Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: AFTERCARE WITHOUT CC/MCC

Facility

$7,067.55

Service Code	MSDRG 950
Min. Negotiated Rate	$4,795.84
Max. Negotiated Rate	$7,067.55
Rate for Payer: Anthem Medicaid	$4,795.84
Rate for Payer: Anthem Medicare Advantage/PPO	$5,048.25
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,067.55
Rate for Payer: CareSource Just4Me Medicare	$6,815.14
Rate for Payer: Humana KY Medicaid	$4,795.84
Rate for Payer: Humana Medicare Advantage	$5,048.25
Rate for Payer: Kentucky WC Medicaid	$4,843.80
Rate for Payer: Molina Healthcare Benefit Exchange	$6,057.90
Rate for Payer: Molina Healthcare Medicaid	$4,891.75

MS-DRG 42.00: AICD GENERATOR PROCEDURES

Facility

$58,927.78

Service Code	MSDRG 245
Min. Negotiated Rate	$39,986.71
Max. Negotiated Rate	$58,927.78
Rate for Payer: Anthem Medicaid	$39,986.71
Rate for Payer: Anthem Medicare Advantage/PPO	$42,091.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$58,927.78
Rate for Payer: CareSource Just4Me Medicare	$56,823.21
Rate for Payer: Humana KY Medicaid	$39,986.71
Rate for Payer: Humana Medicare Advantage	$42,091.27
Rate for Payer: Kentucky WC Medicaid	$40,386.57
Rate for Payer: Molina Healthcare Benefit Exchange	$50,509.52
Rate for Payer: Molina Healthcare Medicaid	$40,786.44

MS-DRG 42.00: AICD LEAD PROCEDURES

Facility

$43,015.32

Service Code	MSDRG 265
Min. Negotiated Rate	$29,188.97
Max. Negotiated Rate	$43,015.32
Rate for Payer: Anthem Medicaid	$29,188.97
Rate for Payer: Anthem Medicare Advantage/PPO	$30,725.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$43,015.32
Rate for Payer: CareSource Just4Me Medicare	$41,479.06
Rate for Payer: Humana KY Medicaid	$29,188.97
Rate for Payer: Humana Medicare Advantage	$30,725.23
Rate for Payer: Kentucky WC Medicaid	$29,480.86
Rate for Payer: Molina Healthcare Benefit Exchange	$36,870.28
Rate for Payer: Molina Healthcare Medicaid	$29,772.75

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$7,525.74

Service Code	MSDRG 894
Min. Negotiated Rate	$5,106.75
Max. Negotiated Rate	$7,525.74
Rate for Payer: Anthem Medicaid	$5,106.75
Rate for Payer: Anthem Medicare Advantage/PPO	$5,375.53
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,525.74
Rate for Payer: CareSource Just4Me Medicare	$7,256.97
Rate for Payer: Humana KY Medicaid	$5,106.75
Rate for Payer: Humana Medicare Advantage	$5,375.53
Rate for Payer: Kentucky WC Medicaid	$5,157.82
Rate for Payer: Molina Healthcare Benefit Exchange	$6,450.64
Rate for Payer: Molina Healthcare Medicaid	$5,208.89

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$21,473.90

Service Code	MSDRG 896
Min. Negotiated Rate	$14,571.58
Max. Negotiated Rate	$21,473.90
Rate for Payer: Anthem Medicaid	$14,571.58
Rate for Payer: Anthem Medicare Advantage/PPO	$15,338.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,473.90
Rate for Payer: CareSource Just4Me Medicare	$20,706.97
Rate for Payer: Humana KY Medicaid	$14,571.58
Rate for Payer: Humana Medicare Advantage	$15,338.50
Rate for Payer: Kentucky WC Medicaid	$14,717.29
Rate for Payer: Molina Healthcare Benefit Exchange	$18,406.20
Rate for Payer: Molina Healthcare Medicaid	$14,863.01

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$10,638.04

Service Code	MSDRG 897
Min. Negotiated Rate	$7,218.67
Max. Negotiated Rate	$10,638.04
Rate for Payer: Anthem Medicaid	$7,218.67
Rate for Payer: Anthem Medicare Advantage/PPO	$7,598.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,638.04
Rate for Payer: CareSource Just4Me Medicare	$10,258.11
Rate for Payer: Humana KY Medicaid	$7,218.67
Rate for Payer: Humana Medicare Advantage	$7,598.60
Rate for Payer: Kentucky WC Medicaid	$7,290.86
Rate for Payer: Molina Healthcare Benefit Exchange	$9,118.32
Rate for Payer: Molina Healthcare Medicaid	$7,363.04

