Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$37,186.21

Service Code	MSDRG 829
Min. Negotiated Rate	$25,233.50
Max. Negotiated Rate	$37,186.21
Rate for Payer: Anthem Medicaid	$25,233.50
Rate for Payer: Anthem Medicare Advantage/PPO	$26,561.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,186.21
Rate for Payer: CareSource Just4Me Medicare	$35,858.13
Rate for Payer: Humana KY Medicaid	$25,233.50
Rate for Payer: Humana Medicare Advantage	$26,561.58
Rate for Payer: Kentucky WC Medicaid	$25,485.84
Rate for Payer: Molina Healthcare Benefit Exchange	$31,873.90
Rate for Payer: Molina Healthcare Medicaid	$25,738.17

MS-DRG 42.00: MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$17,635.66

Service Code	MSDRG 830
Min. Negotiated Rate	$11,967.06
Max. Negotiated Rate	$17,635.66
Rate for Payer: Anthem Medicaid	$11,967.06
Rate for Payer: Anthem Medicare Advantage/PPO	$12,596.90
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,635.66
Rate for Payer: CareSource Just4Me Medicare	$17,005.81
Rate for Payer: Humana KY Medicaid	$11,967.06
Rate for Payer: Humana Medicare Advantage	$12,596.90
Rate for Payer: Kentucky WC Medicaid	$12,086.73
Rate for Payer: Molina Healthcare Benefit Exchange	$15,116.28
Rate for Payer: Molina Healthcare Medicaid	$12,206.40

MS-DRG 42.00: NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$21,736.78

Service Code	MSDRG 789
Min. Negotiated Rate	$14,749.96
Max. Negotiated Rate	$21,736.78
Rate for Payer: Anthem Medicaid	$14,749.96
Rate for Payer: Anthem Medicare Advantage/PPO	$15,526.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,736.78
Rate for Payer: CareSource Just4Me Medicare	$20,960.46
Rate for Payer: Humana KY Medicaid	$14,749.96
Rate for Payer: Humana Medicare Advantage	$15,526.27
Rate for Payer: Kentucky WC Medicaid	$14,897.46
Rate for Payer: Molina Healthcare Benefit Exchange	$18,631.52
Rate for Payer: Molina Healthcare Medicaid	$15,044.96

MS-DRG 42.00: NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$17,800.85

Service Code	MSDRG 794
Min. Negotiated Rate	$12,079.15
Max. Negotiated Rate	$17,800.85
Rate for Payer: Anthem Medicaid	$12,079.15
Rate for Payer: Anthem Medicare Advantage/PPO	$12,714.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,800.85
Rate for Payer: CareSource Just4Me Medicare	$17,165.10
Rate for Payer: Humana KY Medicaid	$12,079.15
Rate for Payer: Humana Medicare Advantage	$12,714.89
Rate for Payer: Kentucky WC Medicaid	$12,199.94
Rate for Payer: Molina Healthcare Benefit Exchange	$15,257.87
Rate for Payer: Molina Healthcare Medicaid	$12,320.73

MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$18,077.00

Service Code	MSDRG 054
Min. Negotiated Rate	$12,266.53
Max. Negotiated Rate	$18,077.00
Rate for Payer: Anthem Medicaid	$12,266.53
Rate for Payer: Anthem Medicare Advantage/PPO	$12,912.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,077.00
Rate for Payer: CareSource Just4Me Medicare	$17,431.39
Rate for Payer: Humana KY Medicaid	$12,266.53
Rate for Payer: Humana Medicare Advantage	$12,912.14
Rate for Payer: Kentucky WC Medicaid	$12,389.20
Rate for Payer: Molina Healthcare Benefit Exchange	$15,494.57
Rate for Payer: Molina Healthcare Medicaid	$12,511.86

MS-DRG 42.00: NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$13,155.88

Service Code	MSDRG 055
Min. Negotiated Rate	$8,927.21
Max. Negotiated Rate	$13,155.88
Rate for Payer: Anthem Medicaid	$8,927.21
Rate for Payer: Anthem Medicare Advantage/PPO	$9,397.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,155.88
Rate for Payer: CareSource Just4Me Medicare	$12,686.03
Rate for Payer: Humana KY Medicaid	$8,927.21
Rate for Payer: Humana Medicare Advantage	$9,397.06
Rate for Payer: Kentucky WC Medicaid	$9,016.48
Rate for Payer: Molina Healthcare Benefit Exchange	$11,276.47
Rate for Payer: Molina Healthcare Medicaid	$9,105.75

