Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$11,884.92

Service Code	MSDRG 760
Min. Negotiated Rate	$8,064.77
Max. Negotiated Rate	$11,884.92
Rate for Payer: Anthem Medicaid	$8,064.77
Rate for Payer: Anthem Medicare Advantage/PPO	$8,489.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,884.92
Rate for Payer: CareSource Just4Me Medicare	$11,460.46
Rate for Payer: Humana KY Medicaid	$8,064.77
Rate for Payer: Humana Medicare Advantage	$8,489.23
Rate for Payer: Kentucky WC Medicaid	$8,145.42
Rate for Payer: Molina Healthcare Benefit Exchange	$10,187.08
Rate for Payer: Molina Healthcare Medicaid	$8,226.06

MS-DRG 42.00: MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$7,643.93

Service Code	MSDRG 761
Min. Negotiated Rate	$5,186.95
Max. Negotiated Rate	$7,643.93
Rate for Payer: Anthem Medicaid	$5,186.95
Rate for Payer: Anthem Medicare Advantage/PPO	$5,459.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,643.93
Rate for Payer: CareSource Just4Me Medicare	$7,370.93
Rate for Payer: Humana KY Medicaid	$5,186.95
Rate for Payer: Humana Medicare Advantage	$5,459.95
Rate for Payer: Kentucky WC Medicaid	$5,238.82
Rate for Payer: Molina Healthcare Benefit Exchange	$6,551.94
Rate for Payer: Molina Healthcare Medicaid	$5,290.69

MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH CC

Facility

$18,418.26

Service Code	MSDRG 663
Min. Negotiated Rate	$12,498.10
Max. Negotiated Rate	$18,418.26
Rate for Payer: Anthem Medicaid	$12,498.10
Rate for Payer: Anthem Medicare Advantage/PPO	$13,155.90
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,418.26
Rate for Payer: CareSource Just4Me Medicare	$17,760.47
Rate for Payer: Humana KY Medicaid	$12,498.10
Rate for Payer: Humana Medicare Advantage	$13,155.90
Rate for Payer: Kentucky WC Medicaid	$12,623.09
Rate for Payer: Molina Healthcare Benefit Exchange	$15,787.08
Rate for Payer: Molina Healthcare Medicaid	$12,748.07

MS-DRG 42.00: MINOR BLADDER PROCEDURES WITH MCC

Facility

$37,617.89

Service Code	MSDRG 662
Min. Negotiated Rate	$25,526.42
Max. Negotiated Rate	$37,617.89
Rate for Payer: Anthem Medicaid	$25,526.42
Rate for Payer: Anthem Medicare Advantage/PPO	$26,869.92
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,617.89
Rate for Payer: CareSource Just4Me Medicare	$36,274.39
Rate for Payer: Humana KY Medicaid	$25,526.42
Rate for Payer: Humana Medicare Advantage	$26,869.92
Rate for Payer: Kentucky WC Medicaid	$25,781.69
Rate for Payer: Molina Healthcare Benefit Exchange	$32,243.90
Rate for Payer: Molina Healthcare Medicaid	$26,036.95

MS-DRG 42.00: MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$13,020.85

Service Code	MSDRG 664
Min. Negotiated Rate	$8,835.58
Max. Negotiated Rate	$13,020.85
Rate for Payer: Anthem Medicaid	$8,835.58
Rate for Payer: Anthem Medicare Advantage/PPO	$9,300.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,020.85
Rate for Payer: CareSource Just4Me Medicare	$12,555.82
Rate for Payer: Humana KY Medicaid	$8,835.58
Rate for Payer: Humana Medicare Advantage	$9,300.61
Rate for Payer: Kentucky WC Medicaid	$8,923.94
Rate for Payer: Molina Healthcare Benefit Exchange	$11,160.73
Rate for Payer: Molina Healthcare Medicaid	$9,012.29

MS-DRG 42.00: MINOR SKIN DISORDERS WITH MCC

Facility

$19,417.92

Service Code	MSDRG 606
Min. Negotiated Rate	$13,176.44
Max. Negotiated Rate	$19,417.92
Rate for Payer: Anthem Medicaid	$13,176.44
Rate for Payer: Anthem Medicare Advantage/PPO	$13,869.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,417.92
Rate for Payer: CareSource Just4Me Medicare	$18,724.42
Rate for Payer: Humana KY Medicaid	$13,176.44
Rate for Payer: Humana Medicare Advantage	$13,869.94
Rate for Payer: Kentucky WC Medicaid	$13,308.21
Rate for Payer: Molina Healthcare Benefit Exchange	$16,643.93
Rate for Payer: Molina Healthcare Medicaid	$13,439.97

