Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC

Facility

$14,807.93

Service Code	MSDRG 294
Min. Negotiated Rate	$10,048.24
Max. Negotiated Rate	$14,807.93
Rate for Payer: Anthem Medicaid	$10,048.24
Rate for Payer: Anthem Medicare Advantage/PPO	$10,577.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,807.93
Rate for Payer: CareSource Just4Me Medicare	$14,279.07
Rate for Payer: Humana KY Medicaid	$10,048.24
Rate for Payer: Humana Medicare Advantage	$10,577.09
Rate for Payer: Kentucky WC Medicaid	$10,148.72
Rate for Payer: Molina Healthcare Benefit Exchange	$12,692.51
Rate for Payer: Molina Healthcare Medicaid	$10,249.20

MS-DRG 42.00: DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC

Facility

$9,523.84

Service Code	MSDRG 295
Min. Negotiated Rate	$6,462.60
Max. Negotiated Rate	$9,523.84
Rate for Payer: Anthem Medicaid	$6,462.60
Rate for Payer: Anthem Medicare Advantage/PPO	$6,802.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,523.84
Rate for Payer: CareSource Just4Me Medicare	$9,183.70
Rate for Payer: Humana KY Medicaid	$6,462.60
Rate for Payer: Humana Medicare Advantage	$6,802.74
Rate for Payer: Kentucky WC Medicaid	$6,527.23
Rate for Payer: Molina Healthcare Benefit Exchange	$8,163.29
Rate for Payer: Molina Healthcare Medicaid	$6,591.86

MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC

Facility

$30,195.86

Service Code	MSDRG 056
Min. Negotiated Rate	$20,490.05
Max. Negotiated Rate	$30,195.86
Rate for Payer: Anthem Medicaid	$20,490.05
Rate for Payer: Anthem Medicare Advantage/PPO	$21,568.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$30,195.86
Rate for Payer: CareSource Just4Me Medicare	$29,117.43
Rate for Payer: Humana KY Medicaid	$20,490.05
Rate for Payer: Humana Medicare Advantage	$21,568.47
Rate for Payer: Kentucky WC Medicaid	$20,694.95
Rate for Payer: Molina Healthcare Benefit Exchange	$25,882.16
Rate for Payer: Molina Healthcare Medicaid	$20,899.85

MS-DRG 42.00: DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC

Facility

$16,090.96

Service Code	MSDRG 057
Min. Negotiated Rate	$10,918.86
Max. Negotiated Rate	$16,090.96
Rate for Payer: Anthem Medicaid	$10,918.86
Rate for Payer: Anthem Medicare Advantage/PPO	$11,493.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,090.96
Rate for Payer: CareSource Just4Me Medicare	$15,516.28
Rate for Payer: Humana KY Medicaid	$10,918.86
Rate for Payer: Humana Medicare Advantage	$11,493.54
Rate for Payer: Kentucky WC Medicaid	$11,028.05
Rate for Payer: Molina Healthcare Benefit Exchange	$13,792.25
Rate for Payer: Molina Healthcare Medicaid	$11,137.24

MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH CC

Facility

$11,342.30

Service Code	MSDRG 158
Min. Negotiated Rate	$7,696.56
Max. Negotiated Rate	$11,342.30
Rate for Payer: Anthem Medicaid	$7,696.56
Rate for Payer: Anthem Medicare Advantage/PPO	$8,101.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,342.30
Rate for Payer: CareSource Just4Me Medicare	$10,937.21
Rate for Payer: Humana KY Medicaid	$7,696.56
Rate for Payer: Humana Medicare Advantage	$8,101.64
Rate for Payer: Kentucky WC Medicaid	$7,773.52
Rate for Payer: Molina Healthcare Benefit Exchange	$9,721.97
Rate for Payer: Molina Healthcare Medicaid	$7,850.49

MS-DRG 42.00: DENTAL AND ORAL DISEASES WITH MCC

Facility

$19,745.91

Service Code	MSDRG 157
Min. Negotiated Rate	$13,399.01
Max. Negotiated Rate	$19,745.91
Rate for Payer: Anthem Medicaid	$13,399.01
Rate for Payer: Anthem Medicare Advantage/PPO	$14,104.22
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,745.91
Rate for Payer: CareSource Just4Me Medicare	$19,040.70
Rate for Payer: Humana KY Medicaid	$13,399.01
Rate for Payer: Humana Medicare Advantage	$14,104.22
Rate for Payer: Kentucky WC Medicaid	$13,533.00
Rate for Payer: Molina Healthcare Benefit Exchange	$16,925.06
Rate for Payer: Molina Healthcare Medicaid	$13,666.99

