Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$14,089.31

Service Code	MSDRG 809
Min. Negotiated Rate	$9,560.60
Max. Negotiated Rate	$14,089.31
Rate for Payer: Anthem Medicaid	$9,560.60
Rate for Payer: Anthem Medicare Advantage/PPO	$10,063.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,089.31
Rate for Payer: CareSource Just4Me Medicare	$13,586.12
Rate for Payer: Humana KY Medicaid	$9,560.60
Rate for Payer: Humana Medicare Advantage	$10,063.79
Rate for Payer: Kentucky WC Medicaid	$9,656.21
Rate for Payer: Molina Healthcare Benefit Exchange	$12,076.55
Rate for Payer: Molina Healthcare Medicaid	$9,751.81

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$25,620.24

Service Code	MSDRG 808
Min. Negotiated Rate	$17,385.16
Max. Negotiated Rate	$25,620.24
Rate for Payer: Anthem Medicaid	$17,385.16
Rate for Payer: Anthem Medicare Advantage/PPO	$18,300.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,620.24
Rate for Payer: CareSource Just4Me Medicare	$24,705.23
Rate for Payer: Humana KY Medicaid	$17,385.16
Rate for Payer: Humana Medicare Advantage	$18,300.17
Rate for Payer: Kentucky WC Medicaid	$17,559.01
Rate for Payer: Molina Healthcare Benefit Exchange	$21,960.20
Rate for Payer: Molina Healthcare Medicaid	$17,732.86

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$11,750.84

Service Code	MSDRG 810
Min. Negotiated Rate	$7,973.79
Max. Negotiated Rate	$11,750.84
Rate for Payer: Anthem Medicaid	$7,973.79
Rate for Payer: Anthem Medicare Advantage/PPO	$8,393.46
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,750.84
Rate for Payer: CareSource Just4Me Medicare	$11,331.17
Rate for Payer: Humana KY Medicaid	$7,973.79
Rate for Payer: Humana Medicare Advantage	$8,393.46
Rate for Payer: Kentucky WC Medicaid	$8,053.52
Rate for Payer: Molina Healthcare Benefit Exchange	$10,072.15
Rate for Payer: Molina Healthcare Medicaid	$8,133.26

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$38,952.69

Service Code	MSDRG 469
Min. Negotiated Rate	$26,432.18
Max. Negotiated Rate	$38,952.69
Rate for Payer: Anthem Medicaid	$26,432.18
Rate for Payer: Anthem Medicare Advantage/PPO	$27,823.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,952.69
Rate for Payer: CareSource Just4Me Medicare	$37,561.52
Rate for Payer: Humana KY Medicaid	$26,432.18
Rate for Payer: Humana Medicare Advantage	$27,823.35
Rate for Payer: Kentucky WC Medicaid	$26,696.50
Rate for Payer: Molina Healthcare Benefit Exchange	$33,388.02
Rate for Payer: Molina Healthcare Medicaid	$26,960.83

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$22,012.52

Service Code	MSDRG 470
Min. Negotiated Rate	$14,937.07
Max. Negotiated Rate	$22,012.52
Rate for Payer: Anthem Medicaid	$14,937.07
Rate for Payer: Anthem Medicare Advantage/PPO	$15,723.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,012.52
Rate for Payer: CareSource Just4Me Medicare	$21,226.36
Rate for Payer: Humana KY Medicaid	$14,937.07
Rate for Payer: Humana Medicare Advantage	$15,723.23
Rate for Payer: Kentucky WC Medicaid	$15,086.44
Rate for Payer: Molina Healthcare Benefit Exchange	$18,867.88
Rate for Payer: Molina Healthcare Medicaid	$15,235.81

MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES

Facility

$29,060.67

Service Code	MSDRG 483
Min. Negotiated Rate	$19,719.74
Max. Negotiated Rate	$29,060.67
Rate for Payer: Anthem Medicaid	$19,719.74
Rate for Payer: Anthem Medicare Advantage/PPO	$20,757.62
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,060.67
Rate for Payer: CareSource Just4Me Medicare	$28,022.79
Rate for Payer: Humana KY Medicaid	$19,719.74
Rate for Payer: Humana Medicare Advantage	$20,757.62
Rate for Payer: Kentucky WC Medicaid	$19,916.94
Rate for Payer: Molina Healthcare Benefit Exchange	$24,909.14
Rate for Payer: Molina Healthcare Medicaid	$20,114.13

MAJOR MALE PELVIC PROCEDURES WITH CC/MCC

Facility

$22,950.70

Service Code	MSDRG 707
Min. Negotiated Rate	$15,573.69
Max. Negotiated Rate	$22,950.70
Rate for Payer: Anthem Medicaid	$15,573.69
Rate for Payer: Anthem Medicare Advantage/PPO	$16,393.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,950.70
Rate for Payer: CareSource Just4Me Medicare	$22,131.04
Rate for Payer: Humana KY Medicaid	$15,573.69
Rate for Payer: Humana Medicare Advantage	$16,393.36
Rate for Payer: Kentucky WC Medicaid	$15,729.43
Rate for Payer: Molina Healthcare Benefit Exchange	$19,672.03
Rate for Payer: Molina Healthcare Medicaid	$15,885.17

MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC

Facility

$17,061.83

Service Code	MSDRG 708
Min. Negotiated Rate	$11,577.67
Max. Negotiated Rate	$17,061.83
Rate for Payer: Anthem Medicaid	$11,577.67
Rate for Payer: Anthem Medicare Advantage/PPO	$12,187.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,061.83
Rate for Payer: CareSource Just4Me Medicare	$16,452.48
Rate for Payer: Humana KY Medicaid	$11,577.67
Rate for Payer: Humana Medicare Advantage	$12,187.02
Rate for Payer: Kentucky WC Medicaid	$11,693.45
Rate for Payer: Molina Healthcare Benefit Exchange	$14,624.42
Rate for Payer: Molina Healthcare Medicaid	$11,809.22

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC

Facility

$24,937.08

Service Code	MSDRG 507
Min. Negotiated Rate	$16,921.59
Max. Negotiated Rate	$24,937.08
Rate for Payer: Anthem Medicaid	$16,921.59
Rate for Payer: Anthem Medicare Advantage/PPO	$17,812.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,937.08
Rate for Payer: CareSource Just4Me Medicare	$24,046.47
Rate for Payer: Humana KY Medicaid	$16,921.59
Rate for Payer: Humana Medicare Advantage	$17,812.20
Rate for Payer: Kentucky WC Medicaid	$17,090.81
Rate for Payer: Molina Healthcare Benefit Exchange	$21,374.64
Rate for Payer: Molina Healthcare Medicaid	$17,260.02

MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC

Facility

$16,775.22

Service Code	MSDRG 508
Min. Negotiated Rate	$11,383.18
Max. Negotiated Rate	$16,775.22
Rate for Payer: Anthem Medicaid	$11,383.18
Rate for Payer: Anthem Medicare Advantage/PPO	$11,982.30
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,775.22
Rate for Payer: CareSource Just4Me Medicare	$16,176.10
Rate for Payer: Humana KY Medicaid	$11,383.18
Rate for Payer: Humana Medicare Advantage	$11,982.30
Rate for Payer: Kentucky WC Medicaid	$11,497.02
Rate for Payer: Molina Healthcare Benefit Exchange	$14,378.76
Rate for Payer: Molina Healthcare Medicaid	$11,610.85

MAJOR SKIN DISORDERS WITH MCC

Facility

$25,443.57

Service Code	MSDRG 595
Min. Negotiated Rate	$17,265.28
Max. Negotiated Rate	$25,443.57
Rate for Payer: Anthem Medicaid	$17,265.28
Rate for Payer: Anthem Medicare Advantage/PPO	$18,173.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,443.57
Rate for Payer: CareSource Just4Me Medicare	$24,534.87
Rate for Payer: Humana KY Medicaid	$17,265.28
Rate for Payer: Humana Medicare Advantage	$18,173.98
Rate for Payer: Kentucky WC Medicaid	$17,437.93
Rate for Payer: Molina Healthcare Benefit Exchange	$21,808.78
Rate for Payer: Molina Healthcare Medicaid	$17,610.59