MS-DRG 42.00: MINOR SKIN DISORDERS WITHOUT MCC

Facility

$10,421.01

Service Code	MSDRG 607
Min. Negotiated Rate	$7,071.40
Max. Negotiated Rate	$10,421.01
Rate for Payer: Anthem Medicaid	$7,071.40
Rate for Payer: Anthem Medicare Advantage/PPO	$7,443.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,421.01
Rate for Payer: CareSource Just4Me Medicare	$10,048.83
Rate for Payer: Humana KY Medicaid	$7,071.40
Rate for Payer: Humana Medicare Advantage	$7,443.58
Rate for Payer: Kentucky WC Medicaid	$7,142.12
Rate for Payer: Molina Healthcare Benefit Exchange	$8,932.30
Rate for Payer: Molina Healthcare Medicaid	$7,212.83

MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$17,951.60

Service Code	MSDRG 345
Min. Negotiated Rate	$12,181.44
Max. Negotiated Rate	$17,951.60
Rate for Payer: Anthem Medicaid	$12,181.44
Rate for Payer: Anthem Medicare Advantage/PPO	$12,822.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,951.60
Rate for Payer: CareSource Just4Me Medicare	$17,310.47
Rate for Payer: Humana KY Medicaid	$12,181.44
Rate for Payer: Humana Medicare Advantage	$12,822.57
Rate for Payer: Kentucky WC Medicaid	$12,303.26
Rate for Payer: Molina Healthcare Benefit Exchange	$15,387.08
Rate for Payer: Molina Healthcare Medicaid	$12,425.07

MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$32,491.82

Service Code	MSDRG 344
Min. Negotiated Rate	$22,048.02
Max. Negotiated Rate	$32,491.82
Rate for Payer: Anthem Medicaid	$22,048.02
Rate for Payer: Anthem Medicare Advantage/PPO	$23,208.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$32,491.82
Rate for Payer: CareSource Just4Me Medicare	$31,331.39
Rate for Payer: Humana KY Medicaid	$22,048.02
Rate for Payer: Humana Medicare Advantage	$23,208.44
Rate for Payer: Kentucky WC Medicaid	$22,268.50
Rate for Payer: Molina Healthcare Benefit Exchange	$27,850.13
Rate for Payer: Molina Healthcare Medicaid	$22,488.98

MS-DRG 42.00: MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$15,016.54

Service Code	MSDRG 346
Min. Negotiated Rate	$10,189.80
Max. Negotiated Rate	$15,016.54
Rate for Payer: Anthem Medicaid	$10,189.80
Rate for Payer: Anthem Medicare Advantage/PPO	$10,726.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,016.54
Rate for Payer: CareSource Just4Me Medicare	$14,480.24
Rate for Payer: Humana KY Medicaid	$10,189.80
Rate for Payer: Humana Medicare Advantage	$10,726.10
Rate for Payer: Kentucky WC Medicaid	$10,291.69
Rate for Payer: Molina Healthcare Benefit Exchange	$12,871.32
Rate for Payer: Molina Healthcare Medicaid	$10,393.59

MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$16,013.79

Service Code	MSDRG 640
Min. Negotiated Rate	$10,866.50
Max. Negotiated Rate	$16,013.79
Rate for Payer: Anthem Medicaid	$10,866.50
Rate for Payer: Anthem Medicare Advantage/PPO	$11,438.42
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,013.79
Rate for Payer: CareSource Just4Me Medicare	$15,441.87
Rate for Payer: Humana KY Medicaid	$10,866.50
Rate for Payer: Humana Medicare Advantage	$11,438.42
Rate for Payer: Kentucky WC Medicaid	$10,975.16
Rate for Payer: Molina Healthcare Benefit Exchange	$13,726.10
Rate for Payer: Molina Healthcare Medicaid	$11,083.83

MS-DRG 42.00: MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$9,422.56

Service Code	MSDRG 641
Min. Negotiated Rate	$6,393.88
Max. Negotiated Rate	$9,422.56
Rate for Payer: Anthem Medicaid	$6,393.88
Rate for Payer: Anthem Medicare Advantage/PPO	$6,730.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,422.56
Rate for Payer: CareSource Just4Me Medicare	$9,086.04
Rate for Payer: Humana KY Medicaid	$6,393.88
Rate for Payer: Humana Medicare Advantage	$6,730.40
Rate for Payer: Kentucky WC Medicaid	$6,457.82
Rate for Payer: Molina Healthcare Benefit Exchange	$8,076.48
Rate for Payer: Molina Healthcare Medicaid	$6,521.76