MS-DRG 42.00: DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$7,953.83

Service Code	MSDRG 159
Min. Negotiated Rate	$5,397.24
Max. Negotiated Rate	$7,953.83
Rate for Payer: Anthem Medicaid	$5,397.24
Rate for Payer: Anthem Medicare Advantage/PPO	$5,681.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,953.83
Rate for Payer: CareSource Just4Me Medicare	$7,669.77
Rate for Payer: Humana KY Medicaid	$5,397.24
Rate for Payer: Humana Medicare Advantage	$5,681.31
Rate for Payer: Kentucky WC Medicaid	$5,451.22
Rate for Payer: Molina Healthcare Benefit Exchange	$6,817.57
Rate for Payer: Molina Healthcare Medicaid	$5,505.19

MS-DRG 42.00: DEPRESSIVE NEUROSES

Facility

$11,022.72

Service Code	MSDRG 881
Min. Negotiated Rate	$7,479.70
Max. Negotiated Rate	$11,022.72
Rate for Payer: Anthem Medicaid	$7,479.70
Rate for Payer: Anthem Medicare Advantage/PPO	$7,873.37
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,022.72
Rate for Payer: CareSource Just4Me Medicare	$10,629.05
Rate for Payer: Humana KY Medicaid	$7,479.70
Rate for Payer: Humana Medicare Advantage	$7,873.37
Rate for Payer: Kentucky WC Medicaid	$7,554.50
Rate for Payer: Molina Healthcare Benefit Exchange	$9,448.04
Rate for Payer: Molina Healthcare Medicaid	$7,629.30

MS-DRG 42.00: DIABETES WITH CC

Facility

$11,060.08

Service Code	MSDRG 638
Min. Negotiated Rate	$7,505.06
Max. Negotiated Rate	$11,060.08
Rate for Payer: Anthem Medicaid	$7,505.06
Rate for Payer: Anthem Medicare Advantage/PPO	$7,900.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,060.08
Rate for Payer: CareSource Just4Me Medicare	$10,665.08
Rate for Payer: Humana KY Medicaid	$7,505.06
Rate for Payer: Humana Medicare Advantage	$7,900.06
Rate for Payer: Kentucky WC Medicaid	$7,580.11
Rate for Payer: Molina Healthcare Benefit Exchange	$9,480.07
Rate for Payer: Molina Healthcare Medicaid	$7,655.16

MS-DRG 42.00: DIABETES WITH MCC

Facility

$17,560.91

Service Code	MSDRG 637
Min. Negotiated Rate	$11,916.33
Max. Negotiated Rate	$17,560.91
Rate for Payer: Anthem Medicaid	$11,916.33
Rate for Payer: Anthem Medicare Advantage/PPO	$12,543.51
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,560.91
Rate for Payer: CareSource Just4Me Medicare	$16,933.74
Rate for Payer: Humana KY Medicaid	$11,916.33
Rate for Payer: Humana Medicare Advantage	$12,543.51
Rate for Payer: Kentucky WC Medicaid	$12,035.50
Rate for Payer: Molina Healthcare Benefit Exchange	$15,052.21
Rate for Payer: Molina Healthcare Medicaid	$12,154.66

MS-DRG 42.00: DIABETES WITHOUT CC/MCC

Facility

$7,555.90

Service Code	MSDRG 639
Min. Negotiated Rate	$5,127.22
Max. Negotiated Rate	$7,555.90
Rate for Payer: Anthem Medicaid	$5,127.22
Rate for Payer: Anthem Medicare Advantage/PPO	$5,397.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,555.90
Rate for Payer: CareSource Just4Me Medicare	$7,286.04
Rate for Payer: Humana KY Medicaid	$5,127.22
Rate for Payer: Humana Medicare Advantage	$5,397.07
Rate for Payer: Kentucky WC Medicaid	$5,178.49
Rate for Payer: Molina Healthcare Benefit Exchange	$6,476.48
Rate for Payer: Molina Healthcare Medicaid	$5,229.76

MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH CC

Facility

$14,816.37

Service Code	MSDRG 375
Min. Negotiated Rate	$10,053.96
Max. Negotiated Rate	$14,816.37
Rate for Payer: Anthem Medicaid	$10,053.96
Rate for Payer: Anthem Medicare Advantage/PPO	$10,583.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,816.37
Rate for Payer: CareSource Just4Me Medicare	$14,287.21
Rate for Payer: Humana KY Medicaid	$10,053.96
Rate for Payer: Humana Medicare Advantage	$10,583.12
Rate for Payer: Kentucky WC Medicaid	$10,154.50
Rate for Payer: Molina Healthcare Benefit Exchange	$12,699.74
Rate for Payer: Molina Healthcare Medicaid	$10,255.04

