Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$18,089.06

Service Code	MSDRG 964
Min. Negotiated Rate	$12,274.72
Max. Negotiated Rate	$18,089.06
Rate for Payer: Anthem Medicaid	$12,274.72
Rate for Payer: Anthem Medicare Advantage/PPO	$12,920.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,089.06
Rate for Payer: CareSource Just4Me Medicare	$17,443.03
Rate for Payer: Humana KY Medicaid	$12,274.72
Rate for Payer: Humana Medicare Advantage	$12,920.76
Rate for Payer: Kentucky WC Medicaid	$12,397.47
Rate for Payer: Molina Healthcare Benefit Exchange	$15,504.91
Rate for Payer: Molina Healthcare Medicaid	$12,520.22

MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$32,759.52

Service Code	MSDRG 963
Min. Negotiated Rate	$22,229.68
Max. Negotiated Rate	$32,759.52
Rate for Payer: Anthem Medicaid	$22,229.68
Rate for Payer: Anthem Medicare Advantage/PPO	$23,399.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$32,759.52
Rate for Payer: CareSource Just4Me Medicare	$31,589.54
Rate for Payer: Humana KY Medicaid	$22,229.68
Rate for Payer: Humana Medicare Advantage	$23,399.66
Rate for Payer: Kentucky WC Medicaid	$22,451.97
Rate for Payer: Molina Healthcare Benefit Exchange	$28,079.59
Rate for Payer: Molina Healthcare Medicaid	$22,674.27

MS-DRG 42.00: OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$11,004.64

Service Code	MSDRG 965
Min. Negotiated Rate	$7,467.44
Max. Negotiated Rate	$11,004.64
Rate for Payer: Anthem Medicaid	$7,467.44
Rate for Payer: Anthem Medicare Advantage/PPO	$7,860.46
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,004.64
Rate for Payer: CareSource Just4Me Medicare	$10,611.62
Rate for Payer: Humana KY Medicaid	$7,467.44
Rate for Payer: Humana Medicare Advantage	$7,860.46
Rate for Payer: Kentucky WC Medicaid	$7,542.11
Rate for Payer: Molina Healthcare Benefit Exchange	$9,432.55
Rate for Payer: Molina Healthcare Medicaid	$7,616.79

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$12,296.14

Service Code	MSDRG 565
Min. Negotiated Rate	$8,343.81
Max. Negotiated Rate	$12,296.14
Rate for Payer: Anthem Medicaid	$8,343.81
Rate for Payer: Anthem Medicare Advantage/PPO	$8,782.96
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,296.14
Rate for Payer: CareSource Just4Me Medicare	$11,857.00
Rate for Payer: Humana KY Medicaid	$8,343.81
Rate for Payer: Humana Medicare Advantage	$8,782.96
Rate for Payer: Kentucky WC Medicaid	$8,427.25
Rate for Payer: Molina Healthcare Benefit Exchange	$10,539.55
Rate for Payer: Molina Healthcare Medicaid	$8,510.69

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$18,922.32

Service Code	MSDRG 564
Min. Negotiated Rate	$12,840.14
Max. Negotiated Rate	$18,922.32
Rate for Payer: Anthem Medicaid	$12,840.14
Rate for Payer: Anthem Medicare Advantage/PPO	$13,515.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,922.32
Rate for Payer: CareSource Just4Me Medicare	$18,246.52
Rate for Payer: Humana KY Medicaid	$12,840.14
Rate for Payer: Humana Medicare Advantage	$13,515.94
Rate for Payer: Kentucky WC Medicaid	$12,968.54
Rate for Payer: Molina Healthcare Benefit Exchange	$16,219.13
Rate for Payer: Molina Healthcare Medicaid	$13,096.95

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$9,021.00

Service Code	MSDRG 566
Min. Negotiated Rate	$6,121.39
Max. Negotiated Rate	$9,021.00
Rate for Payer: Anthem Medicaid	$6,121.39
Rate for Payer: Anthem Medicare Advantage/PPO	$6,443.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,021.00
Rate for Payer: CareSource Just4Me Medicare	$8,698.82
Rate for Payer: Humana KY Medicaid	$6,121.39
Rate for Payer: Humana Medicare Advantage	$6,443.57
Rate for Payer: Kentucky WC Medicaid	$6,182.61
Rate for Payer: Molina Healthcare Benefit Exchange	$7,732.28
Rate for Payer: Molina Healthcare Medicaid	$6,243.82