MS-DRG 42.00: MOUTH PROCEDURES WITH CC/MCC

Facility

$16,865.09

Service Code	MSDRG 137
Min. Negotiated Rate	$11,444.17
Max. Negotiated Rate	$16,865.09
Rate for Payer: Anthem Medicaid	$11,444.17
Rate for Payer: Anthem Medicare Advantage/PPO	$12,046.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,865.09
Rate for Payer: CareSource Just4Me Medicare	$16,262.76
Rate for Payer: Humana KY Medicaid	$11,444.17
Rate for Payer: Humana Medicare Advantage	$12,046.49
Rate for Payer: Kentucky WC Medicaid	$11,558.61
Rate for Payer: Molina Healthcare Benefit Exchange	$14,455.79
Rate for Payer: Molina Healthcare Medicaid	$11,673.05

MS-DRG 42.00: MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$9,809.63

Service Code	MSDRG 138
Min. Negotiated Rate	$6,656.54
Max. Negotiated Rate	$9,809.63
Rate for Payer: Anthem Medicaid	$6,656.54
Rate for Payer: Anthem Medicare Advantage/PPO	$7,006.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,809.63
Rate for Payer: CareSource Just4Me Medicare	$9,459.29
Rate for Payer: Humana KY Medicaid	$6,656.54
Rate for Payer: Humana Medicare Advantage	$7,006.88
Rate for Payer: Kentucky WC Medicaid	$6,723.10
Rate for Payer: Molina Healthcare Benefit Exchange	$8,408.26
Rate for Payer: Molina Healthcare Medicaid	$6,789.67

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$85,648.39

Service Code	MSDRG 427
Min. Negotiated Rate	$58,118.55
Max. Negotiated Rate	$85,648.39
Rate for Payer: Anthem Medicaid	$58,118.55
Rate for Payer: Anthem Medicare Advantage/PPO	$61,177.42
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$85,648.39
Rate for Payer: CareSource Just4Me Medicare	$82,589.52
Rate for Payer: Humana KY Medicaid	$58,118.55
Rate for Payer: Humana Medicare Advantage	$61,177.42
Rate for Payer: Kentucky WC Medicaid	$58,699.73
Rate for Payer: Molina Healthcare Benefit Exchange	$73,412.90
Rate for Payer: Molina Healthcare Medicaid	$59,280.92

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$126,318.32

Service Code	MSDRG 426
Min. Negotiated Rate	$85,716.00
Max. Negotiated Rate	$126,318.32
Rate for Payer: Anthem Medicaid	$85,716.00
Rate for Payer: Anthem Medicare Advantage/PPO	$90,227.37
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$126,318.32
Rate for Payer: CareSource Just4Me Medicare	$121,806.95
Rate for Payer: Humana KY Medicaid	$85,716.00
Rate for Payer: Humana Medicare Advantage	$90,227.37
Rate for Payer: Kentucky WC Medicaid	$86,573.16
Rate for Payer: Molina Healthcare Benefit Exchange	$108,272.84
Rate for Payer: Molina Healthcare Medicaid	$87,430.32

MS-DRG 42.00: MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$66,371.56

Service Code	MSDRG 428
Min. Negotiated Rate	$45,037.85
Max. Negotiated Rate	$66,371.56
Rate for Payer: Anthem Medicaid	$45,037.85
Rate for Payer: Anthem Medicare Advantage/PPO	$47,408.26
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$66,371.56
Rate for Payer: CareSource Just4Me Medicare	$64,001.15
Rate for Payer: Humana KY Medicaid	$45,037.85
Rate for Payer: Humana Medicare Advantage	$47,408.26
Rate for Payer: Kentucky WC Medicaid	$45,488.23
Rate for Payer: Molina Healthcare Benefit Exchange	$56,889.91
Rate for Payer: Molina Healthcare Medicaid	$45,938.60

MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$80,849.09

Service Code	MSDRG 447
Min. Negotiated Rate	$54,861.88
Max. Negotiated Rate	$80,849.09
Rate for Payer: Anthem Medicaid	$54,861.88
Rate for Payer: Anthem Medicare Advantage/PPO	$57,749.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$80,849.09
Rate for Payer: CareSource Just4Me Medicare	$77,961.62
Rate for Payer: Humana KY Medicaid	$54,861.88
Rate for Payer: Humana Medicare Advantage	$57,749.35
Rate for Payer: Kentucky WC Medicaid	$55,410.50
Rate for Payer: Molina Healthcare Benefit Exchange	$69,299.22
Rate for Payer: Molina Healthcare Medicaid	$55,959.12

MS-DRG 42.00: MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$49,241.18

Service Code	MSDRG 448
Min. Negotiated Rate	$33,413.66
Max. Negotiated Rate	$49,241.18
Rate for Payer: Anthem Medicaid	$33,413.66
Rate for Payer: Anthem Medicare Advantage/PPO	$35,172.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$49,241.18
Rate for Payer: CareSource Just4Me Medicare	$47,482.56
Rate for Payer: Humana KY Medicaid	$33,413.66
Rate for Payer: Humana Medicare Advantage	$35,172.27
Rate for Payer: Kentucky WC Medicaid	$33,747.79
Rate for Payer: Molina Healthcare Benefit Exchange	$42,206.72
Rate for Payer: Molina Healthcare Medicaid	$34,081.93

