Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$11,350.74

Service Code	MSDRG 394
Min. Negotiated Rate	$7,702.29
Max. Negotiated Rate	$11,350.74
Rate for Payer: Anthem Medicaid	$7,702.29
Rate for Payer: Anthem Medicare Advantage/PPO	$8,107.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,350.74
Rate for Payer: CareSource Just4Me Medicare	$10,945.35
Rate for Payer: Humana KY Medicaid	$7,702.29
Rate for Payer: Humana Medicare Advantage	$8,107.67
Rate for Payer: Kentucky WC Medicaid	$7,779.31
Rate for Payer: Molina Healthcare Benefit Exchange	$9,729.20
Rate for Payer: Molina Healthcare Medicaid	$7,856.33

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$19,969.00

Service Code	MSDRG 393
Min. Negotiated Rate	$13,550.39
Max. Negotiated Rate	$19,969.00
Rate for Payer: Anthem Medicaid	$13,550.39
Rate for Payer: Anthem Medicare Advantage/PPO	$14,263.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,969.00
Rate for Payer: CareSource Just4Me Medicare	$19,255.82
Rate for Payer: Humana KY Medicaid	$13,550.39
Rate for Payer: Humana Medicare Advantage	$14,263.57
Rate for Payer: Kentucky WC Medicaid	$13,685.90
Rate for Payer: Molina Healthcare Benefit Exchange	$17,116.28
Rate for Payer: Molina Healthcare Medicaid	$13,821.40

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

Facility

$7,674.07

Service Code	MSDRG 395
Min. Negotiated Rate	$5,207.41
Max. Negotiated Rate	$7,674.07
Rate for Payer: Anthem Medicaid	$5,207.41
Rate for Payer: Anthem Medicare Advantage/PPO	$5,481.48
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,674.07
Rate for Payer: CareSource Just4Me Medicare	$7,400.00
Rate for Payer: Humana KY Medicaid	$5,207.41
Rate for Payer: Humana Medicare Advantage	$5,481.48
Rate for Payer: Kentucky WC Medicaid	$5,259.48
Rate for Payer: Molina Healthcare Benefit Exchange	$6,577.78
Rate for Payer: Molina Healthcare Medicaid	$5,311.55

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$27,155.88

Service Code	MSDRG 357
Min. Negotiated Rate	$18,427.21
Max. Negotiated Rate	$27,155.88
Rate for Payer: Anthem Medicaid	$18,427.21
Rate for Payer: Anthem Medicare Advantage/PPO	$19,397.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,155.88
Rate for Payer: CareSource Just4Me Medicare	$26,186.03
Rate for Payer: Humana KY Medicaid	$18,427.21
Rate for Payer: Humana Medicare Advantage	$19,397.06
Rate for Payer: Kentucky WC Medicaid	$18,611.48
Rate for Payer: Molina Healthcare Benefit Exchange	$23,276.47
Rate for Payer: Molina Healthcare Medicaid	$18,795.75

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$51,438.23

Service Code	MSDRG 356
Min. Negotiated Rate	$34,904.51
Max. Negotiated Rate	$51,438.23
Rate for Payer: Anthem Medicaid	$34,904.51
Rate for Payer: Anthem Medicare Advantage/PPO	$36,741.59
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$51,438.23
Rate for Payer: CareSource Just4Me Medicare	$49,601.15
Rate for Payer: Humana KY Medicaid	$34,904.51
Rate for Payer: Humana Medicare Advantage	$36,741.59
Rate for Payer: Kentucky WC Medicaid	$35,253.56
Rate for Payer: Molina Healthcare Benefit Exchange	$44,089.91
Rate for Payer: Molina Healthcare Medicaid	$35,602.60

MS-DRG 42.00: OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$16,340.58

Service Code	MSDRG 358
Min. Negotiated Rate	$11,088.25
Max. Negotiated Rate	$16,340.58
Rate for Payer: Anthem Medicaid	$11,088.25
Rate for Payer: Anthem Medicare Advantage/PPO	$11,671.84
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,340.58
Rate for Payer: CareSource Just4Me Medicare	$15,756.98
Rate for Payer: Humana KY Medicaid	$11,088.25
Rate for Payer: Humana Medicare Advantage	$11,671.84
Rate for Payer: Kentucky WC Medicaid	$11,199.13
Rate for Payer: Molina Healthcare Benefit Exchange	$14,006.21
Rate for Payer: Molina Healthcare Medicaid	$11,310.01