MS-DRG 42.00: DIGESTIVE MALIGNANCY WITH MCC

Facility

$25,460.46

Service Code	MSDRG 374
Min. Negotiated Rate	$17,276.74
Max. Negotiated Rate	$25,460.46
Rate for Payer: Anthem Medicaid	$17,276.74
Rate for Payer: Anthem Medicare Advantage/PPO	$18,186.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,460.46
Rate for Payer: CareSource Just4Me Medicare	$24,551.15
Rate for Payer: Humana KY Medicaid	$17,276.74
Rate for Payer: Humana Medicare Advantage	$18,186.04
Rate for Payer: Kentucky WC Medicaid	$17,449.51
Rate for Payer: Molina Healthcare Benefit Exchange	$21,823.25
Rate for Payer: Molina Healthcare Medicaid	$17,622.27

MS-DRG 42.00: DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$10,647.70

Service Code	MSDRG 376
Min. Negotiated Rate	$7,225.23
Max. Negotiated Rate	$10,647.70
Rate for Payer: Anthem Medicaid	$7,225.23
Rate for Payer: Anthem Medicare Advantage/PPO	$7,605.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,647.70
Rate for Payer: CareSource Just4Me Medicare	$10,267.42
Rate for Payer: Humana KY Medicaid	$7,225.23
Rate for Payer: Humana Medicare Advantage	$7,605.50
Rate for Payer: Kentucky WC Medicaid	$7,297.48
Rate for Payer: Molina Healthcare Benefit Exchange	$9,126.60
Rate for Payer: Molina Healthcare Medicaid	$7,369.73

MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC

Facility

$11,650.98

Service Code	MSDRG 442
Min. Negotiated Rate	$7,906.02
Max. Negotiated Rate	$11,650.98
Rate for Payer: Anthem Medicaid	$7,906.02
Rate for Payer: Anthem Medicare Advantage/PPO	$8,322.13
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,650.98
Rate for Payer: CareSource Just4Me Medicare	$11,234.88
Rate for Payer: Humana KY Medicaid	$7,906.02
Rate for Payer: Humana Medicare Advantage	$8,322.13
Rate for Payer: Kentucky WC Medicaid	$7,985.08
Rate for Payer: Molina Healthcare Benefit Exchange	$9,986.56
Rate for Payer: Molina Healthcare Medicaid	$8,064.14

MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC

Facility

$22,795.53

Service Code	MSDRG 441
Min. Negotiated Rate	$15,468.39
Max. Negotiated Rate	$22,795.53
Rate for Payer: Anthem Medicaid	$15,468.39
Rate for Payer: Anthem Medicare Advantage/PPO	$16,282.52
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,795.53
Rate for Payer: CareSource Just4Me Medicare	$21,981.40
Rate for Payer: Humana KY Medicaid	$15,468.39
Rate for Payer: Humana Medicare Advantage	$16,282.52
Rate for Payer: Kentucky WC Medicaid	$15,623.08
Rate for Payer: Molina Healthcare Benefit Exchange	$19,539.02
Rate for Payer: Molina Healthcare Medicaid	$15,777.76

MS-DRG 42.00: DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$8,473.57

Service Code	MSDRG 443
Min. Negotiated Rate	$5,749.92
Max. Negotiated Rate	$8,473.57
Rate for Payer: Anthem Medicaid	$5,749.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,052.55
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,473.57
Rate for Payer: CareSource Just4Me Medicare	$8,170.94
Rate for Payer: Humana KY Medicaid	$5,749.92
Rate for Payer: Humana Medicare Advantage	$6,052.55
Rate for Payer: Kentucky WC Medicaid	$5,807.42
Rate for Payer: Molina Healthcare Benefit Exchange	$7,263.06
Rate for Payer: Molina Healthcare Medicaid	$5,864.92

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$10,372.78

Service Code	MSDRG 439
Min. Negotiated Rate	$7,038.67
Max. Negotiated Rate	$10,372.78
Rate for Payer: Anthem Medicaid	$7,038.67
Rate for Payer: Anthem Medicare Advantage/PPO	$7,409.13
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,372.78
Rate for Payer: CareSource Just4Me Medicare	$10,002.33
Rate for Payer: Humana KY Medicaid	$7,038.67
Rate for Payer: Humana Medicare Advantage	$7,409.13
Rate for Payer: Kentucky WC Medicaid	$7,109.06
Rate for Payer: Molina Healthcare Benefit Exchange	$8,890.96
Rate for Payer: Molina Healthcare Medicaid	$7,179.45

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$20,061.85

Service Code	MSDRG 438
Min. Negotiated Rate	$13,613.40
Max. Negotiated Rate	$20,061.85
Rate for Payer: Anthem Medicaid	$13,613.40
Rate for Payer: Anthem Medicare Advantage/PPO	$14,329.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,061.85
Rate for Payer: CareSource Just4Me Medicare	$19,345.35
Rate for Payer: Humana KY Medicaid	$13,613.40
Rate for Payer: Humana Medicare Advantage	$14,329.89
Rate for Payer: Kentucky WC Medicaid	$13,749.53
Rate for Payer: Molina Healthcare Benefit Exchange	$17,195.87
Rate for Payer: Molina Healthcare Medicaid	$13,885.66