MS-DRG 42.00: NEUROLOGICAL EYE DISORDERS

Facility

$9,685.45

Service Code	MSDRG 123
Min. Negotiated Rate	$6,572.27
Max. Negotiated Rate	$9,685.45
Rate for Payer: Anthem Medicaid	$6,572.27
Rate for Payer: Anthem Medicare Advantage/PPO	$6,918.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,685.45
Rate for Payer: CareSource Just4Me Medicare	$9,339.54
Rate for Payer: Humana KY Medicaid	$6,572.27
Rate for Payer: Humana Medicare Advantage	$6,918.18
Rate for Payer: Kentucky WC Medicaid	$6,637.99
Rate for Payer: Molina Healthcare Benefit Exchange	$8,301.82
Rate for Payer: Molina Healthcare Medicaid	$6,703.72

MS-DRG 42.00: NEUROSES EXCEPT DEPRESSIVE

Facility

$11,600.36

Service Code	MSDRG 882
Min. Negotiated Rate	$7,871.67
Max. Negotiated Rate	$11,600.36
Rate for Payer: Anthem Medicaid	$7,871.67
Rate for Payer: Anthem Medicare Advantage/PPO	$8,285.97
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,600.36
Rate for Payer: CareSource Just4Me Medicare	$11,186.06
Rate for Payer: Humana KY Medicaid	$7,871.67
Rate for Payer: Humana Medicare Advantage	$8,285.97
Rate for Payer: Kentucky WC Medicaid	$7,950.39
Rate for Payer: Molina Healthcare Benefit Exchange	$9,943.16
Rate for Payer: Molina Healthcare Medicaid	$8,029.10

MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$26,158.64

Service Code	MSDRG 098
Min. Negotiated Rate	$17,750.50
Max. Negotiated Rate	$26,158.64
Rate for Payer: Anthem Medicaid	$17,750.50
Rate for Payer: Anthem Medicare Advantage/PPO	$18,684.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$26,158.64
Rate for Payer: CareSource Just4Me Medicare	$25,224.40
Rate for Payer: Humana KY Medicaid	$17,750.50
Rate for Payer: Humana Medicare Advantage	$18,684.74
Rate for Payer: Kentucky WC Medicaid	$17,928.01
Rate for Payer: Molina Healthcare Benefit Exchange	$22,421.69
Rate for Payer: Molina Healthcare Medicaid	$18,105.51

MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$43,225.14

Service Code	MSDRG 097
Min. Negotiated Rate	$29,331.35
Max. Negotiated Rate	$43,225.14
Rate for Payer: Anthem Medicaid	$29,331.35
Rate for Payer: Anthem Medicare Advantage/PPO	$30,875.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$43,225.14
Rate for Payer: CareSource Just4Me Medicare	$41,681.39
Rate for Payer: Humana KY Medicaid	$29,331.35
Rate for Payer: Humana Medicare Advantage	$30,875.10
Rate for Payer: Kentucky WC Medicaid	$29,624.66
Rate for Payer: Molina Healthcare Benefit Exchange	$37,050.12
Rate for Payer: Molina Healthcare Medicaid	$29,917.97

MS-DRG 42.00: NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$16,801.19

Service Code	MSDRG 099
Min. Negotiated Rate	$11,400.81
Max. Negotiated Rate	$16,801.19
Rate for Payer: Anthem Medicaid	$11,400.81
Rate for Payer: Anthem Medicare Advantage/PPO	$12,000.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,801.19
Rate for Payer: CareSource Just4Me Medicare	$16,201.15
Rate for Payer: Humana KY Medicaid	$11,400.81
Rate for Payer: Humana Medicare Advantage	$12,000.85
Rate for Payer: Kentucky WC Medicaid	$11,514.82
Rate for Payer: Molina Healthcare Benefit Exchange	$14,401.02
Rate for Payer: Molina Healthcare Medicaid	$11,628.82

MS-DRG 42.00: NON-EXTENSIVE BURNS

Facility

$26,485.42

Service Code	MSDRG 935
Min. Negotiated Rate	$17,972.25
Max. Negotiated Rate	$26,485.42
Rate for Payer: Anthem Medicaid	$17,972.25
Rate for Payer: Anthem Medicare Advantage/PPO	$18,918.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$26,485.42
Rate for Payer: CareSource Just4Me Medicare	$25,539.52
Rate for Payer: Humana KY Medicaid	$17,972.25
Rate for Payer: Humana Medicare Advantage	$18,918.16
Rate for Payer: Kentucky WC Medicaid	$18,151.97
Rate for Payer: Molina Healthcare Benefit Exchange	$22,701.79
Rate for Payer: Molina Healthcare Medicaid	$18,331.70

MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$20,692.50

Service Code	MSDRG 988
Min. Negotiated Rate	$14,041.34
Max. Negotiated Rate	$20,692.50
Rate for Payer: Anthem Medicaid	$14,041.34
Rate for Payer: Anthem Medicare Advantage/PPO	$14,780.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,692.50
Rate for Payer: CareSource Just4Me Medicare	$19,953.49
Rate for Payer: Humana KY Medicaid	$14,041.34
Rate for Payer: Humana Medicare Advantage	$14,780.36
Rate for Payer: Kentucky WC Medicaid	$14,181.76
Rate for Payer: Molina Healthcare Benefit Exchange	$17,736.43
Rate for Payer: Molina Healthcare Medicaid	$14,322.17

MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$42,237.54

Service Code	MSDRG 987
Min. Negotiated Rate	$28,661.19
Max. Negotiated Rate	$42,237.54
Rate for Payer: Anthem Medicaid	$28,661.19
Rate for Payer: Anthem Medicare Advantage/PPO	$30,169.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$42,237.54
Rate for Payer: CareSource Just4Me Medicare	$40,729.05
Rate for Payer: Humana KY Medicaid	$28,661.19
Rate for Payer: Humana Medicare Advantage	$30,169.67
Rate for Payer: Kentucky WC Medicaid	$28,947.80
Rate for Payer: Molina Healthcare Benefit Exchange	$36,203.60
Rate for Payer: Molina Healthcare Medicaid	$29,234.41

MS-DRG 42.00: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$13,933.67

Service Code	MSDRG 989
Min. Negotiated Rate	$9,454.99
Max. Negotiated Rate	$13,933.67
Rate for Payer: Anthem Medicaid	$9,454.99
Rate for Payer: Anthem Medicare Advantage/PPO	$9,952.62
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,933.67
Rate for Payer: CareSource Just4Me Medicare	$13,436.04
Rate for Payer: Humana KY Medicaid	$9,454.99
Rate for Payer: Humana Medicare Advantage	$9,952.62
Rate for Payer: Kentucky WC Medicaid	$9,549.54
Rate for Payer: Molina Healthcare Benefit Exchange	$11,943.14
Rate for Payer: Molina Healthcare Medicaid	$9,644.09

MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$11,535.23

Service Code	MSDRG 600
Min. Negotiated Rate	$7,827.48
Max. Negotiated Rate	$11,535.23
Rate for Payer: Anthem Medicaid	$7,827.48
Rate for Payer: Anthem Medicare Advantage/PPO	$8,239.45
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,535.23
Rate for Payer: CareSource Just4Me Medicare	$11,123.26
Rate for Payer: Humana KY Medicaid	$7,827.48
Rate for Payer: Humana Medicare Advantage	$8,239.45
Rate for Payer: Kentucky WC Medicaid	$7,905.75
Rate for Payer: Molina Healthcare Benefit Exchange	$9,887.34
Rate for Payer: Molina Healthcare Medicaid	$7,984.03

MS-DRG 42.00: NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$7,229.11

Service Code	MSDRG 601
Min. Negotiated Rate	$4,905.47
Max. Negotiated Rate	$7,229.11
Rate for Payer: Anthem Medicaid	$4,905.47
Rate for Payer: Anthem Medicare Advantage/PPO	$5,163.65
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,229.11
Rate for Payer: CareSource Just4Me Medicare	$6,970.93
Rate for Payer: Humana KY Medicaid	$4,905.47
Rate for Payer: Humana Medicare Advantage	$5,163.65
Rate for Payer: Kentucky WC Medicaid	$4,954.52
Rate for Payer: Molina Healthcare Benefit Exchange	$6,196.38
Rate for Payer: Molina Healthcare Medicaid	$5,003.58

MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC

Facility

$12,708.53

Service Code	MSDRG 071
Min. Negotiated Rate	$8,623.64
Max. Negotiated Rate	$12,708.53
Rate for Payer: Anthem Medicaid	$8,623.64
Rate for Payer: Anthem Medicare Advantage/PPO	$9,077.52
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,708.53
Rate for Payer: CareSource Just4Me Medicare	$12,254.65
Rate for Payer: Humana KY Medicaid	$8,623.64
Rate for Payer: Humana Medicare Advantage	$9,077.52
Rate for Payer: Kentucky WC Medicaid	$8,709.88
Rate for Payer: Molina Healthcare Benefit Exchange	$10,893.02
Rate for Payer: Molina Healthcare Medicaid	$8,796.12

MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC

Facility

$20,967.45

Service Code	MSDRG 070
Min. Negotiated Rate	$14,227.91
Max. Negotiated Rate	$20,967.45
Rate for Payer: Anthem Medicaid	$14,227.91
Rate for Payer: Anthem Medicare Advantage/PPO	$14,976.75
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,967.45
Rate for Payer: CareSource Just4Me Medicare	$20,218.61
Rate for Payer: Humana KY Medicaid	$14,227.91
Rate for Payer: Humana Medicare Advantage	$14,976.75
Rate for Payer: Kentucky WC Medicaid	$14,370.19
Rate for Payer: Molina Healthcare Benefit Exchange	$17,972.10
Rate for Payer: Molina Healthcare Medicaid	$14,512.47

