Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$16,326.11

Service Code	MSDRG 168
Min. Negotiated Rate	$11,078.43
Max. Negotiated Rate	$16,326.11
Rate for Payer: Anthem Medicaid	$11,078.43
Rate for Payer: Anthem Medicare Advantage/PPO	$11,661.51
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,326.11
Rate for Payer: CareSource Just4Me Medicare	$15,743.04
Rate for Payer: Humana KY Medicaid	$11,078.43
Rate for Payer: Humana Medicare Advantage	$11,661.51
Rate for Payer: Kentucky WC Medicaid	$11,189.22
Rate for Payer: Molina Healthcare Benefit Exchange	$13,993.81
Rate for Payer: Molina Healthcare Medicaid	$11,300.00

MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$21,379.83

Service Code	MSDRG 580
Min. Negotiated Rate	$14,507.74
Max. Negotiated Rate	$21,379.83
Rate for Payer: Anthem Medicaid	$14,507.74
Rate for Payer: Anthem Medicare Advantage/PPO	$15,271.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,379.83
Rate for Payer: CareSource Just4Me Medicare	$20,616.27
Rate for Payer: Humana KY Medicaid	$14,507.74
Rate for Payer: Humana Medicare Advantage	$15,271.31
Rate for Payer: Kentucky WC Medicaid	$14,652.82
Rate for Payer: Molina Healthcare Benefit Exchange	$18,325.57
Rate for Payer: Molina Healthcare Medicaid	$14,797.90

MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$39,303.70

Service Code	MSDRG 579
Min. Negotiated Rate	$26,670.37
Max. Negotiated Rate	$39,303.70
Rate for Payer: Anthem Medicaid	$26,670.37
Rate for Payer: Anthem Medicare Advantage/PPO	$28,074.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$39,303.70
Rate for Payer: CareSource Just4Me Medicare	$37,899.99
Rate for Payer: Humana KY Medicaid	$26,670.37
Rate for Payer: Humana Medicare Advantage	$28,074.07
Rate for Payer: Kentucky WC Medicaid	$26,937.07
Rate for Payer: Molina Healthcare Benefit Exchange	$33,688.88
Rate for Payer: Molina Healthcare Medicaid	$27,203.77

MS-DRG 42.00: OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$17,354.69

Service Code	MSDRG 581
Min. Negotiated Rate	$11,776.40
Max. Negotiated Rate	$17,354.69
Rate for Payer: Anthem Medicaid	$11,776.40
Rate for Payer: Anthem Medicare Advantage/PPO	$12,396.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,354.69
Rate for Payer: CareSource Just4Me Medicare	$16,734.88
Rate for Payer: Humana KY Medicaid	$11,776.40
Rate for Payer: Humana Medicare Advantage	$12,396.21
Rate for Payer: Kentucky WC Medicaid	$11,894.16
Rate for Payer: Molina Healthcare Benefit Exchange	$14,875.45
Rate for Payer: Molina Healthcare Medicaid	$12,011.93

MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH CC

Facility

$30,785.52

Service Code	MSDRG 253
Min. Negotiated Rate	$20,890.18
Max. Negotiated Rate	$30,785.52
Rate for Payer: Anthem Medicaid	$20,890.18
Rate for Payer: Anthem Medicare Advantage/PPO	$21,989.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$30,785.52
Rate for Payer: CareSource Just4Me Medicare	$29,686.04
Rate for Payer: Humana KY Medicaid	$20,890.18
Rate for Payer: Humana Medicare Advantage	$21,989.66
Rate for Payer: Kentucky WC Medicaid	$21,099.08
Rate for Payer: Molina Healthcare Benefit Exchange	$26,387.59
Rate for Payer: Molina Healthcare Medicaid	$21,307.98

MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITH MCC

Facility

$41,365.70

Service Code	MSDRG 252
Min. Negotiated Rate	$28,069.58
Max. Negotiated Rate	$41,365.70
Rate for Payer: Anthem Medicaid	$28,069.58
Rate for Payer: Anthem Medicare Advantage/PPO	$29,546.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$41,365.70
Rate for Payer: CareSource Just4Me Medicare	$39,888.36
Rate for Payer: Humana KY Medicaid	$28,069.58
Rate for Payer: Humana Medicare Advantage	$29,546.93
Rate for Payer: Kentucky WC Medicaid	$28,350.28
Rate for Payer: Molina Healthcare Benefit Exchange	$35,456.32
Rate for Payer: Molina Healthcare Medicaid	$28,630.98