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$12,766.40

Service Code	MSDRG 092
Min. Negotiated Rate	$8,662.92
Max. Negotiated Rate	$12,766.40
Rate for Payer: Anthem Medicaid	$8,662.92
Rate for Payer: Anthem Medicare Advantage/PPO	$9,118.86
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,766.40
Rate for Payer: CareSource Just4Me Medicare	$12,310.46
Rate for Payer: Humana KY Medicaid	$8,662.92
Rate for Payer: Humana Medicare Advantage	$9,118.86
Rate for Payer: Kentucky WC Medicaid	$8,749.55
Rate for Payer: Molina Healthcare Benefit Exchange	$10,942.63
Rate for Payer: Molina Healthcare Medicaid	$8,836.18

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$21,981.57

Service Code	MSDRG 091
Min. Negotiated Rate	$14,916.06
Max. Negotiated Rate	$21,981.57
Rate for Payer: Anthem Medicaid	$14,916.06
Rate for Payer: Anthem Medicare Advantage/PPO	$15,701.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,981.57
Rate for Payer: CareSource Just4Me Medicare	$21,196.51
Rate for Payer: Humana KY Medicaid	$14,916.06
Rate for Payer: Humana Medicare Advantage	$15,701.12
Rate for Payer: Kentucky WC Medicaid	$15,065.22
Rate for Payer: Molina Healthcare Benefit Exchange	$18,841.34
Rate for Payer: Molina Healthcare Medicaid	$15,214.39

MS-DRG 42.00: OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$9,517.82

Service Code	MSDRG 093
Min. Negotiated Rate	$6,458.52
Max. Negotiated Rate	$9,517.82
Rate for Payer: Anthem Medicaid	$6,458.52
Rate for Payer: Anthem Medicare Advantage/PPO	$6,798.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,517.82
Rate for Payer: CareSource Just4Me Medicare	$9,177.89
Rate for Payer: Humana KY Medicaid	$6,458.52
Rate for Payer: Humana Medicare Advantage	$6,798.44
Rate for Payer: Kentucky WC Medicaid	$6,523.10
Rate for Payer: Molina Healthcare Benefit Exchange	$8,158.13
Rate for Payer: Molina Healthcare Medicaid	$6,587.69

MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$15,723.16

Service Code	MSDRG 124
Min. Negotiated Rate	$10,669.29
Max. Negotiated Rate	$15,723.16
Rate for Payer: Anthem Medicaid	$10,669.29
Rate for Payer: Anthem Medicare Advantage/PPO	$11,230.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,723.16
Rate for Payer: CareSource Just4Me Medicare	$15,161.62
Rate for Payer: Humana KY Medicaid	$10,669.29
Rate for Payer: Humana Medicare Advantage	$11,230.83
Rate for Payer: Kentucky WC Medicaid	$10,775.98
Rate for Payer: Molina Healthcare Benefit Exchange	$13,477.00
Rate for Payer: Molina Healthcare Medicaid	$10,882.67

MS-DRG 42.00: OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$9,956.74

Service Code	MSDRG 125
Min. Negotiated Rate	$6,756.36
Max. Negotiated Rate	$9,956.74
Rate for Payer: Anthem Medicaid	$6,756.36
Rate for Payer: Anthem Medicare Advantage/PPO	$7,111.96
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,956.74
Rate for Payer: CareSource Just4Me Medicare	$9,601.15
Rate for Payer: Humana KY Medicaid	$6,756.36
Rate for Payer: Humana Medicare Advantage	$7,111.96
Rate for Payer: Kentucky WC Medicaid	$6,823.93
Rate for Payer: Molina Healthcare Benefit Exchange	$8,534.35
Rate for Payer: Molina Healthcare Medicaid	$6,891.49

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$11,257.89

Service Code	MSDRG 155
Min. Negotiated Rate	$7,639.28
Max. Negotiated Rate	$11,257.89
Rate for Payer: Anthem Medicaid	$7,639.28
Rate for Payer: Anthem Medicare Advantage/PPO	$8,041.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,257.89
Rate for Payer: CareSource Just4Me Medicare	$10,855.82
Rate for Payer: Humana KY Medicaid	$7,639.28
Rate for Payer: Humana Medicare Advantage	$8,041.35
Rate for Payer: Kentucky WC Medicaid	$7,715.68
Rate for Payer: Molina Healthcare Benefit Exchange	$9,649.62
Rate for Payer: Molina Healthcare Medicaid	$7,792.07

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$19,610.84

Service Code	MSDRG 154
Min. Negotiated Rate	$13,307.35
Max. Negotiated Rate	$19,610.84
Rate for Payer: Anthem Medicaid	$13,307.35
Rate for Payer: Anthem Medicare Advantage/PPO	$14,007.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,610.84
Rate for Payer: CareSource Just4Me Medicare	$18,910.45
Rate for Payer: Humana KY Medicaid	$13,307.35
Rate for Payer: Humana Medicare Advantage	$14,007.74
Rate for Payer: Kentucky WC Medicaid	$13,440.43
Rate for Payer: Molina Healthcare Benefit Exchange	$16,809.29
Rate for Payer: Molina Healthcare Medicaid	$13,573.50