MS-DRG 42.00: ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$17,459.61

Service Code	MSDRG 895
Min. Negotiated Rate	$11,847.59
Max. Negotiated Rate	$17,459.61
Rate for Payer: Anthem Medicaid	$11,847.59
Rate for Payer: Anthem Medicare Advantage/PPO	$12,471.15
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,459.61
Rate for Payer: CareSource Just4Me Medicare	$16,836.05
Rate for Payer: Humana KY Medicaid	$11,847.59
Rate for Payer: Humana Medicare Advantage	$12,471.15
Rate for Payer: Kentucky WC Medicaid	$11,966.07
Rate for Payer: Molina Healthcare Benefit Exchange	$14,965.38
Rate for Payer: Molina Healthcare Medicaid	$12,084.54

MS-DRG 42.00: ALLERGIC REACTIONS WITH MCC

Facility

$20,956.59

Service Code	MSDRG 915
Min. Negotiated Rate	$14,220.54
Max. Negotiated Rate	$20,956.59
Rate for Payer: Anthem Medicaid	$14,220.54
Rate for Payer: Anthem Medicare Advantage/PPO	$14,968.99
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,956.59
Rate for Payer: CareSource Just4Me Medicare	$20,208.14
Rate for Payer: Humana KY Medicaid	$14,220.54
Rate for Payer: Humana Medicare Advantage	$14,968.99
Rate for Payer: Kentucky WC Medicaid	$14,362.75
Rate for Payer: Molina Healthcare Benefit Exchange	$17,962.79
Rate for Payer: Molina Healthcare Medicaid	$14,504.95

MS-DRG 42.00: ALLERGIC REACTIONS WITHOUT MCC

Facility

$8,008.08

Service Code	MSDRG 916
Min. Negotiated Rate	$5,434.06
Max. Negotiated Rate	$8,008.08
Rate for Payer: Anthem Medicaid	$5,434.06
Rate for Payer: Anthem Medicare Advantage/PPO	$5,720.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,008.08
Rate for Payer: CareSource Just4Me Medicare	$7,722.08
Rate for Payer: Humana KY Medicaid	$5,434.06
Rate for Payer: Humana Medicare Advantage	$5,720.06
Rate for Payer: Kentucky WC Medicaid	$5,488.40
Rate for Payer: Molina Healthcare Benefit Exchange	$6,864.07
Rate for Payer: Molina Healthcare Medicaid	$5,542.74

MS-DRG 42.00: ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$157,988.95

Service Code	MSDRG 014
Min. Negotiated Rate	$107,206.79
Max. Negotiated Rate	$157,988.95
Rate for Payer: Anthem Medicaid	$107,206.79
Rate for Payer: Anthem Medicare Advantage/PPO	$112,849.25
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$157,988.95
Rate for Payer: CareSource Just4Me Medicare	$152,346.49
Rate for Payer: Humana KY Medicaid	$107,206.79
Rate for Payer: Humana Medicare Advantage	$112,849.25
Rate for Payer: Kentucky WC Medicaid	$108,278.86
Rate for Payer: Molina Healthcare Benefit Exchange	$135,419.10
Rate for Payer: Molina Healthcare Medicaid	$109,350.92

MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC

Facility

$35,116.96

Service Code	MSDRG 240
Min. Negotiated Rate	$23,829.36
Max. Negotiated Rate	$35,116.96
Rate for Payer: Anthem Medicaid	$23,829.36
Rate for Payer: Anthem Medicare Advantage/PPO	$25,083.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$35,116.96
Rate for Payer: CareSource Just4Me Medicare	$33,862.78
Rate for Payer: Humana KY Medicaid	$23,829.36
Rate for Payer: Humana Medicare Advantage	$25,083.54
Rate for Payer: Kentucky WC Medicaid	$24,067.66
Rate for Payer: Molina Healthcare Benefit Exchange	$30,100.25
Rate for Payer: Molina Healthcare Medicaid	$24,305.95

MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC

Facility

$60,737.82

Service Code	MSDRG 239
Min. Negotiated Rate	$41,214.95
Max. Negotiated Rate	$60,737.82
Rate for Payer: Anthem Medicaid	$41,214.95
Rate for Payer: Anthem Medicare Advantage/PPO	$43,384.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$60,737.82
Rate for Payer: CareSource Just4Me Medicare	$58,568.62
Rate for Payer: Humana KY Medicaid	$41,214.95
Rate for Payer: Humana Medicare Advantage	$43,384.16
Rate for Payer: Kentucky WC Medicaid	$41,627.10
Rate for Payer: Molina Healthcare Benefit Exchange	$52,060.99
Rate for Payer: Molina Healthcare Medicaid	$42,039.25