MS-DRG 42.00: DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$7,417.23

Service Code	MSDRG 440
Min. Negotiated Rate	$5,033.12
Max. Negotiated Rate	$7,417.23
Rate for Payer: Anthem Medicaid	$5,033.12
Rate for Payer: Anthem Medicare Advantage/PPO	$5,298.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,417.23
Rate for Payer: CareSource Just4Me Medicare	$7,152.33
Rate for Payer: Humana KY Medicaid	$5,033.12
Rate for Payer: Humana Medicare Advantage	$5,298.02
Rate for Payer: Kentucky WC Medicaid	$5,083.45
Rate for Payer: Molina Healthcare Benefit Exchange	$6,357.62
Rate for Payer: Molina Healthcare Medicaid	$5,133.78

MS-DRG 42.00: DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$22,355.38

Service Code	MSDRG 883
Min. Negotiated Rate	$15,169.72
Max. Negotiated Rate	$22,355.38
Rate for Payer: Anthem Medicaid	$15,169.72
Rate for Payer: Anthem Medicare Advantage/PPO	$15,968.13
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,355.38
Rate for Payer: CareSource Just4Me Medicare	$21,556.98
Rate for Payer: Humana KY Medicaid	$15,169.72
Rate for Payer: Humana Medicare Advantage	$15,968.13
Rate for Payer: Kentucky WC Medicaid	$15,321.42
Rate for Payer: Molina Healthcare Benefit Exchange	$19,161.76
Rate for Payer: Molina Healthcare Medicaid	$15,473.12

MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$13,077.51

Service Code	MSDRG 445
Min. Negotiated Rate	$8,874.03
Max. Negotiated Rate	$13,077.51
Rate for Payer: Anthem Medicaid	$8,874.03
Rate for Payer: Anthem Medicare Advantage/PPO	$9,341.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,077.51
Rate for Payer: CareSource Just4Me Medicare	$12,610.46
Rate for Payer: Humana KY Medicaid	$8,874.03
Rate for Payer: Humana Medicare Advantage	$9,341.08
Rate for Payer: Kentucky WC Medicaid	$8,962.77
Rate for Payer: Molina Healthcare Benefit Exchange	$11,209.30
Rate for Payer: Molina Healthcare Medicaid	$9,051.51

MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$20,311.44

Service Code	MSDRG 444
Min. Negotiated Rate	$13,782.76
Max. Negotiated Rate	$20,311.44
Rate for Payer: Anthem Medicaid	$13,782.76
Rate for Payer: Anthem Medicare Advantage/PPO	$14,508.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,311.44
Rate for Payer: CareSource Just4Me Medicare	$19,586.03
Rate for Payer: Humana KY Medicaid	$13,782.76
Rate for Payer: Humana Medicare Advantage	$14,508.17
Rate for Payer: Kentucky WC Medicaid	$13,920.59
Rate for Payer: Molina Healthcare Benefit Exchange	$17,409.80
Rate for Payer: Molina Healthcare Medicaid	$14,058.42

MS-DRG 42.00: DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$9,614.28

Service Code	MSDRG 446
Min. Negotiated Rate	$6,523.97
Max. Negotiated Rate	$9,614.28
Rate for Payer: Anthem Medicaid	$6,523.97
Rate for Payer: Anthem Medicare Advantage/PPO	$6,867.34
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,614.28
Rate for Payer: CareSource Just4Me Medicare	$9,270.91
Rate for Payer: Humana KY Medicaid	$6,523.97
Rate for Payer: Humana Medicare Advantage	$6,867.34
Rate for Payer: Kentucky WC Medicaid	$6,589.21
Rate for Payer: Molina Healthcare Benefit Exchange	$8,240.81
Rate for Payer: Molina Healthcare Medicaid	$6,654.45

MS-DRG 42.00: DYSEQUILIBRIUM

Facility

$9,013.77

Service Code	MSDRG 149
Min. Negotiated Rate	$6,116.49
Max. Negotiated Rate	$9,013.77
Rate for Payer: Anthem Medicaid	$6,116.49
Rate for Payer: Anthem Medicare Advantage/PPO	$6,438.41
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,013.77
Rate for Payer: CareSource Just4Me Medicare	$8,691.85
Rate for Payer: Humana KY Medicaid	$6,116.49
Rate for Payer: Humana Medicare Advantage	$6,438.41
Rate for Payer: Kentucky WC Medicaid	$6,177.65
Rate for Payer: Molina Healthcare Benefit Exchange	$7,726.09
Rate for Payer: Molina Healthcare Medicaid	$6,238.82

Know your out-of-pocket cost for care.

All Charges