Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: ORBITAL PROCEDURES WITH CC/MCC

Facility

$27,211.37

Service Code	MSDRG 113
Min. Negotiated Rate	$18,464.86
Max. Negotiated Rate	$27,211.37
Rate for Payer: Anthem Medicaid	$18,464.86
Rate for Payer: Anthem Medicare Advantage/PPO	$19,436.69
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,211.37
Rate for Payer: CareSource Just4Me Medicare	$26,239.53
Rate for Payer: Humana KY Medicaid	$18,464.86
Rate for Payer: Humana Medicare Advantage	$19,436.69
Rate for Payer: Kentucky WC Medicaid	$18,649.50
Rate for Payer: Molina Healthcare Benefit Exchange	$23,324.03
Rate for Payer: Molina Healthcare Medicaid	$18,834.15

MS-DRG 42.00: ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$14,254.42

Service Code	MSDRG 114
Min. Negotiated Rate	$9,672.64
Max. Negotiated Rate	$14,254.42
Rate for Payer: Anthem Medicaid	$9,672.64
Rate for Payer: Anthem Medicare Advantage/PPO	$10,181.73
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,254.42
Rate for Payer: CareSource Just4Me Medicare	$13,745.34
Rate for Payer: Humana KY Medicaid	$9,672.64
Rate for Payer: Humana Medicare Advantage	$10,181.73
Rate for Payer: Kentucky WC Medicaid	$9,769.37
Rate for Payer: Molina Healthcare Benefit Exchange	$12,218.08
Rate for Payer: Molina Healthcare Medicaid	$9,866.10

MS-DRG 42.00: ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$20,140.25

Service Code	MSDRG 884
Min. Negotiated Rate	$13,666.60
Max. Negotiated Rate	$20,140.25
Rate for Payer: Anthem Medicaid	$13,666.60
Rate for Payer: Anthem Medicare Advantage/PPO	$14,385.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,140.25
Rate for Payer: CareSource Just4Me Medicare	$19,420.95
Rate for Payer: Humana KY Medicaid	$13,666.60
Rate for Payer: Humana Medicare Advantage	$14,385.89
Rate for Payer: Kentucky WC Medicaid	$13,803.26
Rate for Payer: Molina Healthcare Benefit Exchange	$17,263.07
Rate for Payer: Molina Healthcare Medicaid	$13,939.93

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$19,257.53

Service Code	MSDRG 620
Min. Negotiated Rate	$13,067.61
Max. Negotiated Rate	$19,257.53
Rate for Payer: Anthem Medicaid	$13,067.61
Rate for Payer: Anthem Medicare Advantage/PPO	$13,755.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,257.53
Rate for Payer: CareSource Just4Me Medicare	$18,569.76
Rate for Payer: Humana KY Medicaid	$13,067.61
Rate for Payer: Humana Medicare Advantage	$13,755.38
Rate for Payer: Kentucky WC Medicaid	$13,198.29
Rate for Payer: Molina Healthcare Benefit Exchange	$16,506.46
Rate for Payer: Molina Healthcare Medicaid	$13,328.96

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$32,877.67

Service Code	MSDRG 619
Min. Negotiated Rate	$22,309.85
Max. Negotiated Rate	$32,877.67
Rate for Payer: Anthem Medicaid	$22,309.85
Rate for Payer: Anthem Medicare Advantage/PPO	$23,484.05
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$32,877.67
Rate for Payer: CareSource Just4Me Medicare	$31,703.47
Rate for Payer: Humana KY Medicaid	$22,309.85
Rate for Payer: Humana Medicare Advantage	$23,484.05
Rate for Payer: Kentucky WC Medicaid	$22,532.95
Rate for Payer: Molina Healthcare Benefit Exchange	$28,180.86
Rate for Payer: Molina Healthcare Medicaid	$22,756.04

MS-DRG 42.00: O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$17,627.22

Service Code	MSDRG 621
Min. Negotiated Rate	$11,961.33
Max. Negotiated Rate	$17,627.22
Rate for Payer: Anthem Medicaid	$11,961.33
Rate for Payer: Anthem Medicare Advantage/PPO	$12,590.87
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,627.22
Rate for Payer: CareSource Just4Me Medicare	$16,997.67
Rate for Payer: Humana KY Medicaid	$11,961.33
Rate for Payer: Humana Medicare Advantage	$12,590.87
Rate for Payer: Kentucky WC Medicaid	$12,080.94
Rate for Payer: Molina Healthcare Benefit Exchange	$15,109.04
Rate for Payer: Molina Healthcare Medicaid	$12,200.55

MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$25,460.46

Service Code	MSDRG 940
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: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$38,273.90

Service Code	MSDRG 939
Min. Negotiated Rate	$25,971.58
Max. Negotiated Rate	$38,273.90
Rate for Payer: Anthem Medicaid	$25,971.58
Rate for Payer: Anthem Medicare Advantage/PPO	$27,338.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,273.90
Rate for Payer: CareSource Just4Me Medicare	$36,906.97
Rate for Payer: Humana KY Medicaid	$25,971.58
Rate for Payer: Humana Medicare Advantage	$27,338.50
Rate for Payer: Kentucky WC Medicaid	$26,231.29
Rate for Payer: Molina Healthcare Benefit Exchange	$32,806.20
Rate for Payer: Molina Healthcare Medicaid	$26,491.01

MS-DRG 42.00: O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$23,566.06

Service Code	MSDRG 941
Min. Negotiated Rate	$15,991.25
Max. Negotiated Rate	$23,566.06
Rate for Payer: Anthem Medicaid	$15,991.25
Rate for Payer: Anthem Medicare Advantage/PPO	$16,832.90
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,566.06
Rate for Payer: CareSource Just4Me Medicare	$22,724.42
Rate for Payer: Humana KY Medicaid	$15,991.25
Rate for Payer: Humana Medicare Advantage	$16,832.90
Rate for Payer: Kentucky WC Medicaid	$16,151.17
Rate for Payer: Molina Healthcare Benefit Exchange	$20,199.48
Rate for Payer: Molina Healthcare Medicaid	$16,311.08

MS-DRG 42.00: O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$47,385.32

Service Code	MSDRG 876
Min. Negotiated Rate	$32,154.33
Max. Negotiated Rate	$47,385.32
Rate for Payer: Anthem Medicaid	$32,154.33
Rate for Payer: Anthem Medicare Advantage/PPO	$33,846.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,385.32
Rate for Payer: CareSource Just4Me Medicare	$45,692.99
Rate for Payer: Humana KY Medicaid	$32,154.33
Rate for Payer: Humana Medicare Advantage	$33,846.66
Rate for Payer: Kentucky WC Medicaid	$32,475.87
Rate for Payer: Molina Healthcare Benefit Exchange	$40,615.99
Rate for Payer: Molina Healthcare Medicaid	$32,797.41

MS-DRG 42.00: OSTEOMYELITIS WITH CC

Facility

$15,604.97

Service Code	MSDRG 540
Min. Negotiated Rate	$10,589.09
Max. Negotiated Rate	$15,604.97
Rate for Payer: Anthem Medicaid	$10,589.09
Rate for Payer: Anthem Medicare Advantage/PPO	$11,146.41
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,604.97
Rate for Payer: CareSource Just4Me Medicare	$15,047.65
Rate for Payer: Humana KY Medicaid	$10,589.09
Rate for Payer: Humana Medicare Advantage	$11,146.41
Rate for Payer: Kentucky WC Medicaid	$10,694.98
Rate for Payer: Molina Healthcare Benefit Exchange	$13,375.69
Rate for Payer: Molina Healthcare Medicaid	$10,800.87

MS-DRG 42.00: OSTEOMYELITIS WITH MCC

Facility

$24,387.24

Service Code	MSDRG 539
Min. Negotiated Rate	$16,548.49
Max. Negotiated Rate	$24,387.24
Rate for Payer: Anthem Medicaid	$16,548.49
Rate for Payer: Anthem Medicare Advantage/PPO	$17,419.46
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,387.24
Rate for Payer: CareSource Just4Me Medicare	$23,516.27
Rate for Payer: Humana KY Medicaid	$16,548.49
Rate for Payer: Humana Medicare Advantage	$17,419.46
Rate for Payer: Kentucky WC Medicaid	$16,713.97
Rate for Payer: Molina Healthcare Benefit Exchange	$20,903.35
Rate for Payer: Molina Healthcare Medicaid	$16,879.46

MS-DRG 42.00: OSTEOMYELITIS WITHOUT CC/MCC

Facility

$10,550.04

Service Code	MSDRG 541
Min. Negotiated Rate	$7,158.95
Max. Negotiated Rate	$10,550.04
Rate for Payer: Anthem Medicaid	$7,158.95
Rate for Payer: Anthem Medicare Advantage/PPO	$7,535.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,550.04
Rate for Payer: CareSource Just4Me Medicare	$10,173.25
Rate for Payer: Humana KY Medicaid	$7,158.95
Rate for Payer: Humana Medicare Advantage	$7,535.74
Rate for Payer: Kentucky WC Medicaid	$7,230.54
Rate for Payer: Molina Healthcare Benefit Exchange	$9,042.89
Rate for Payer: Molina Healthcare Medicaid	$7,302.13