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$24,258.22

Service Code	MSDRG 516
Min. Negotiated Rate	$16,460.94
Max. Negotiated Rate	$24,258.22
Rate for Payer: Anthem Medicaid	$16,460.94
Rate for Payer: Anthem Medicare Advantage/PPO	$17,327.30
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,258.22
Rate for Payer: CareSource Just4Me Medicare	$23,391.85
Rate for Payer: Humana KY Medicaid	$16,460.94
Rate for Payer: Humana Medicare Advantage	$17,327.30
Rate for Payer: Kentucky WC Medicaid	$16,625.54
Rate for Payer: Molina Healthcare Benefit Exchange	$20,792.76
Rate for Payer: Molina Healthcare Medicaid	$16,790.15

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$37,289.90

Service Code	MSDRG 515
Min. Negotiated Rate	$25,303.86
Max. Negotiated Rate	$37,289.90
Rate for Payer: Anthem Medicaid	$25,303.86
Rate for Payer: Anthem Medicare Advantage/PPO	$26,635.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,289.90
Rate for Payer: CareSource Just4Me Medicare	$35,958.11
Rate for Payer: Humana KY Medicaid	$25,303.86
Rate for Payer: Humana Medicare Advantage	$26,635.64
Rate for Payer: Kentucky WC Medicaid	$25,556.90
Rate for Payer: Molina Healthcare Benefit Exchange	$31,962.77
Rate for Payer: Molina Healthcare Medicaid	$25,809.94

MS-DRG 42.00: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$17,999.84

Service Code	MSDRG 517
Min. Negotiated Rate	$12,214.18
Max. Negotiated Rate	$17,999.84
Rate for Payer: Anthem Medicaid	$12,214.18
Rate for Payer: Anthem Medicare Advantage/PPO	$12,857.03
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,999.84
Rate for Payer: CareSource Just4Me Medicare	$17,356.99
Rate for Payer: Humana KY Medicaid	$12,214.18
Rate for Payer: Humana Medicare Advantage	$12,857.03
Rate for Payer: Kentucky WC Medicaid	$12,336.32
Rate for Payer: Molina Healthcare Benefit Exchange	$15,428.44
Rate for Payer: Molina Healthcare Medicaid	$12,458.46

MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$14,412.40

Service Code	MSDRG 844
Min. Negotiated Rate	$9,779.84
Max. Negotiated Rate	$14,412.40
Rate for Payer: Anthem Medicaid	$9,779.84
Rate for Payer: Anthem Medicare Advantage/PPO	$10,294.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,412.40
Rate for Payer: CareSource Just4Me Medicare	$13,897.67
Rate for Payer: Humana KY Medicaid	$9,779.84
Rate for Payer: Humana Medicare Advantage	$10,294.57
Rate for Payer: Kentucky WC Medicaid	$9,877.64
Rate for Payer: Molina Healthcare Benefit Exchange	$12,353.48
Rate for Payer: Molina Healthcare Medicaid	$9,975.44

MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$22,830.49

Service Code	MSDRG 843
Min. Negotiated Rate	$15,492.12
Max. Negotiated Rate	$22,830.49
Rate for Payer: Anthem Medicaid	$15,492.12
Rate for Payer: Anthem Medicare Advantage/PPO	$16,307.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,830.49
Rate for Payer: CareSource Just4Me Medicare	$22,015.11
Rate for Payer: Humana KY Medicaid	$15,492.12
Rate for Payer: Humana Medicare Advantage	$16,307.49
Rate for Payer: Kentucky WC Medicaid	$15,647.04
Rate for Payer: Molina Healthcare Benefit Exchange	$19,568.99
Rate for Payer: Molina Healthcare Medicaid	$15,801.96

MS-DRG 42.00: OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$10,090.61

Service Code	MSDRG 845
Min. Negotiated Rate	$6,847.20
Max. Negotiated Rate	$10,090.61
Rate for Payer: Anthem Medicaid	$6,847.20
Rate for Payer: Anthem Medicare Advantage/PPO	$7,207.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,090.61
Rate for Payer: CareSource Just4Me Medicare	$9,730.23
Rate for Payer: Humana KY Medicaid	$6,847.20
Rate for Payer: Humana Medicare Advantage	$7,207.58
Rate for Payer: Kentucky WC Medicaid	$6,915.67
Rate for Payer: Molina Healthcare Benefit Exchange	$8,649.10
Rate for Payer: Molina Healthcare Medicaid	$6,984.15

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

Facility

$24,323.33

Service Code	MSDRG 908
Min. Negotiated Rate	$16,505.12
Max. Negotiated Rate	$24,323.33
Rate for Payer: Anthem Medicaid	$16,505.12
Rate for Payer: Anthem Medicare Advantage/PPO	$17,373.81
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,323.33
Rate for Payer: CareSource Just4Me Medicare	$23,454.64
Rate for Payer: Humana KY Medicaid	$16,505.12
Rate for Payer: Humana Medicare Advantage	$17,373.81
Rate for Payer: Kentucky WC Medicaid	$16,670.17
Rate for Payer: Molina Healthcare Benefit Exchange	$20,848.57
Rate for Payer: Molina Healthcare Medicaid	$16,835.22