MS-DRG 42.00: OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$21,095.24

Service Code	MSDRG 254
Min. Negotiated Rate	$14,314.63
Max. Negotiated Rate	$21,095.24
Rate for Payer: Anthem Medicaid	$14,314.63
Rate for Payer: Anthem Medicare Advantage/PPO	$15,068.03
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,095.24
Rate for Payer: CareSource Just4Me Medicare	$20,341.84
Rate for Payer: Humana KY Medicaid	$14,314.63
Rate for Payer: Humana Medicare Advantage	$15,068.03
Rate for Payer: Kentucky WC Medicaid	$14,457.77
Rate for Payer: Molina Healthcare Benefit Exchange	$18,081.64
Rate for Payer: Molina Healthcare Medicaid	$14,600.92

MS-DRG 42.00: OTITIS MEDIA AND URI WITH MCC

Facility

$13,684.05

Service Code	MSDRG 152
Min. Negotiated Rate	$9,285.60
Max. Negotiated Rate	$13,684.05
Rate for Payer: Anthem Medicaid	$9,285.60
Rate for Payer: Anthem Medicare Advantage/PPO	$9,774.32
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,684.05
Rate for Payer: CareSource Just4Me Medicare	$13,195.33
Rate for Payer: Humana KY Medicaid	$9,285.60
Rate for Payer: Humana Medicare Advantage	$9,774.32
Rate for Payer: Kentucky WC Medicaid	$9,378.46
Rate for Payer: Molina Healthcare Benefit Exchange	$11,729.18
Rate for Payer: Molina Healthcare Medicaid	$9,471.32

MS-DRG 42.00: OTITIS MEDIA AND URI WITHOUT MCC

Facility

$8,582.10

Service Code	MSDRG 153
Min. Negotiated Rate	$5,823.57
Max. Negotiated Rate	$8,582.10
Rate for Payer: Anthem Medicaid	$5,823.57
Rate for Payer: Anthem Medicare Advantage/PPO	$6,130.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,582.10
Rate for Payer: CareSource Just4Me Medicare	$8,275.59
Rate for Payer: Humana KY Medicaid	$5,823.57
Rate for Payer: Humana Medicare Advantage	$6,130.07
Rate for Payer: Kentucky WC Medicaid	$5,881.80
Rate for Payer: Molina Healthcare Benefit Exchange	$7,356.08
Rate for Payer: Molina Healthcare Medicaid	$5,940.04

MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$33,865.29

Service Code	MSDRG 406
Min. Negotiated Rate	$22,980.02
Max. Negotiated Rate	$33,865.29
Rate for Payer: Anthem Medicaid	$22,980.02
Rate for Payer: Anthem Medicare Advantage/PPO	$24,189.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$33,865.29
Rate for Payer: CareSource Just4Me Medicare	$32,655.81
Rate for Payer: Humana KY Medicaid	$22,980.02
Rate for Payer: Humana Medicare Advantage	$24,189.49
Rate for Payer: Kentucky WC Medicaid	$23,209.82
Rate for Payer: Molina Healthcare Benefit Exchange	$29,027.39
Rate for Payer: Molina Healthcare Medicaid	$23,439.62

MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$65,462.33

Service Code	MSDRG 405
Min. Negotiated Rate	$44,420.87
Max. Negotiated Rate	$65,462.33
Rate for Payer: Anthem Medicaid	$44,420.87
Rate for Payer: Anthem Medicare Advantage/PPO	$46,758.81
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$65,462.33
Rate for Payer: CareSource Just4Me Medicare	$63,124.39
Rate for Payer: Humana KY Medicaid	$44,420.87
Rate for Payer: Humana Medicare Advantage	$46,758.81
Rate for Payer: Kentucky WC Medicaid	$44,865.08
Rate for Payer: Molina Healthcare Benefit Exchange	$56,110.57
Rate for Payer: Molina Healthcare Medicaid	$45,309.29

MS-DRG 42.00: PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$25,754.69

Service Code	MSDRG 407
Min. Negotiated Rate	$17,476.40
Max. Negotiated Rate	$25,754.69
Rate for Payer: Anthem Medicaid	$17,476.40
Rate for Payer: Anthem Medicare Advantage/PPO	$18,396.21
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,754.69
Rate for Payer: CareSource Just4Me Medicare	$24,834.88
Rate for Payer: Humana KY Medicaid	$17,476.40
Rate for Payer: Humana Medicare Advantage	$18,396.21
Rate for Payer: Kentucky WC Medicaid	$17,651.16
Rate for Payer: Molina Healthcare Benefit Exchange	$22,075.45
Rate for Payer: Molina Healthcare Medicaid	$17,825.93

MS-DRG 42.00: PANCREAS TRANSPLANT

Facility

$96,142.96

Service Code	MSDRG 010
Min. Negotiated Rate	$65,239.86
Max. Negotiated Rate	$96,142.96
Rate for Payer: Anthem Medicaid	$65,239.86
Rate for Payer: Anthem Medicare Advantage/PPO	$68,673.54
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$96,142.96
Rate for Payer: CareSource Just4Me Medicare	$92,709.28
Rate for Payer: Humana KY Medicaid	$65,239.86
Rate for Payer: Humana Medicare Advantage	$68,673.54
Rate for Payer: Kentucky WC Medicaid	$65,892.26
Rate for Payer: Molina Healthcare Benefit Exchange	$82,408.25
Rate for Payer: Molina Healthcare Medicaid	$66,544.66

MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$12,792.95

Service Code	MSDRG 543
Min. Negotiated Rate	$8,680.93
Max. Negotiated Rate	$12,792.95
Rate for Payer: Anthem Medicaid	$8,680.93
Rate for Payer: Anthem Medicare Advantage/PPO	$9,137.82
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,792.95
Rate for Payer: CareSource Just4Me Medicare	$12,336.06
Rate for Payer: Humana KY Medicaid	$8,680.93
Rate for Payer: Humana Medicare Advantage	$9,137.82
Rate for Payer: Kentucky WC Medicaid	$8,767.74
Rate for Payer: Molina Healthcare Benefit Exchange	$10,965.38
Rate for Payer: Molina Healthcare Medicaid	$8,854.55

MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility

$22,490.44

Service Code	MSDRG 542
Min. Negotiated Rate	$15,261.37
Max. Negotiated Rate	$22,490.44
Rate for Payer: Anthem Medicaid	$15,261.37
Rate for Payer: Anthem Medicare Advantage/PPO	$16,064.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,490.44
Rate for Payer: CareSource Just4Me Medicare	$21,687.21
Rate for Payer: Humana KY Medicaid	$15,261.37
Rate for Payer: Humana Medicare Advantage	$16,064.60
Rate for Payer: Kentucky WC Medicaid	$15,413.98
Rate for Payer: Molina Healthcare Benefit Exchange	$19,277.52
Rate for Payer: Molina Healthcare Medicaid	$15,566.60

MS-DRG 42.00: PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility

$9,112.66

Service Code	MSDRG 544
Min. Negotiated Rate	$6,183.59
Max. Negotiated Rate	$9,112.66
Rate for Payer: Anthem Medicaid	$6,183.59
Rate for Payer: Anthem Medicare Advantage/PPO	$6,509.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,112.66
Rate for Payer: CareSource Just4Me Medicare	$8,787.20
Rate for Payer: Humana KY Medicaid	$6,183.59
Rate for Payer: Humana Medicare Advantage	$6,509.04
Rate for Payer: Kentucky WC Medicaid	$6,245.42
Rate for Payer: Molina Healthcare Benefit Exchange	$7,810.85
Rate for Payer: Molina Healthcare Medicaid	$6,307.26

MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC

Facility

$25,356.76

Service Code	MSDRG 734
Min. Negotiated Rate	$17,206.37
Max. Negotiated Rate	$25,356.76
Rate for Payer: Anthem Medicaid	$17,206.37
Rate for Payer: Anthem Medicare Advantage/PPO	$18,111.97
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,356.76
Rate for Payer: CareSource Just4Me Medicare	$24,451.16
Rate for Payer: Humana KY Medicaid	$17,206.37
Rate for Payer: Humana Medicare Advantage	$18,111.97
Rate for Payer: Kentucky WC Medicaid	$17,378.44
Rate for Payer: Molina Healthcare Benefit Exchange	$21,734.36
Rate for Payer: Molina Healthcare Medicaid	$17,550.50

MS-DRG 42.00: PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC

Facility

$14,637.90

Service Code	MSDRG 735
Min. Negotiated Rate	$9,932.86
Max. Negotiated Rate	$14,637.90
Rate for Payer: Anthem Medicaid	$9,932.86
Rate for Payer: Anthem Medicare Advantage/PPO	$10,455.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,637.90
Rate for Payer: CareSource Just4Me Medicare	$14,115.11
Rate for Payer: Humana KY Medicaid	$9,932.86
Rate for Payer: Humana Medicare Advantage	$10,455.64
Rate for Payer: Kentucky WC Medicaid	$10,032.19
Rate for Payer: Molina Healthcare Benefit Exchange	$12,546.77
Rate for Payer: Molina Healthcare Medicaid	$10,131.52

MS-DRG 42.00: PENIS PROCEDURES WITH CC/MCC

Facility

$27,096.82

Service Code	MSDRG 709
Min. Negotiated Rate	$18,387.13
Max. Negotiated Rate	$27,096.82
Rate for Payer: Anthem Medicaid	$18,387.13
Rate for Payer: Anthem Medicare Advantage/PPO	$19,354.87
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,096.82
Rate for Payer: CareSource Just4Me Medicare	$26,129.07
Rate for Payer: Humana KY Medicaid	$18,387.13
Rate for Payer: Humana Medicare Advantage	$19,354.87
Rate for Payer: Kentucky WC Medicaid	$18,571.00
Rate for Payer: Molina Healthcare Benefit Exchange	$23,225.84
Rate for Payer: Molina Healthcare Medicaid	$18,754.87