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$15,531.45

Service Code	MSDRG 818
Min. Negotiated Rate	$10,539.20
Max. Negotiated Rate	$15,531.45
Rate for Payer: Anthem Medicaid	$10,539.20
Rate for Payer: Anthem Medicare Advantage/PPO	$11,093.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,531.45
Rate for Payer: CareSource Just4Me Medicare	$14,976.75
Rate for Payer: Humana KY Medicaid	$10,539.20
Rate for Payer: Humana Medicare Advantage	$11,093.89
Rate for Payer: Kentucky WC Medicaid	$10,644.59
Rate for Payer: Molina Healthcare Benefit Exchange	$13,312.67
Rate for Payer: Molina Healthcare Medicaid	$10,749.98

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$30,569.69

Service Code	MSDRG 817
Min. Negotiated Rate	$20,743.72
Max. Negotiated Rate	$30,569.69
Rate for Payer: Anthem Medicaid	$20,743.72
Rate for Payer: Anthem Medicare Advantage/PPO	$21,835.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$30,569.69
Rate for Payer: CareSource Just4Me Medicare	$29,477.91
Rate for Payer: Humana KY Medicaid	$20,743.72
Rate for Payer: Humana Medicare Advantage	$21,835.49
Rate for Payer: Kentucky WC Medicaid	$20,951.15
Rate for Payer: Molina Healthcare Benefit Exchange	$26,202.59
Rate for Payer: Molina Healthcare Medicaid	$21,158.59

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,845.84

Service Code	MSDRG 819
Min. Negotiated Rate	$6,681.10
Max. Negotiated Rate	$9,845.84
Rate for Payer: Anthem Medicaid	$6,681.10
Rate for Payer: Anthem Medicare Advantage/PPO	$7,032.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,845.84
Rate for Payer: CareSource Just4Me Medicare	$9,494.20
Rate for Payer: Humana KY Medicaid	$6,681.10
Rate for Payer: Humana Medicare Advantage	$7,032.74
Rate for Payer: Kentucky WC Medicaid	$6,747.91
Rate for Payer: Molina Healthcare Benefit Exchange	$8,439.29
Rate for Payer: Molina Healthcare Medicaid	$6,814.73

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$9,012.58

Service Code	MSDRG 832
Min. Negotiated Rate	$6,115.68
Max. Negotiated Rate	$9,012.58
Rate for Payer: Anthem Medicaid	$6,115.68
Rate for Payer: Anthem Medicare Advantage/PPO	$6,437.56
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,012.58
Rate for Payer: CareSource Just4Me Medicare	$8,690.71
Rate for Payer: Humana KY Medicaid	$6,115.68
Rate for Payer: Humana Medicare Advantage	$6,437.56
Rate for Payer: Kentucky WC Medicaid	$6,176.84
Rate for Payer: Molina Healthcare Benefit Exchange	$7,725.07
Rate for Payer: Molina Healthcare Medicaid	$6,238.00

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$13,879.40

Service Code	MSDRG 831
Min. Negotiated Rate	$9,418.17
Max. Negotiated Rate	$13,879.40
Rate for Payer: Anthem Medicaid	$9,418.17
Rate for Payer: Anthem Medicare Advantage/PPO	$9,913.86
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,879.40
Rate for Payer: CareSource Just4Me Medicare	$13,383.71
Rate for Payer: Humana KY Medicaid	$9,418.17
Rate for Payer: Humana Medicare Advantage	$9,913.86
Rate for Payer: Kentucky WC Medicaid	$9,512.35
Rate for Payer: Molina Healthcare Benefit Exchange	$11,896.63
Rate for Payer: Molina Healthcare Medicaid	$9,606.53

MS-DRG 42.00: OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$6,268.05

Service Code	MSDRG 833
Min. Negotiated Rate	$4,253.32
Max. Negotiated Rate	$6,268.05
Rate for Payer: Anthem Medicaid	$4,253.32
Rate for Payer: Anthem Medicare Advantage/PPO	$4,477.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,268.05
Rate for Payer: CareSource Just4Me Medicare	$6,044.19
Rate for Payer: Humana KY Medicaid	$4,253.32
Rate for Payer: Humana Medicare Advantage	$4,477.18
Rate for Payer: Kentucky WC Medicaid	$4,295.85
Rate for Payer: Molina Healthcare Benefit Exchange	$5,372.62
Rate for Payer: Molina Healthcare Medicaid	$4,338.39

MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$60,091.46

Service Code	MSDRG 228
Min. Negotiated Rate	$40,776.35
Max. Negotiated Rate	$60,091.46
Rate for Payer: Anthem Medicaid	$40,776.35
Rate for Payer: Anthem Medicare Advantage/PPO	$42,922.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$60,091.46
Rate for Payer: CareSource Just4Me Medicare	$57,945.33
Rate for Payer: Humana KY Medicaid	$40,776.35
Rate for Payer: Humana Medicare Advantage	$42,922.47
Rate for Payer: Kentucky WC Medicaid	$41,184.11
Rate for Payer: Molina Healthcare Benefit Exchange	$51,506.96
Rate for Payer: Molina Healthcare Medicaid	$41,591.87

MS-DRG 42.00: OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$37,457.53

Service Code	MSDRG 229
Min. Negotiated Rate	$25,417.61
Max. Negotiated Rate	$37,457.53
Rate for Payer: Anthem Medicaid	$25,417.61
Rate for Payer: Anthem Medicare Advantage/PPO	$26,755.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,457.53
Rate for Payer: CareSource Just4Me Medicare	$36,119.76
Rate for Payer: Humana KY Medicaid	$25,417.61
Rate for Payer: Humana Medicare Advantage	$26,755.38
Rate for Payer: Kentucky WC Medicaid	$25,671.79
Rate for Payer: Molina Healthcare Benefit Exchange	$32,106.46
Rate for Payer: Molina Healthcare Medicaid	$25,925.96

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$11,603.96

Service Code	MSDRG 315
Min. Negotiated Rate	$7,874.11
Max. Negotiated Rate	$11,603.96
Rate for Payer: Anthem Medicaid	$7,874.11
Rate for Payer: Anthem Medicare Advantage/PPO	$8,288.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,603.96
Rate for Payer: CareSource Just4Me Medicare	$11,189.53
Rate for Payer: Humana KY Medicaid	$7,874.11
Rate for Payer: Humana Medicare Advantage	$8,288.54
Rate for Payer: Kentucky WC Medicaid	$7,952.85
Rate for Payer: Molina Healthcare Benefit Exchange	$9,946.25
Rate for Payer: Molina Healthcare Medicaid	$8,031.60

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$25,968.12

Service Code	MSDRG 314
Min. Negotiated Rate	$17,621.23
Max. Negotiated Rate	$25,968.12
Rate for Payer: Anthem Medicaid	$17,621.23
Rate for Payer: Anthem Medicare Advantage/PPO	$18,548.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,968.12
Rate for Payer: CareSource Just4Me Medicare	$25,040.69
Rate for Payer: Humana KY Medicaid	$17,621.23
Rate for Payer: Humana Medicare Advantage	$18,548.66
Rate for Payer: Kentucky WC Medicaid	$17,797.44
Rate for Payer: Molina Healthcare Benefit Exchange	$22,258.39
Rate for Payer: Molina Healthcare Medicaid	$17,973.65

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$8,232.36

Service Code	MSDRG 316
Min. Negotiated Rate	$5,586.25
Max. Negotiated Rate	$8,232.36
Rate for Payer: Anthem Medicaid	$5,586.25
Rate for Payer: Anthem Medicare Advantage/PPO	$5,880.26
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,232.36
Rate for Payer: CareSource Just4Me Medicare	$7,938.35
Rate for Payer: Humana KY Medicaid	$5,586.25
Rate for Payer: Humana Medicare Advantage	$5,880.26
Rate for Payer: Kentucky WC Medicaid	$5,642.11
Rate for Payer: Molina Healthcare Benefit Exchange	$7,056.31
Rate for Payer: Molina Healthcare Medicaid	$5,697.97

MS-DRG 42.00: OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$42,145.89

Service Code	MSDRG 264
Min. Negotiated Rate	$28,599.00
Max. Negotiated Rate	$42,145.89
Rate for Payer: Anthem Medicaid	$28,599.00
Rate for Payer: Anthem Medicare Advantage/PPO	$30,104.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$42,145.89
Rate for Payer: CareSource Just4Me Medicare	$40,640.68
Rate for Payer: Humana KY Medicaid	$28,599.00
Rate for Payer: Humana Medicare Advantage	$30,104.21
Rate for Payer: Kentucky WC Medicaid	$28,884.99
Rate for Payer: Molina Healthcare Benefit Exchange	$36,125.05
Rate for Payer: Molina Healthcare Medicaid	$29,170.98

Know your out-of-pocket cost for care.

All Charges