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

Facility

$48,037.74

Service Code	MSDRG 907
Min. Negotiated Rate	$32,597.04
Max. Negotiated Rate	$48,037.74
Rate for Payer: Anthem Medicaid	$32,597.04
Rate for Payer: Anthem Medicare Advantage/PPO	$34,312.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$48,037.74
Rate for Payer: CareSource Just4Me Medicare	$46,322.10
Rate for Payer: Humana KY Medicaid	$32,597.04
Rate for Payer: Humana Medicare Advantage	$34,312.67
Rate for Payer: Kentucky WC Medicaid	$32,923.01
Rate for Payer: Molina Healthcare Benefit Exchange	$41,175.20
Rate for Payer: Molina Healthcare Medicaid	$33,248.98

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

Facility

$15,293.88

Service Code	MSDRG 909
Min. Negotiated Rate	$10,377.99
Max. Negotiated Rate	$15,293.88
Rate for Payer: Anthem Medicaid	$10,377.99
Rate for Payer: Anthem Medicare Advantage/PPO	$10,924.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,293.88
Rate for Payer: CareSource Just4Me Medicare	$14,747.67
Rate for Payer: Humana KY Medicaid	$10,377.99
Rate for Payer: Humana Medicare Advantage	$10,924.20
Rate for Payer: Kentucky WC Medicaid	$10,481.77
Rate for Payer: Molina Healthcare Benefit Exchange	$13,109.04
Rate for Payer: Molina Healthcare Medicaid	$10,585.55

MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$49,558.32

Service Code	MSDRG 958
Min. Negotiated Rate	$33,628.86
Max. Negotiated Rate	$49,558.32
Rate for Payer: Anthem Medicaid	$33,628.86
Rate for Payer: Anthem Medicare Advantage/PPO	$35,398.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$49,558.32
Rate for Payer: CareSource Just4Me Medicare	$47,788.38
Rate for Payer: Humana KY Medicaid	$33,628.86
Rate for Payer: Humana Medicare Advantage	$35,398.80
Rate for Payer: Kentucky WC Medicaid	$33,965.15
Rate for Payer: Molina Healthcare Benefit Exchange	$42,478.56
Rate for Payer: Molina Healthcare Medicaid	$34,301.44

MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$90,007.54

Service Code	MSDRG 957
Min. Negotiated Rate	$61,076.54
Max. Negotiated Rate	$90,007.54
Rate for Payer: Anthem Medicaid	$61,076.54
Rate for Payer: Anthem Medicare Advantage/PPO	$64,291.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$90,007.54
Rate for Payer: CareSource Just4Me Medicare	$86,792.99
Rate for Payer: Humana KY Medicaid	$61,076.54
Rate for Payer: Humana Medicare Advantage	$64,291.10
Rate for Payer: Kentucky WC Medicaid	$61,687.31
Rate for Payer: Molina Healthcare Benefit Exchange	$77,149.32
Rate for Payer: Molina Healthcare Medicaid	$62,298.08

MS-DRG 42.00: OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$31,881.64

Service Code	MSDRG 959
Min. Negotiated Rate	$21,633.97
Max. Negotiated Rate	$31,881.64
Rate for Payer: Anthem Medicaid	$21,633.97
Rate for Payer: Anthem Medicare Advantage/PPO	$22,772.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$31,881.64
Rate for Payer: CareSource Just4Me Medicare	$30,743.01
Rate for Payer: Humana KY Medicaid	$21,633.97
Rate for Payer: Humana Medicare Advantage	$22,772.60
Rate for Payer: Kentucky WC Medicaid	$21,850.31
Rate for Payer: Molina Healthcare Benefit Exchange	$27,327.12
Rate for Payer: Molina Healthcare Medicaid	$22,066.65

MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$21,464.24

Service Code	MSDRG 803
Min. Negotiated Rate	$14,565.02
Max. Negotiated Rate	$21,464.24
Rate for Payer: Anthem Medicaid	$14,565.02
Rate for Payer: Anthem Medicare Advantage/PPO	$15,331.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,464.24
Rate for Payer: CareSource Just4Me Medicare	$20,697.66
Rate for Payer: Humana KY Medicaid	$14,565.02
Rate for Payer: Humana Medicare Advantage	$15,331.60
Rate for Payer: Kentucky WC Medicaid	$14,710.67
Rate for Payer: Molina Healthcare Benefit Exchange	$18,397.92
Rate for Payer: Molina Healthcare Medicaid	$14,856.32

MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$43,227.55

Service Code	MSDRG 802
Min. Negotiated Rate	$29,332.98
Max. Negotiated Rate	$43,227.55
Rate for Payer: Anthem Medicaid	$29,332.98
Rate for Payer: Anthem Medicare Advantage/PPO	$30,876.82
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$43,227.55
Rate for Payer: CareSource Just4Me Medicare	$41,683.71
Rate for Payer: Humana KY Medicaid	$29,332.98
Rate for Payer: Humana Medicare Advantage	$30,876.82
Rate for Payer: Kentucky WC Medicaid	$29,626.31
Rate for Payer: Molina Healthcare Benefit Exchange	$37,052.18
Rate for Payer: Molina Healthcare Medicaid	$29,919.64

MS-DRG 42.00: OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$13,331.98

Service Code	MSDRG 804
Min. Negotiated Rate	$9,046.70
Max. Negotiated Rate	$13,331.98
Rate for Payer: Anthem Medicaid	$9,046.70
Rate for Payer: Anthem Medicare Advantage/PPO	$9,522.84
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,331.98
Rate for Payer: CareSource Just4Me Medicare	$12,855.83
Rate for Payer: Humana KY Medicaid	$9,046.70
Rate for Payer: Humana Medicare Advantage	$9,522.84
Rate for Payer: Kentucky WC Medicaid	$9,137.16
Rate for Payer: Molina Healthcare Benefit Exchange	$11,427.41
Rate for Payer: Molina Healthcare Medicaid	$9,227.63

MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$22,764.17

Service Code	MSDRG 205
Min. Negotiated Rate	$15,447.11
Max. Negotiated Rate	$22,764.17
Rate for Payer: Anthem Medicaid	$15,447.11
Rate for Payer: Anthem Medicare Advantage/PPO	$16,260.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,764.17
Rate for Payer: CareSource Just4Me Medicare	$21,951.16
Rate for Payer: Humana KY Medicaid	$15,447.11
Rate for Payer: Humana Medicare Advantage	$16,260.12
Rate for Payer: Kentucky WC Medicaid	$15,601.59
Rate for Payer: Molina Healthcare Benefit Exchange	$19,512.14
Rate for Payer: Molina Healthcare Medicaid	$15,756.06

MS-DRG 42.00: OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$10,922.65

Service Code	MSDRG 206
Min. Negotiated Rate	$7,411.80
Max. Negotiated Rate	$10,922.65
Rate for Payer: Anthem Medicaid	$7,411.80
Rate for Payer: Anthem Medicare Advantage/PPO	$7,801.89
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,922.65
Rate for Payer: CareSource Just4Me Medicare	$10,532.55
Rate for Payer: Humana KY Medicaid	$7,411.80
Rate for Payer: Humana Medicare Advantage	$7,801.89
Rate for Payer: Kentucky WC Medicaid	$7,485.91
Rate for Payer: Molina Healthcare Benefit Exchange	$9,362.27
Rate for Payer: Molina Healthcare Medicaid	$7,560.03

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

Facility

$22,033.42

Service Code	MSDRG 167
Min. Negotiated Rate	$14,951.25
Max. Negotiated Rate	$22,033.42
Rate for Payer: Anthem Medicaid	$14,951.25
Rate for Payer: Anthem Medicare Advantage/PPO	$15,738.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,033.42
Rate for Payer: CareSource Just4Me Medicare	$21,246.52
Rate for Payer: Humana KY Medicaid	$14,951.25
Rate for Payer: Humana Medicare Advantage	$15,738.16
Rate for Payer: Kentucky WC Medicaid	$15,100.76
Rate for Payer: Molina Healthcare Benefit Exchange	$18,885.79
Rate for Payer: Molina Healthcare Medicaid	$15,250.28

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

Facility

$46,429.11

Service Code	MSDRG 166
Min. Negotiated Rate	$31,505.47
Max. Negotiated Rate	$46,429.11
Rate for Payer: Anthem Medicaid	$31,505.47
Rate for Payer: Anthem Medicare Advantage/PPO	$33,163.65
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$46,429.11
Rate for Payer: CareSource Just4Me Medicare	$44,770.93
Rate for Payer: Humana KY Medicaid	$31,505.47
Rate for Payer: Humana Medicare Advantage	$33,163.65
Rate for Payer: Kentucky WC Medicaid	$31,820.52
Rate for Payer: Molina Healthcare Benefit Exchange	$39,796.38
Rate for Payer: Molina Healthcare Medicaid	$32,135.58

Know your out-of-pocket cost for care.

All Charges