MAJOR SKIN DISORDERS WITHOUT MCC

Facility

$11,803.47

Service Code	MSDRG 596
Min. Negotiated Rate	$8,009.50
Max. Negotiated Rate	$11,803.47
Rate for Payer: Anthem Medicaid	$8,009.50
Rate for Payer: Anthem Medicare Advantage/PPO	$8,431.05
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,803.47
Rate for Payer: CareSource Just4Me Medicare	$11,381.92
Rate for Payer: Humana KY Medicaid	$8,009.50
Rate for Payer: Humana Medicare Advantage	$8,431.05
Rate for Payer: Kentucky WC Medicaid	$8,089.59
Rate for Payer: Molina Healthcare Benefit Exchange	$10,117.26
Rate for Payer: Molina Healthcare Medicaid	$8,169.69

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$27,749.30

Service Code	MSDRG 330
Min. Negotiated Rate	$18,829.88
Max. Negotiated Rate	$27,749.30
Rate for Payer: Anthem Medicaid	$18,829.88
Rate for Payer: Anthem Medicare Advantage/PPO	$19,820.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,749.30
Rate for Payer: CareSource Just4Me Medicare	$26,758.26
Rate for Payer: Humana KY Medicaid	$18,829.88
Rate for Payer: Humana Medicare Advantage	$19,820.93
Rate for Payer: Kentucky WC Medicaid	$19,018.18
Rate for Payer: Molina Healthcare Benefit Exchange	$23,785.12
Rate for Payer: Molina Healthcare Medicaid	$19,206.48

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$52,838.45

Service Code	MSDRG 329
Min. Negotiated Rate	$35,854.66
Max. Negotiated Rate	$52,838.45
Rate for Payer: Anthem Medicaid	$35,854.66
Rate for Payer: Anthem Medicare Advantage/PPO	$37,741.75
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$52,838.45
Rate for Payer: CareSource Just4Me Medicare	$50,951.36
Rate for Payer: Humana KY Medicaid	$35,854.66
Rate for Payer: Humana Medicare Advantage	$37,741.75
Rate for Payer: Kentucky WC Medicaid	$36,213.21
Rate for Payer: Molina Healthcare Benefit Exchange	$45,290.10
Rate for Payer: Molina Healthcare Medicaid	$36,571.76

MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$19,559.39

Service Code	MSDRG 331
Min. Negotiated Rate	$13,272.44
Max. Negotiated Rate	$19,559.39
Rate for Payer: Anthem Medicaid	$13,272.44
Rate for Payer: Anthem Medicare Advantage/PPO	$13,970.99
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,559.39
Rate for Payer: CareSource Just4Me Medicare	$18,860.84
Rate for Payer: Humana KY Medicaid	$13,272.44
Rate for Payer: Humana Medicare Advantage	$13,970.99
Rate for Payer: Kentucky WC Medicaid	$13,405.16
Rate for Payer: Molina Healthcare Benefit Exchange	$16,765.19
Rate for Payer: Molina Healthcare Medicaid	$13,537.89

MAJOR THUMB OR JOINT PROCEDURES

Facility

$17,109.81

Service Code	MSDRG 506
Min. Negotiated Rate	$11,610.23
Max. Negotiated Rate	$17,109.81
Rate for Payer: Anthem Medicaid	$11,610.23
Rate for Payer: Anthem Medicare Advantage/PPO	$12,221.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,109.81
Rate for Payer: CareSource Just4Me Medicare	$16,498.74
Rate for Payer: Humana KY Medicaid	$11,610.23
Rate for Payer: Humana Medicare Advantage	$12,221.29
Rate for Payer: Kentucky WC Medicaid	$11,726.33
Rate for Payer: Molina Healthcare Benefit Exchange	$14,665.55
Rate for Payer: Molina Healthcare Medicaid	$11,842.43