MS-DRG 42.00: NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$9,046.34

Service Code	MSDRG 072
Min. Negotiated Rate	$6,138.59
Max. Negotiated Rate	$9,046.34
Rate for Payer: Anthem Medicaid	$6,138.59
Rate for Payer: Anthem Medicare Advantage/PPO	$6,461.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,046.34
Rate for Payer: CareSource Just4Me Medicare	$8,723.25
Rate for Payer: Humana KY Medicaid	$6,138.59
Rate for Payer: Humana Medicare Advantage	$6,461.67
Rate for Payer: Kentucky WC Medicaid	$6,199.97
Rate for Payer: Molina Healthcare Benefit Exchange	$7,754.00
Rate for Payer: Molina Healthcare Medicaid	$6,261.36

MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$17,544.02

Service Code	MSDRG 067
Min. Negotiated Rate	$11,904.87
Max. Negotiated Rate	$17,544.02
Rate for Payer: Anthem Medicaid	$11,904.87
Rate for Payer: Anthem Medicare Advantage/PPO	$12,531.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,544.02
Rate for Payer: CareSource Just4Me Medicare	$16,917.44
Rate for Payer: Humana KY Medicaid	$11,904.87
Rate for Payer: Humana Medicare Advantage	$12,531.44
Rate for Payer: Kentucky WC Medicaid	$12,023.92
Rate for Payer: Molina Healthcare Benefit Exchange	$15,037.73
Rate for Payer: Molina Healthcare Medicaid	$12,142.97

MS-DRG 42.00: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$10,629.63

Service Code	MSDRG 068
Min. Negotiated Rate	$7,212.96
Max. Negotiated Rate	$10,629.63
Rate for Payer: Anthem Medicaid	$7,212.96
Rate for Payer: Anthem Medicare Advantage/PPO	$7,592.59
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,629.63
Rate for Payer: CareSource Just4Me Medicare	$10,250.00
Rate for Payer: Humana KY Medicaid	$7,212.96
Rate for Payer: Humana Medicare Advantage	$7,592.59
Rate for Payer: Kentucky WC Medicaid	$7,285.09
Rate for Payer: Molina Healthcare Benefit Exchange	$9,111.11
Rate for Payer: Molina Healthcare Medicaid	$7,357.22

MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$23,970.03

Service Code	MSDRG 080
Min. Negotiated Rate	$16,265.38
Max. Negotiated Rate	$23,970.03
Rate for Payer: Anthem Medicaid	$16,265.38
Rate for Payer: Anthem Medicare Advantage/PPO	$17,121.45
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,970.03
Rate for Payer: CareSource Just4Me Medicare	$23,113.96
Rate for Payer: Humana KY Medicaid	$16,265.38
Rate for Payer: Humana Medicare Advantage	$17,121.45
Rate for Payer: Kentucky WC Medicaid	$16,428.03
Rate for Payer: Molina Healthcare Benefit Exchange	$20,545.74
Rate for Payer: Molina Healthcare Medicaid	$16,590.69

MS-DRG 42.00: NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$10,910.59

Service Code	MSDRG 081
Min. Negotiated Rate	$7,403.62
Max. Negotiated Rate	$10,910.59
Rate for Payer: Anthem Medicaid	$7,403.62
Rate for Payer: Anthem Medicare Advantage/PPO	$7,793.28
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,910.59
Rate for Payer: CareSource Just4Me Medicare	$10,520.93
Rate for Payer: Humana KY Medicaid	$7,403.62
Rate for Payer: Humana Medicare Advantage	$7,793.28
Rate for Payer: Kentucky WC Medicaid	$7,477.65
Rate for Payer: Molina Healthcare Benefit Exchange	$9,351.94
Rate for Payer: Molina Healthcare Medicaid	$7,551.69

MS-DRG 42.00: NORMAL NEWBORN

Facility

$2,650.96

Service Code	MSDRG 795
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$2,650.96
Rate for Payer: Anthem Medicaid	$1,798.86
Rate for Payer: Anthem Medicare Advantage/PPO	$1,893.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$2,650.96
Rate for Payer: CareSource Just4Me Medicare	$2,556.28
Rate for Payer: Humana KY Medicaid	$1,798.86
Rate for Payer: Humana Medicare Advantage	$1,893.54
Rate for Payer: Kentucky WC Medicaid	$1,816.85
Rate for Payer: Molina Healthcare Benefit Exchange	$1,170.00
Rate for Payer: Molina Healthcare Medicaid	$1,834.84

Know your out-of-pocket cost for care.

All Charges