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$8,108.18

Service Code	MSDRG 156
Min. Negotiated Rate	$5,501.98
Max. Negotiated Rate	$8,108.18
Rate for Payer: Anthem Medicaid	$5,501.98
Rate for Payer: Anthem Medicare Advantage/PPO	$5,791.56
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,108.18
Rate for Payer: CareSource Just4Me Medicare	$7,818.61
Rate for Payer: Humana KY Medicaid	$5,501.98
Rate for Payer: Humana Medicare Advantage	$5,791.56
Rate for Payer: Kentucky WC Medicaid	$5,557.00
Rate for Payer: Molina Healthcare Benefit Exchange	$6,949.87
Rate for Payer: Molina Healthcare Medicaid	$5,612.02

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$21,183.29

Service Code	MSDRG 144
Min. Negotiated Rate	$14,374.37
Max. Negotiated Rate	$21,183.29
Rate for Payer: Anthem Medicaid	$14,374.37
Rate for Payer: Anthem Medicare Advantage/PPO	$15,130.92
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,183.29
Rate for Payer: CareSource Just4Me Medicare	$20,426.74
Rate for Payer: Humana KY Medicaid	$14,374.37
Rate for Payer: Humana Medicare Advantage	$15,130.92
Rate for Payer: Kentucky WC Medicaid	$14,518.12
Rate for Payer: Molina Healthcare Benefit Exchange	$18,157.10
Rate for Payer: Molina Healthcare Medicaid	$14,661.86

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$39,816.17

Service Code	MSDRG 143
Min. Negotiated Rate	$27,018.11
Max. Negotiated Rate	$39,816.17
Rate for Payer: Anthem Medicaid	$27,018.11
Rate for Payer: Anthem Medicare Advantage/PPO	$28,440.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$39,816.17
Rate for Payer: CareSource Just4Me Medicare	$38,394.16
Rate for Payer: Humana KY Medicaid	$27,018.11
Rate for Payer: Humana Medicare Advantage	$28,440.12
Rate for Payer: Kentucky WC Medicaid	$27,288.30
Rate for Payer: Molina Healthcare Benefit Exchange	$34,128.14
Rate for Payer: Molina Healthcare Medicaid	$27,558.48

MS-DRG 42.00: OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$14,286.99

Service Code	MSDRG 145
Min. Negotiated Rate	$9,694.74
Max. Negotiated Rate	$14,286.99
Rate for Payer: Anthem Medicaid	$9,694.74
Rate for Payer: Anthem Medicare Advantage/PPO	$10,204.99
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,286.99
Rate for Payer: CareSource Just4Me Medicare	$13,776.74
Rate for Payer: Humana KY Medicaid	$9,694.74
Rate for Payer: Humana Medicare Advantage	$10,204.99
Rate for Payer: Kentucky WC Medicaid	$9,791.69
Rate for Payer: Molina Healthcare Benefit Exchange	$12,245.99
Rate for Payer: Molina Healthcare Medicaid	$9,888.64

MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$27,120.93

Service Code	MSDRG 629
Min. Negotiated Rate	$18,403.49
Max. Negotiated Rate	$27,120.93
Rate for Payer: Anthem Medicaid	$18,403.49
Rate for Payer: Anthem Medicare Advantage/PPO	$19,372.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,120.93
Rate for Payer: CareSource Just4Me Medicare	$26,152.32
Rate for Payer: Humana KY Medicaid	$18,403.49
Rate for Payer: Humana Medicare Advantage	$19,372.09
Rate for Payer: Kentucky WC Medicaid	$18,587.52
Rate for Payer: Molina Healthcare Benefit Exchange	$23,246.51
Rate for Payer: Molina Healthcare Medicaid	$18,771.56

MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$47,579.50

Service Code	MSDRG 628
Min. Negotiated Rate	$32,286.09
Max. Negotiated Rate	$47,579.50
Rate for Payer: Anthem Medicaid	$32,286.09
Rate for Payer: Anthem Medicare Advantage/PPO	$33,985.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,579.50
Rate for Payer: CareSource Just4Me Medicare	$45,880.24
Rate for Payer: Humana KY Medicaid	$32,286.09
Rate for Payer: Humana Medicare Advantage	$33,985.36
Rate for Payer: Kentucky WC Medicaid	$32,608.95
Rate for Payer: Molina Healthcare Benefit Exchange	$40,782.43
Rate for Payer: Molina Healthcare Medicaid	$32,931.81