Malaria SMEAR

Facility

$93.00

Service Code	HCPCS 87207
Hospital Charge Code	30001330
Hospital Revenue Code	300
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$89.28
Rate for Payer: Aetna Commercial	$71.61
Rate for Payer: Anthem POS/PPO/Traditional	$74.68
Rate for Payer: Cash Price	$46.50
Rate for Payer: Cigna Commercial	$77.19
Rate for Payer: First Health Commercial	$88.35
Rate for Payer: Humana Commercial	$79.05
Rate for Payer: Medical Mutual Of Ohio HMO	$76.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$68.63
Rate for Payer: Molina Healthcare Benefit Exchange	$27.90
Rate for Payer: Ohio Health Choice Commercial	$81.84
Rate for Payer: Ohio Health Group HMO	$69.75
Rate for Payer: Ohio Health Group PPO Differential	$18.60
Rate for Payer: Ohio Health Group PPO No Differential	$12.09
Rate for Payer: Ohio Health Group PPO SOMC Employees	$28.83
Rate for Payer: PHCS Commercial	$89.28
Rate for Payer: United Healthcare All Payer	$81.84

Malaria SMEAR

Facility

$93.00

Service Code	HCPCS 87207
Hospital Charge Code	30001330
Hospital Revenue Code	300
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$89.28
Rate for Payer: Aetna Commercial	$71.61
Rate for Payer: Anthem Medicaid	$5.99
Rate for Payer: Anthem Medicare Advantage/PPO	$5.99
Rate for Payer: Anthem POS/PPO/Traditional	$74.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8.39
Rate for Payer: CareSource Just4Me Medicare	$5.99
Rate for Payer: Cash Price	$46.50
Rate for Payer: Cash Price	$46.50
Rate for Payer: Cigna Commercial	$77.19
Rate for Payer: First Health Commercial	$88.35
Rate for Payer: Humana Commercial	$79.05
Rate for Payer: Humana KY Medicaid	$5.99
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: Kentucky WC Medicaid	$6.05
Rate for Payer: Medical Mutual Of Ohio HMO	$76.26
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$68.63
Rate for Payer: Molina Healthcare Benefit Exchange	$7.19
Rate for Payer: Molina Healthcare Medicaid	$6.11
Rate for Payer: Ohio Health Choice Commercial	$81.84
Rate for Payer: Ohio Health Group HMO	$69.75
Rate for Payer: Ohio Health Group PPO Differential	$18.60
Rate for Payer: Ohio Health Group PPO No Differential	$12.09
Rate for Payer: Ohio Health Group PPO SOMC Employees	$28.83
Rate for Payer: PHCS Commercial	$89.28
Rate for Payer: United Healthcare All Payer	$81.84

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$12,689.05

Service Code	MSDRG 755
Min. Negotiated Rate	$8,610.43
Max. Negotiated Rate	$12,689.05
Rate for Payer: Anthem Medicaid	$8,610.43
Rate for Payer: Anthem Medicare Advantage/PPO	$9,063.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,689.05
Rate for Payer: CareSource Just4Me Medicare	$12,235.87
Rate for Payer: Humana KY Medicaid	$8,610.43
Rate for Payer: Humana Medicare Advantage	$9,063.61
Rate for Payer: Kentucky WC Medicaid	$8,696.53
Rate for Payer: Molina Healthcare Benefit Exchange	$10,876.33
Rate for Payer: Molina Healthcare Medicaid	$8,782.64

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$21,670.94

Service Code	MSDRG 754
Min. Negotiated Rate	$14,705.28
Max. Negotiated Rate	$21,670.94
Rate for Payer: Anthem Medicaid	$14,705.28
Rate for Payer: Anthem Medicare Advantage/PPO	$15,479.24
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,670.94
Rate for Payer: CareSource Just4Me Medicare	$20,896.97
Rate for Payer: Humana KY Medicaid	$14,705.28
Rate for Payer: Humana Medicare Advantage	$15,479.24
Rate for Payer: Kentucky WC Medicaid	$14,852.33
Rate for Payer: Molina Healthcare Benefit Exchange	$18,575.09
Rate for Payer: Molina Healthcare Medicaid	$14,999.38

MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$11,577.71

Service Code	MSDRG 756
Min. Negotiated Rate	$7,856.30
Max. Negotiated Rate	$11,577.71
Rate for Payer: Anthem Medicaid	$7,856.30
Rate for Payer: Anthem Medicare Advantage/PPO	$8,269.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,577.71
Rate for Payer: CareSource Just4Me Medicare	$11,164.22
Rate for Payer: Humana KY Medicaid	$7,856.30
Rate for Payer: Humana Medicare Advantage	$8,269.79
Rate for Payer: Kentucky WC Medicaid	$7,934.86
Rate for Payer: Molina Healthcare Benefit Exchange	$9,923.75
Rate for Payer: Molina Healthcare Medicaid	$8,013.43

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC

Facility

$13,035.32

Service Code	MSDRG 723
Min. Negotiated Rate	$8,845.39
Max. Negotiated Rate	$13,035.32
Rate for Payer: Anthem Medicaid	$8,845.39
Rate for Payer: Anthem Medicare Advantage/PPO	$9,310.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,035.32
Rate for Payer: CareSource Just4Me Medicare	$12,569.77
Rate for Payer: Humana KY Medicaid	$8,845.39
Rate for Payer: Humana Medicare Advantage	$9,310.94
Rate for Payer: Kentucky WC Medicaid	$8,933.85
Rate for Payer: Molina Healthcare Benefit Exchange	$11,173.13
Rate for Payer: Molina Healthcare Medicaid	$9,022.30

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$21,931.80

Service Code	MSDRG 722
Min. Negotiated Rate	$14,882.29
Max. Negotiated Rate	$21,931.80
Rate for Payer: Anthem Medicaid	$14,882.29
Rate for Payer: Anthem Medicare Advantage/PPO	$15,665.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,931.80
Rate for Payer: CareSource Just4Me Medicare	$21,148.52
Rate for Payer: Humana KY Medicaid	$14,882.29
Rate for Payer: Humana Medicare Advantage	$15,665.57
Rate for Payer: Kentucky WC Medicaid	$15,031.11
Rate for Payer: Molina Healthcare Benefit Exchange	$18,798.68
Rate for Payer: Molina Healthcare Medicaid	$15,179.94

MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$9,469.67

Service Code	MSDRG 724
Min. Negotiated Rate	$6,425.85
Max. Negotiated Rate	$9,469.67
Rate for Payer: Anthem Medicaid	$6,425.85
Rate for Payer: Anthem Medicare Advantage/PPO	$6,764.05
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,469.67
Rate for Payer: CareSource Just4Me Medicare	$9,131.47
Rate for Payer: Humana KY Medicaid	$6,425.85
Rate for Payer: Humana Medicare Advantage	$6,764.05
Rate for Payer: Kentucky WC Medicaid	$6,490.11
Rate for Payer: Molina Healthcare Benefit Exchange	$8,116.86
Rate for Payer: Molina Healthcare Medicaid	$6,554.36

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC

Facility

$12,876.21

Service Code	MSDRG 436
Min. Negotiated Rate	$8,737.43
Max. Negotiated Rate	$12,876.21
Rate for Payer: Anthem Medicaid	$8,737.43
Rate for Payer: Anthem Medicare Advantage/PPO	$9,197.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,876.21
Rate for Payer: CareSource Just4Me Medicare	$12,416.34
Rate for Payer: Humana KY Medicaid	$8,737.43
Rate for Payer: Humana Medicare Advantage	$9,197.29
Rate for Payer: Kentucky WC Medicaid	$8,824.80
Rate for Payer: Molina Healthcare Benefit Exchange	$11,036.75
Rate for Payer: Molina Healthcare Medicaid	$8,912.17

Know your out-of-pocket cost for care.

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