMO	$4,457.05
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$4,011.35
Rate for Payer: Molina Healthcare Benefit Exchange	$1,630.63
Rate for Payer: Ohio Health Choice Commercial	$4,783.18
Rate for Payer: Ohio Health Group HMO	$4,076.57
Rate for Payer: Ohio Health Group PPO Differential	$4,348.34
Rate for Payer: Ohio Health Group PPO No Differential	$4,728.82
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,750.45
Rate for Payer: PHCS Commercial	$5,218.01
Rate for Payer: United Healthcare All Payer	$4,783.18

Know your out-of-pocket cost for care.

All Charges