Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: CONCUSSION WITH CC

Facility

$12,928.01

Service Code	MSDRG 089
Min. Negotiated Rate	$8,772.58
Max. Negotiated Rate	$12,928.01
Rate for Payer: Anthem Medicaid	$8,772.58
Rate for Payer: Anthem Medicare Advantage/PPO	$9,234.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,928.01
Rate for Payer: CareSource Just4Me Medicare	$12,466.29
Rate for Payer: Humana KY Medicaid	$8,772.58
Rate for Payer: Humana Medicare Advantage	$9,234.29
Rate for Payer: Kentucky WC Medicaid	$8,860.30
Rate for Payer: Molina Healthcare Benefit Exchange	$11,081.15
Rate for Payer: Molina Healthcare Medicaid	$8,948.03

MS-DRG 42.00: CONCUSSION WITH MCC

Facility

$17,011.02

Service Code	MSDRG 088
Min. Negotiated Rate	$11,543.19
Max. Negotiated Rate	$17,011.02
Rate for Payer: Anthem Medicaid	$11,543.19
Rate for Payer: Anthem Medicare Advantage/PPO	$12,150.73
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,011.02
Rate for Payer: CareSource Just4Me Medicare	$16,403.49
Rate for Payer: Humana KY Medicaid	$11,543.19
Rate for Payer: Humana Medicare Advantage	$12,150.73
Rate for Payer: Kentucky WC Medicaid	$11,658.63
Rate for Payer: Molina Healthcare Benefit Exchange	$14,580.88
Rate for Payer: Molina Healthcare Medicaid	$11,774.06

MS-DRG 42.00: CONCUSSION WITHOUT CC/MCC

Facility

$10,337.80

Service Code	MSDRG 090
Min. Negotiated Rate	$7,014.93
Max. Negotiated Rate	$10,337.80
Rate for Payer: Anthem Medicaid	$7,014.93
Rate for Payer: Anthem Medicare Advantage/PPO	$7,384.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,337.80
Rate for Payer: CareSource Just4Me Medicare	$9,968.59
Rate for Payer: Humana KY Medicaid	$7,014.93
Rate for Payer: Humana Medicare Advantage	$7,384.14
Rate for Payer: Kentucky WC Medicaid	$7,085.08
Rate for Payer: Molina Healthcare Benefit Exchange	$8,860.97
Rate for Payer: Molina Healthcare Medicaid	$7,155.23

MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$13,960.20

Service Code	MSDRG 546
Min. Negotiated Rate	$9,472.99
Max. Negotiated Rate	$13,960.20
Rate for Payer: Anthem Medicaid	$9,472.99
Rate for Payer: Anthem Medicare Advantage/PPO	$9,971.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,960.20
Rate for Payer: CareSource Just4Me Medicare	$13,461.62
Rate for Payer: Humana KY Medicaid	$9,472.99
Rate for Payer: Humana Medicare Advantage	$9,971.57
Rate for Payer: Kentucky WC Medicaid	$9,567.72
Rate for Payer: Molina Healthcare Benefit Exchange	$11,965.88
Rate for Payer: Molina Healthcare Medicaid	$9,662.45

MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$30,470.79

Service Code	MSDRG 545
Min. Negotiated Rate	$20,676.61
Max. Negotiated Rate	$30,470.79
Rate for Payer: Anthem Medicaid	$20,676.61
Rate for Payer: Anthem Medicare Advantage/PPO	$21,764.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$30,470.79
Rate for Payer: CareSource Just4Me Medicare	$29,382.55
Rate for Payer: Humana KY Medicaid	$20,676.61
Rate for Payer: Humana Medicare Advantage	$21,764.85
Rate for Payer: Kentucky WC Medicaid	$20,883.37
Rate for Payer: Molina Healthcare Benefit Exchange	$26,117.82
Rate for Payer: Molina Healthcare Medicaid	$21,090.14

MS-DRG 42.00: CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$8,998.09

Service Code	MSDRG 547
Min. Negotiated Rate	$6,105.85
Max. Negotiated Rate	$8,998.09
Rate for Payer: Anthem Medicaid	$6,105.85
Rate for Payer: Anthem Medicare Advantage/PPO	$6,427.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,998.09
Rate for Payer: CareSource Just4Me Medicare	$8,676.73
Rate for Payer: Humana KY Medicaid	$6,105.85
Rate for Payer: Humana Medicare Advantage	$6,427.21
Rate for Payer: Kentucky WC Medicaid	$6,166.91
Rate for Payer: Molina Healthcare Benefit Exchange	$7,712.65
Rate for Payer: Molina Healthcare Medicaid	$6,227.97

MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$94,254.58

Service Code	MSDRG 233
Min. Negotiated Rate	$63,958.46
Max. Negotiated Rate	$94,254.58
Rate for Payer: Anthem Medicaid	$63,958.46
Rate for Payer: Anthem Medicare Advantage/PPO	$67,324.70
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$94,254.58
Rate for Payer: CareSource Just4Me Medicare	$90,888.35
Rate for Payer: Humana KY Medicaid	$63,958.46
Rate for Payer: Humana Medicare Advantage	$67,324.70
Rate for Payer: Kentucky WC Medicaid	$64,598.05
Rate for Payer: Molina Healthcare Benefit Exchange	$80,789.64
Rate for Payer: Molina Healthcare Medicaid	$65,237.63

MS-DRG 42.00: CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$64,153.99

Service Code	MSDRG 234
Min. Negotiated Rate	$43,533.07
Max. Negotiated Rate	$64,153.99
Rate for Payer: Anthem Medicaid	$43,533.07
Rate for Payer: Anthem Medicare Advantage/PPO	$45,824.28
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$64,153.99
Rate for Payer: CareSource Just4Me Medicare	$61,862.78
Rate for Payer: Humana KY Medicaid	$43,533.07
Rate for Payer: Humana Medicare Advantage	$45,824.28
Rate for Payer: Kentucky WC Medicaid	$43,968.40
Rate for Payer: Molina Healthcare Benefit Exchange	$54,989.14
Rate for Payer: Molina Healthcare Medicaid	$44,403.73

MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$70,955.02

Service Code	MSDRG 235
Min. Negotiated Rate	$48,148.05
Max. Negotiated Rate	$70,955.02
Rate for Payer: Anthem Medicaid	$48,148.05
Rate for Payer: Anthem Medicare Advantage/PPO	$50,682.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$70,955.02
Rate for Payer: CareSource Just4Me Medicare	$68,420.92
Rate for Payer: Humana KY Medicaid	$48,148.05
Rate for Payer: Humana Medicare Advantage	$50,682.16
Rate for Payer: Kentucky WC Medicaid	$48,629.53
Rate for Payer: Molina Healthcare Benefit Exchange	$60,818.59
Rate for Payer: Molina Healthcare Medicaid	$49,111.01

MS-DRG 42.00: CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$49,586.03

Service Code	MSDRG 236
Min. Negotiated Rate	$33,647.66
Max. Negotiated Rate	$49,586.03
Rate for Payer: Anthem Medicaid	$33,647.66
Rate for Payer: Anthem Medicare Advantage/PPO	$35,418.59
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$49,586.03
Rate for Payer: CareSource Just4Me Medicare	$47,815.10
Rate for Payer: Humana KY Medicaid	$33,647.66
Rate for Payer: Humana Medicare Advantage	$35,418.59
Rate for Payer: Kentucky WC Medicaid	$33,984.14
Rate for Payer: Molina Healthcare Benefit Exchange	$42,502.31
Rate for Payer: Molina Healthcare Medicaid	$34,320.61

MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITH MCC

Facility

$102,183.12

Service Code	MSDRG 231
Min. Negotiated Rate	$69,338.54
Max. Negotiated Rate	$102,183.12
Rate for Payer: Anthem Medicaid	$69,338.54
Rate for Payer: Anthem Medicare Advantage/PPO	$72,987.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$102,183.12
Rate for Payer: CareSource Just4Me Medicare	$98,533.72
Rate for Payer: Humana KY Medicaid	$69,338.54
Rate for Payer: Humana Medicare Advantage	$72,987.94
Rate for Payer: Kentucky WC Medicaid	$70,031.93
Rate for Payer: Molina Healthcare Benefit Exchange	$87,585.53
Rate for Payer: Molina Healthcare Medicaid	$70,725.31

MS-DRG 42.00: CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$73,662.16

Service Code	MSDRG 232
Min. Negotiated Rate	$49,985.04
Max. Negotiated Rate	$73,662.16
Rate for Payer: Anthem Medicaid	$49,985.04
Rate for Payer: Anthem Medicare Advantage/PPO	$52,615.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$73,662.16
Rate for Payer: CareSource Just4Me Medicare	$71,031.37
Rate for Payer: Humana KY Medicaid	$49,985.04
Rate for Payer: Humana Medicare Advantage	$52,615.83
Rate for Payer: Kentucky WC Medicaid	$50,484.89
Rate for Payer: Molina Healthcare Benefit Exchange	$63,139.00
Rate for Payer: Molina Healthcare Medicaid	$50,984.74

MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$51,362.28

Service Code	MSDRG 323
Min. Negotiated Rate	$34,852.97
Max. Negotiated Rate	$51,362.28
Rate for Payer: Anthem Medicaid	$34,852.97
Rate for Payer: Anthem Medicare Advantage/PPO	$36,687.34
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$51,362.28
Rate for Payer: CareSource Just4Me Medicare	$49,527.91
Rate for Payer: Humana KY Medicaid	$34,852.97
Rate for Payer: Humana Medicare Advantage	$36,687.34
Rate for Payer: Kentucky WC Medicaid	$35,201.50
Rate for Payer: Molina Healthcare Benefit Exchange	$44,024.81
Rate for Payer: Molina Healthcare Medicaid	$35,550.03

MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$38,528.32

Service Code	MSDRG 324
Min. Negotiated Rate	$26,144.22
Max. Negotiated Rate	$38,528.32
Rate for Payer: Anthem Medicaid	$26,144.22
Rate for Payer: Anthem Medicare Advantage/PPO	$27,520.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,528.32
Rate for Payer: CareSource Just4Me Medicare	$37,152.31
Rate for Payer: Humana KY Medicaid	$26,144.22
Rate for Payer: Humana Medicare Advantage	$27,520.23
Rate for Payer: Kentucky WC Medicaid	$26,405.66
Rate for Payer: Molina Healthcare Benefit Exchange	$33,024.28
Rate for Payer: Molina Healthcare Medicaid	$26,667.10

MS-DRG 42.00: CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$34,512.81

Service Code	MSDRG 325
Min. Negotiated Rate	$23,419.41
Max. Negotiated Rate	$34,512.81
Rate for Payer: Anthem Medicaid	$23,419.41
Rate for Payer: Anthem Medicare Advantage/PPO	$24,652.01
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$34,512.81
Rate for Payer: CareSource Just4Me Medicare	$33,280.21
Rate for Payer: Humana KY Medicaid	$23,419.41
Rate for Payer: Humana Medicare Advantage	$24,652.01
Rate for Payer: Kentucky WC Medicaid	$23,653.60
Rate for Payer: Molina Healthcare Benefit Exchange	$29,582.41
Rate for Payer: Molina Healthcare Medicaid	$23,887.80

MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$18,637.72

Service Code	MSDRG 073
Min. Negotiated Rate	$12,647.03
Max. Negotiated Rate	$18,637.72
Rate for Payer: Anthem Medicaid	$12,647.03
Rate for Payer: Anthem Medicare Advantage/PPO	$13,312.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,637.72
Rate for Payer: CareSource Just4Me Medicare	$17,972.09
Rate for Payer: Humana KY Medicaid	$12,647.03
Rate for Payer: Humana Medicare Advantage	$13,312.66
Rate for Payer: Kentucky WC Medicaid	$12,773.50
Rate for Payer: Molina Healthcare Benefit Exchange	$15,975.19
Rate for Payer: Molina Healthcare Medicaid	$12,899.97

MS-DRG 42.00: CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$12,569.84

Service Code	MSDRG 074
Min. Negotiated Rate	$8,529.54
Max. Negotiated Rate	$12,569.84
Rate for Payer: Anthem Medicaid	$8,529.54
Rate for Payer: Anthem Medicare Advantage/PPO	$8,978.46
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,569.84
Rate for Payer: CareSource Just4Me Medicare	$12,120.92
Rate for Payer: Humana KY Medicaid	$8,529.54
Rate for Payer: Humana Medicare Advantage	$8,978.46
Rate for Payer: Kentucky WC Medicaid	$8,614.83
Rate for Payer: Molina Healthcare Benefit Exchange	$10,774.15
Rate for Payer: Molina Healthcare Medicaid	$8,700.13

MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$36,882.34

Service Code	MSDRG 026
Min. Negotiated Rate	$25,027.30
Max. Negotiated Rate	$36,882.34
Rate for Payer: Anthem Medicaid	$25,027.30
Rate for Payer: Anthem Medicare Advantage/PPO	$26,344.53
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$36,882.34
Rate for Payer: CareSource Just4Me Medicare	$35,565.12
Rate for Payer: Humana KY Medicaid	$25,027.30
Rate for Payer: Humana Medicare Advantage	$26,344.53
Rate for Payer: Kentucky WC Medicaid	$25,277.58
Rate for Payer: Molina Healthcare Benefit Exchange	$31,613.44
Rate for Payer: Molina Healthcare Medicaid	$25,527.85

MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$53,929.54

Service Code	MSDRG 025
Min. Negotiated Rate	$36,595.04
Max. Negotiated Rate	$53,929.54
Rate for Payer: Anthem Medicaid	$36,595.04
Rate for Payer: Anthem Medicare Advantage/PPO	$38,521.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$53,929.54
Rate for Payer: CareSource Just4Me Medicare	$52,003.49
Rate for Payer: Humana KY Medicaid	$36,595.04
Rate for Payer: Humana Medicare Advantage	$38,521.10
Rate for Payer: Kentucky WC Medicaid	$36,961.00
Rate for Payer: Molina Healthcare Benefit Exchange	$46,225.32
Rate for Payer: Molina Healthcare Medicaid	$37,326.95