MS-DRG 42.00: PENIS PROCEDURES WITHOUT CC/MCC

Facility

$18,104.74

Service Code	MSDRG 710
Min. Negotiated Rate	$12,285.36
Max. Negotiated Rate	$18,104.74
Rate for Payer: Anthem Medicaid	$12,285.36
Rate for Payer: Anthem Medicare Advantage/PPO	$12,931.96
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,104.74
Rate for Payer: CareSource Just4Me Medicare	$17,458.15
Rate for Payer: Humana KY Medicaid	$12,285.36
Rate for Payer: Humana Medicare Advantage	$12,931.96
Rate for Payer: Kentucky WC Medicaid	$12,408.22
Rate for Payer: Molina Healthcare Benefit Exchange	$15,518.35
Rate for Payer: Molina Healthcare Medicaid	$12,531.07

MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$47,152.62

Service Code	MSDRG 273
Min. Negotiated Rate	$31,996.42
Max. Negotiated Rate	$47,152.62
Rate for Payer: Anthem Medicaid	$31,996.42
Rate for Payer: Anthem Medicare Advantage/PPO	$33,680.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,152.62
Rate for Payer: CareSource Just4Me Medicare	$45,468.59
Rate for Payer: Humana KY Medicaid	$31,996.42
Rate for Payer: Humana Medicare Advantage	$33,680.44
Rate for Payer: Kentucky WC Medicaid	$32,316.38
Rate for Payer: Molina Healthcare Benefit Exchange	$40,416.53
Rate for Payer: Molina Healthcare Medicaid	$32,636.35

MS-DRG 42.00: PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$37,634.77

Service Code	MSDRG 274
Min. Negotiated Rate	$25,537.88
Max. Negotiated Rate	$37,634.77
Rate for Payer: Anthem Medicaid	$25,537.88
Rate for Payer: Anthem Medicare Advantage/PPO	$26,881.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,634.77
Rate for Payer: CareSource Just4Me Medicare	$36,290.67
Rate for Payer: Humana KY Medicaid	$25,537.88
Rate for Payer: Humana Medicare Advantage	$26,881.98
Rate for Payer: Kentucky WC Medicaid	$25,793.26
Rate for Payer: Molina Healthcare Benefit Exchange	$32,258.38
Rate for Payer: Molina Healthcare Medicaid	$26,048.64

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$34,328.34

Service Code	MSDRG 321
Min. Negotiated Rate	$23,294.23
Max. Negotiated Rate	$34,328.34
Rate for Payer: Anthem Medicaid	$23,294.23
Rate for Payer: Anthem Medicare Advantage/PPO	$24,520.24
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$34,328.34
Rate for Payer: CareSource Just4Me Medicare	$33,102.32
Rate for Payer: Humana KY Medicaid	$23,294.23
Rate for Payer: Humana Medicare Advantage	$24,520.24
Rate for Payer: Kentucky WC Medicaid	$23,527.17
Rate for Payer: Molina Healthcare Benefit Exchange	$29,424.29
Rate for Payer: Molina Healthcare Medicaid	$23,760.11

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$21,816.35

Service Code	MSDRG 322
Min. Negotiated Rate	$14,803.95
Max. Negotiated Rate	$21,816.35
Rate for Payer: Anthem Medicaid	$14,803.95
Rate for Payer: Anthem Medicare Advantage/PPO	$15,583.11
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,816.35
Rate for Payer: CareSource Just4Me Medicare	$21,037.20
Rate for Payer: Humana KY Medicaid	$14,803.95
Rate for Payer: Humana Medicare Advantage	$15,583.11
Rate for Payer: Kentucky WC Medicaid	$14,951.99
Rate for Payer: Molina Healthcare Benefit Exchange	$18,699.73
Rate for Payer: Molina Healthcare Medicaid	$15,100.03

MS-DRG 42.00: PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$27,886.64

Service Code	MSDRG 250
Min. Negotiated Rate	$18,923.08
Max. Negotiated Rate	$27,886.64
Rate for Payer: Anthem Medicaid	$18,923.08
Rate for Payer: Anthem Medicare Advantage/PPO	$19,919.03
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,886.64
Rate for Payer: CareSource Just4Me Medicare	$26,890.69
Rate for Payer: Humana KY Medicaid	$18,923.08
Rate for Payer: Humana Medicare Advantage	$19,919.03
Rate for Payer: Kentucky WC Medicaid	$19,112.31
Rate for Payer: Molina Healthcare Benefit Exchange	$23,902.84
Rate for Payer: Molina Healthcare Medicaid	$19,301.54

Know your out-of-pocket cost for care.

All Charges