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$14,754.87

Service Code	MSDRG 059
Min. Negotiated Rate	$10,012.23
Max. Negotiated Rate	$14,754.87
Rate for Payer: Anthem Medicaid	$10,012.23
Rate for Payer: Anthem Medicare Advantage/PPO	$10,539.19
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,754.87
Rate for Payer: CareSource Just4Me Medicare	$14,227.91
Rate for Payer: Humana KY Medicaid	$10,012.23
Rate for Payer: Humana Medicare Advantage	$10,539.19
Rate for Payer: Kentucky WC Medicaid	$10,112.35
Rate for Payer: Molina Healthcare Benefit Exchange	$12,647.03
Rate for Payer: Molina Healthcare Medicaid	$10,212.48

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$22,258.92

Service Code	MSDRG 058
Min. Negotiated Rate	$15,104.27
Max. Negotiated Rate	$22,258.92
Rate for Payer: Anthem Medicaid	$15,104.27
Rate for Payer: Anthem Medicare Advantage/PPO	$15,899.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,258.92
Rate for Payer: CareSource Just4Me Medicare	$21,463.96
Rate for Payer: Humana KY Medicaid	$15,104.27
Rate for Payer: Humana Medicare Advantage	$15,899.23
Rate for Payer: Kentucky WC Medicaid	$15,255.31
Rate for Payer: Molina Healthcare Benefit Exchange	$19,079.08
Rate for Payer: Molina Healthcare Medicaid	$15,406.35

MS-DRG 42.00: MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$10,761.09

Service Code	MSDRG 060
Min. Negotiated Rate	$7,302.17
Max. Negotiated Rate	$10,761.09
Rate for Payer: Anthem Medicaid	$7,302.17
Rate for Payer: Anthem Medicare Advantage/PPO	$7,686.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,761.09
Rate for Payer: CareSource Just4Me Medicare	$10,376.76
Rate for Payer: Humana KY Medicaid	$7,302.17
Rate for Payer: Humana Medicare Advantage	$7,686.49
Rate for Payer: Kentucky WC Medicaid	$7,375.19
Rate for Payer: Molina Healthcare Benefit Exchange	$9,223.79
Rate for Payer: Molina Healthcare Medicaid	$7,448.21

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$28,457.00

Service Code	MSDRG 827
Min. Negotiated Rate	$19,310.11
Max. Negotiated Rate	$28,457.00
Rate for Payer: Anthem Medicaid	$19,310.11
Rate for Payer: Anthem Medicare Advantage/PPO	$20,326.43
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$28,457.00
Rate for Payer: CareSource Just4Me Medicare	$27,440.68
Rate for Payer: Humana KY Medicaid	$19,310.11
Rate for Payer: Humana Medicare Advantage	$20,326.43
Rate for Payer: Kentucky WC Medicaid	$19,503.21
Rate for Payer: Molina Healthcare Benefit Exchange	$24,391.72
Rate for Payer: Molina Healthcare Medicaid	$19,696.31

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$57,585.70

Service Code	MSDRG 826
Min. Negotiated Rate	$39,076.01
Max. Negotiated Rate	$57,585.70
Rate for Payer: Anthem Medicaid	$39,076.01
Rate for Payer: Anthem Medicare Advantage/PPO	$41,132.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$57,585.70
Rate for Payer: CareSource Just4Me Medicare	$55,529.06
Rate for Payer: Humana KY Medicaid	$39,076.01
Rate for Payer: Humana Medicare Advantage	$41,132.64
Rate for Payer: Kentucky WC Medicaid	$39,466.77
Rate for Payer: Molina Healthcare Benefit Exchange	$49,359.17
Rate for Payer: Molina Healthcare Medicaid	$39,857.53

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$19,328.68

Service Code	MSDRG 828
Min. Negotiated Rate	$13,115.89
Max. Negotiated Rate	$19,328.68
Rate for Payer: Anthem Medicaid	$13,115.89
Rate for Payer: Anthem Medicare Advantage/PPO	$13,806.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,328.68
Rate for Payer: CareSource Just4Me Medicare	$18,638.37
Rate for Payer: Humana KY Medicaid	$13,115.89
Rate for Payer: Humana Medicare Advantage	$13,806.20
Rate for Payer: Kentucky WC Medicaid	$13,247.05
Rate for Payer: Molina Healthcare Benefit Exchange	$16,567.44
Rate for Payer: Molina Healthcare Medicaid	$13,378.21

Know your out-of-pocket cost for care.

All Charges