MS-DRG 42.00: CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$29,758.12

Service Code	MSDRG 027
Min. Negotiated Rate	$20,193.01
Max. Negotiated Rate	$29,758.12
Rate for Payer: Anthem Medicaid	$20,193.01
Rate for Payer: Anthem Medicare Advantage/PPO	$21,255.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,758.12
Rate for Payer: CareSource Just4Me Medicare	$28,695.33
Rate for Payer: Humana KY Medicaid	$20,193.01
Rate for Payer: Humana Medicare Advantage	$21,255.80
Rate for Payer: Kentucky WC Medicaid	$20,394.94
Rate for Payer: Molina Healthcare Benefit Exchange	$25,506.96
Rate for Payer: Molina Healthcare Medicaid	$20,596.87

MS-DRG 42.00: CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$82,339.50

Service Code	MSDRG 955
Min. Negotiated Rate	$55,873.23
Max. Negotiated Rate	$82,339.50
Rate for Payer: Anthem Medicaid	$55,873.23
Rate for Payer: Anthem Medicare Advantage/PPO	$58,813.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$82,339.50
Rate for Payer: CareSource Just4Me Medicare	$79,398.81
Rate for Payer: Humana KY Medicaid	$55,873.23
Rate for Payer: Humana Medicare Advantage	$58,813.93
Rate for Payer: Kentucky WC Medicaid	$56,431.97
Rate for Payer: Molina Healthcare Benefit Exchange	$70,576.72
Rate for Payer: Molina Healthcare Medicaid	$56,990.70

MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$68,795.33

Service Code	MSDRG 023
Min. Negotiated Rate	$46,682.54
Max. Negotiated Rate	$68,795.33
Rate for Payer: Anthem Medicaid	$46,682.54
Rate for Payer: Anthem Medicare Advantage/PPO	$49,139.52
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$68,795.33
Rate for Payer: CareSource Just4Me Medicare	$66,338.35
Rate for Payer: Humana KY Medicaid	$46,682.54
Rate for Payer: Humana Medicare Advantage	$49,139.52
Rate for Payer: Kentucky WC Medicaid	$47,149.37
Rate for Payer: Molina Healthcare Benefit Exchange	$58,967.42
Rate for Payer: Molina Healthcare Medicaid	$47,616.19

MS-DRG 42.00: CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$45,843.07

Service Code	MSDRG 024
Min. Negotiated Rate	$31,107.80
Max. Negotiated Rate	$45,843.07
Rate for Payer: Anthem Medicaid	$31,107.80
Rate for Payer: Anthem Medicare Advantage/PPO	$32,745.05
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$45,843.07
Rate for Payer: CareSource Just4Me Medicare	$44,205.82
Rate for Payer: Humana KY Medicaid	$31,107.80
Rate for Payer: Humana Medicare Advantage	$32,745.05
Rate for Payer: Kentucky WC Medicaid	$31,418.88
Rate for Payer: Molina Healthcare Benefit Exchange	$39,294.06
Rate for Payer: Molina Healthcare Medicaid	$31,729.95

MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$23,562.43

Service Code	MSDRG 744
Min. Negotiated Rate	$15,988.79
Max. Negotiated Rate	$23,562.43
Rate for Payer: Anthem Medicaid	$15,988.79
Rate for Payer: Anthem Medicare Advantage/PPO	$16,830.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,562.43
Rate for Payer: CareSource Just4Me Medicare	$22,720.92
Rate for Payer: Humana KY Medicaid	$15,988.79
Rate for Payer: Humana Medicare Advantage	$16,830.31
Rate for Payer: Kentucky WC Medicaid	$16,148.68
Rate for Payer: Molina Healthcare Benefit Exchange	$20,196.37
Rate for Payer: Molina Healthcare Medicaid	$16,308.57

MS-DRG 42.00: D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$12,357.62

Service Code	MSDRG 745
Min. Negotiated Rate	$8,385.53
Max. Negotiated Rate	$12,357.62
Rate for Payer: Anthem Medicaid	$8,385.53
Rate for Payer: Anthem Medicare Advantage/PPO	$8,826.87
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,357.62
Rate for Payer: CareSource Just4Me Medicare	$11,916.27
Rate for Payer: Humana KY Medicaid	$8,385.53
Rate for Payer: Humana Medicare Advantage	$8,826.87
Rate for Payer: Kentucky WC Medicaid	$8,469.38
Rate for Payer: Molina Healthcare Benefit Exchange	$10,592.24
Rate for Payer: Molina Healthcare Medicaid	$8,553.24

Know your out-of-pocket cost for care.

All Charges