MS-DRG 42.00: AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC

Facility

$18,207.24

Service Code	MSDRG 241
Min. Negotiated Rate	$12,354.91
Max. Negotiated Rate	$18,207.24
Rate for Payer: Anthem Medicaid	$12,354.91
Rate for Payer: Anthem Medicare Advantage/PPO	$13,005.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,207.24
Rate for Payer: CareSource Just4Me Medicare	$17,556.98
Rate for Payer: Humana KY Medicaid	$12,354.91
Rate for Payer: Humana Medicare Advantage	$13,005.17
Rate for Payer: Kentucky WC Medicaid	$12,478.46
Rate for Payer: Molina Healthcare Benefit Exchange	$15,606.20
Rate for Payer: Molina Healthcare Medicaid	$12,602.01

MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$26,013.95

Service Code	MSDRG 475
Min. Negotiated Rate	$17,652.32
Max. Negotiated Rate	$26,013.95
Rate for Payer: Anthem Medicaid	$17,652.32
Rate for Payer: Anthem Medicare Advantage/PPO	$18,581.39
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$26,013.95
Rate for Payer: CareSource Just4Me Medicare	$25,084.88
Rate for Payer: Humana KY Medicaid	$17,652.32
Rate for Payer: Humana Medicare Advantage	$18,581.39
Rate for Payer: Kentucky WC Medicaid	$17,828.84
Rate for Payer: Molina Healthcare Benefit Exchange	$22,297.67
Rate for Payer: Molina Healthcare Medicaid	$18,005.37

MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$54,079.05

Service Code	MSDRG 474
Min. Negotiated Rate	$36,696.50
Max. Negotiated Rate	$54,079.05
Rate for Payer: Anthem Medicaid	$36,696.50
Rate for Payer: Anthem Medicare Advantage/PPO	$38,627.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$54,079.05
Rate for Payer: CareSource Just4Me Medicare	$52,147.65
Rate for Payer: Humana KY Medicaid	$36,696.50
Rate for Payer: Humana Medicare Advantage	$38,627.89
Rate for Payer: Kentucky WC Medicaid	$37,063.46
Rate for Payer: Molina Healthcare Benefit Exchange	$46,353.47
Rate for Payer: Molina Healthcare Medicaid	$37,430.43

MS-DRG 42.00: AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$14,025.33

Service Code	MSDRG 476
Min. Negotiated Rate	$9,517.19
Max. Negotiated Rate	$14,025.33
Rate for Payer: Anthem Medicaid	$9,517.19
Rate for Payer: Anthem Medicare Advantage/PPO	$10,018.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,025.33
Rate for Payer: CareSource Just4Me Medicare	$13,524.42
Rate for Payer: Humana KY Medicaid	$9,517.19
Rate for Payer: Humana Medicare Advantage	$10,018.09
Rate for Payer: Kentucky WC Medicaid	$9,612.36
Rate for Payer: Molina Healthcare Benefit Exchange	$12,021.71
Rate for Payer: Molina Healthcare Medicaid	$9,707.53

MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$23,292.33

Service Code	MSDRG 617
Min. Negotiated Rate	$15,805.51
Max. Negotiated Rate	$23,292.33
Rate for Payer: Anthem Medicaid	$15,805.51
Rate for Payer: Anthem Medicare Advantage/PPO	$16,637.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,292.33
Rate for Payer: CareSource Just4Me Medicare	$22,460.46
Rate for Payer: Humana KY Medicaid	$15,805.51
Rate for Payer: Humana Medicare Advantage	$16,637.38
Rate for Payer: Kentucky WC Medicaid	$15,963.57
Rate for Payer: Molina Healthcare Benefit Exchange	$19,964.86
Rate for Payer: Molina Healthcare Medicaid	$16,121.62

MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$46,606.38

Service Code	MSDRG 616
Min. Negotiated Rate	$31,625.76
Max. Negotiated Rate	$46,606.38
Rate for Payer: Anthem Medicaid	$31,625.76
Rate for Payer: Anthem Medicare Advantage/PPO	$33,290.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$46,606.38
Rate for Payer: CareSource Just4Me Medicare	$44,941.86
Rate for Payer: Humana KY Medicaid	$31,625.76
Rate for Payer: Humana Medicare Advantage	$33,290.27
Rate for Payer: Kentucky WC Medicaid	$31,942.01
Rate for Payer: Molina Healthcare Benefit Exchange	$39,948.32
Rate for Payer: Molina Healthcare Medicaid	$32,258.27

MS-DRG 42.00: AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$15,014.13

Service Code	MSDRG 618
Min. Negotiated Rate	$10,188.16
Max. Negotiated Rate	$15,014.13
Rate for Payer: Anthem Medicaid	$10,188.16
Rate for Payer: Anthem Medicare Advantage/PPO	$10,724.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,014.13
Rate for Payer: CareSource Just4Me Medicare	$14,477.91
Rate for Payer: Humana KY Medicaid	$10,188.16
Rate for Payer: Humana Medicare Advantage	$10,724.38
Rate for Payer: Kentucky WC Medicaid	$10,290.04
Rate for Payer: Molina Healthcare Benefit Exchange	$12,869.26
Rate for Payer: Molina Healthcare Medicaid	$10,391.92

MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH CC

Facility

$15,180.54

Service Code	MSDRG 348
Min. Negotiated Rate	$10,301.08
Max. Negotiated Rate	$15,180.54
Rate for Payer: Anthem Medicaid	$10,301.08
Rate for Payer: Anthem Medicare Advantage/PPO	$10,843.24
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,180.54
Rate for Payer: CareSource Just4Me Medicare	$14,638.37
Rate for Payer: Humana KY Medicaid	$10,301.08
Rate for Payer: Humana Medicare Advantage	$10,843.24
Rate for Payer: Kentucky WC Medicaid	$10,404.09
Rate for Payer: Molina Healthcare Benefit Exchange	$13,011.89
Rate for Payer: Molina Healthcare Medicaid	$10,507.10

MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$28,540.23

Service Code	MSDRG 347
Min. Negotiated Rate	$19,366.59
Max. Negotiated Rate	$28,540.23
Rate for Payer: Anthem Medicaid	$19,366.59
Rate for Payer: Anthem Medicare Advantage/PPO	$20,385.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$28,540.23
Rate for Payer: CareSource Just4Me Medicare	$27,520.94
Rate for Payer: Humana KY Medicaid	$19,366.59
Rate for Payer: Humana Medicare Advantage	$20,385.88
Rate for Payer: Kentucky WC Medicaid	$19,560.25
Rate for Payer: Molina Healthcare Benefit Exchange	$24,463.06
Rate for Payer: Molina Healthcare Medicaid	$19,753.92

MS-DRG 42.00: ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$10,622.39

Service Code	MSDRG 349
Min. Negotiated Rate	$7,208.05
Max. Negotiated Rate	$10,622.39
Rate for Payer: Anthem Medicaid	$7,208.05
Rate for Payer: Anthem Medicare Advantage/PPO	$7,587.42
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,622.39
Rate for Payer: CareSource Just4Me Medicare	$10,243.02
Rate for Payer: Humana KY Medicaid	$7,208.05
Rate for Payer: Humana Medicare Advantage	$7,587.42
Rate for Payer: Kentucky WC Medicaid	$7,280.13
Rate for Payer: Molina Healthcare Benefit Exchange	$9,104.90
Rate for Payer: Molina Healthcare Medicaid	$7,352.21

MS-DRG 42.00: ANGINA PECTORIS

Facility

$8,420.50

Service Code	MSDRG 311
Min. Negotiated Rate	$5,713.91
Max. Negotiated Rate	$8,420.50
Rate for Payer: Anthem Medicaid	$5,713.91
Rate for Payer: Anthem Medicare Advantage/PPO	$6,014.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,420.50
Rate for Payer: CareSource Just4Me Medicare	$8,119.76
Rate for Payer: Humana KY Medicaid	$5,713.91
Rate for Payer: Humana Medicare Advantage	$6,014.64
Rate for Payer: Kentucky WC Medicaid	$5,771.05
Rate for Payer: Molina Healthcare Benefit Exchange	$7,217.57
Rate for Payer: Molina Healthcare Medicaid	$5,828.19

MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$80,401.71

Service Code	MSDRG 268
Min. Negotiated Rate	$54,558.30
Max. Negotiated Rate	$80,401.71
Rate for Payer: Anthem Medicaid	$54,558.30
Rate for Payer: Anthem Medicare Advantage/PPO	$57,429.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$80,401.71
Rate for Payer: CareSource Just4Me Medicare	$77,530.22
Rate for Payer: Humana KY Medicaid	$54,558.30
Rate for Payer: Humana Medicare Advantage	$57,429.79
Rate for Payer: Kentucky WC Medicaid	$55,103.88
Rate for Payer: Molina Healthcare Benefit Exchange	$68,915.75
Rate for Payer: Molina Healthcare Medicaid	$55,649.47

MS-DRG 42.00: AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$50,172.08

Service Code	MSDRG 269
Min. Negotiated Rate	$34,045.34
Max. Negotiated Rate	$50,172.08
Rate for Payer: Anthem Medicaid	$34,045.34
Rate for Payer: Anthem Medicare Advantage/PPO	$35,837.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$50,172.08
Rate for Payer: CareSource Just4Me Medicare	$48,380.22
Rate for Payer: Humana KY Medicaid	$34,045.34
Rate for Payer: Humana Medicare Advantage	$35,837.20
Rate for Payer: Kentucky WC Medicaid	$34,385.79
Rate for Payer: Molina Healthcare Benefit Exchange	$43,004.64
Rate for Payer: Molina Healthcare Medicaid	$34,726.25

Know your out-of-pocket cost for care.

All Charges