MS-DRG 42.00: OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$16,897.66

Service Code	MSDRG 630
Min. Negotiated Rate	$11,466.27
Max. Negotiated Rate	$16,897.66
Rate for Payer: Anthem Medicaid	$11,466.27
Rate for Payer: Anthem Medicare Advantage/PPO	$12,069.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,897.66
Rate for Payer: CareSource Just4Me Medicare	$16,294.18
Rate for Payer: Humana KY Medicaid	$11,466.27
Rate for Payer: Humana Medicare Advantage	$12,069.76
Rate for Payer: Kentucky WC Medicaid	$11,580.93
Rate for Payer: Molina Healthcare Benefit Exchange	$14,483.71
Rate for Payer: Molina Healthcare Medicaid	$11,695.60

MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$52,970.89

Service Code	MSDRG 319
Min. Negotiated Rate	$35,944.53
Max. Negotiated Rate	$52,970.89
Rate for Payer: Anthem Medicaid	$35,944.53
Rate for Payer: Anthem Medicare Advantage/PPO	$37,836.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$52,970.89
Rate for Payer: CareSource Just4Me Medicare	$51,079.07
Rate for Payer: Humana KY Medicaid	$35,944.53
Rate for Payer: Humana Medicare Advantage	$37,836.35
Rate for Payer: Kentucky WC Medicaid	$36,303.98
Rate for Payer: Molina Healthcare Benefit Exchange	$45,403.62
Rate for Payer: Molina Healthcare Medicaid	$36,663.42

MS-DRG 42.00: OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$27,913.16

Service Code	MSDRG 320
Min. Negotiated Rate	$18,941.07
Max. Negotiated Rate	$27,913.16
Rate for Payer: Anthem Medicaid	$18,941.07
Rate for Payer: Anthem Medicare Advantage/PPO	$19,937.97
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,913.16
Rate for Payer: CareSource Just4Me Medicare	$26,916.26
Rate for Payer: Humana KY Medicaid	$18,941.07
Rate for Payer: Humana Medicare Advantage	$19,937.97
Rate for Payer: Kentucky WC Medicaid	$19,130.48
Rate for Payer: Molina Healthcare Benefit Exchange	$23,925.56
Rate for Payer: Molina Healthcare Medicaid	$19,319.89

MS-DRG 42.00: OTHER FACTORS INFLUENCING HEALTH STATUS

Facility

$6,837.21

Service Code	MSDRG 951
Min. Negotiated Rate	$4,639.53
Max. Negotiated Rate	$6,837.21
Rate for Payer: Anthem Medicaid	$4,639.53
Rate for Payer: Anthem Medicare Advantage/PPO	$4,883.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$6,837.21
Rate for Payer: CareSource Just4Me Medicare	$6,593.02
Rate for Payer: Humana KY Medicaid	$4,639.53
Rate for Payer: Humana Medicare Advantage	$4,883.72
Rate for Payer: Kentucky WC Medicaid	$4,685.93
Rate for Payer: Molina Healthcare Benefit Exchange	$5,860.46
Rate for Payer: Molina Healthcare Medicaid	$4,732.32

MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC

Facility

$31,214.83

Service Code	MSDRG 749
Min. Negotiated Rate	$21,181.49
Max. Negotiated Rate	$31,214.83
Rate for Payer: Anthem Medicaid	$21,181.49
Rate for Payer: Anthem Medicare Advantage/PPO	$22,296.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$31,214.83
Rate for Payer: CareSource Just4Me Medicare	$30,100.02
Rate for Payer: Humana KY Medicaid	$21,181.49
Rate for Payer: Humana Medicare Advantage	$22,296.31
Rate for Payer: Kentucky WC Medicaid	$21,393.31
Rate for Payer: Molina Healthcare Benefit Exchange	$26,755.57
Rate for Payer: Molina Healthcare Medicaid	$21,605.12

MS-DRG 42.00: OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$15,549.53

Service Code	MSDRG 750
Min. Negotiated Rate	$10,551.47
Max. Negotiated Rate	$15,549.53
Rate for Payer: Anthem Medicaid	$10,551.47
Rate for Payer: Anthem Medicare Advantage/PPO	$11,106.81
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,549.53
Rate for Payer: CareSource Just4Me Medicare	$14,994.19
Rate for Payer: Humana KY Medicaid	$10,551.47
Rate for Payer: Humana Medicare Advantage	$11,106.81
Rate for Payer: Kentucky WC Medicaid	$10,656.98
Rate for Payer: Molina Healthcare Benefit Exchange	$13,328.17
Rate for Payer: Molina Healthcare Medicaid	$10,762.50

Know your out-of-pocket cost for care.

All Charges