Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$18,842.71

Service Code	MSDRG 251
Min. Negotiated Rate	$12,786.13
Max. Negotiated Rate	$18,842.71
Rate for Payer: Anthem Medicaid	$12,786.13
Rate for Payer: Anthem Medicare Advantage/PPO	$13,459.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,842.71
Rate for Payer: CareSource Just4Me Medicare	$18,169.76
Rate for Payer: Humana KY Medicaid	$12,786.13
Rate for Payer: Humana Medicare Advantage	$13,459.08
Rate for Payer: Kentucky WC Medicaid	$12,913.99
Rate for Payer: Molina Healthcare Benefit Exchange	$16,150.90
Rate for Payer: Molina Healthcare Medicaid	$13,041.85

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$27,230.66

Service Code	MSDRG 041
Min. Negotiated Rate	$18,477.95
Max. Negotiated Rate	$27,230.66
Rate for Payer: Anthem Medicaid	$18,477.95
Rate for Payer: Anthem Medicare Advantage/PPO	$19,450.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,230.66
Rate for Payer: CareSource Just4Me Medicare	$26,258.13
Rate for Payer: Humana KY Medicaid	$18,477.95
Rate for Payer: Humana Medicare Advantage	$19,450.47
Rate for Payer: Kentucky WC Medicaid	$18,662.73
Rate for Payer: Molina Healthcare Benefit Exchange	$23,340.56
Rate for Payer: Molina Healthcare Medicaid	$18,847.51

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$45,486.14

Service Code	MSDRG 040
Min. Negotiated Rate	$30,865.60
Max. Negotiated Rate	$45,486.14
Rate for Payer: Anthem Medicaid	$30,865.60
Rate for Payer: Anthem Medicare Advantage/PPO	$32,490.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$45,486.14
Rate for Payer: CareSource Just4Me Medicare	$43,861.64
Rate for Payer: Humana KY Medicaid	$30,865.60
Rate for Payer: Humana Medicare Advantage	$32,490.10
Rate for Payer: Kentucky WC Medicaid	$31,174.25
Rate for Payer: Molina Healthcare Benefit Exchange	$38,988.12
Rate for Payer: Molina Healthcare Medicaid	$31,482.91

MS-DRG 42.00: PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$21,194.14

Service Code	MSDRG 042
Min. Negotiated Rate	$14,381.74
Max. Negotiated Rate	$21,194.14
Rate for Payer: Anthem Medicaid	$14,381.74
Rate for Payer: Anthem Medicare Advantage/PPO	$15,138.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,194.14
Rate for Payer: CareSource Just4Me Medicare	$20,437.20
Rate for Payer: Humana KY Medicaid	$14,381.74
Rate for Payer: Humana Medicare Advantage	$15,138.67
Rate for Payer: Kentucky WC Medicaid	$14,525.55
Rate for Payer: Molina Healthcare Benefit Exchange	$18,166.40
Rate for Payer: Molina Healthcare Medicaid	$14,669.37

MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$12,909.90

Service Code	MSDRG 300
Min. Negotiated Rate	$8,760.29
Max. Negotiated Rate	$12,909.90
Rate for Payer: Anthem Medicaid	$8,760.29
Rate for Payer: Anthem Medicare Advantage/PPO	$9,221.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,909.90
Rate for Payer: CareSource Just4Me Medicare	$12,448.84
Rate for Payer: Humana KY Medicaid	$8,760.29
Rate for Payer: Humana Medicare Advantage	$9,221.36
Rate for Payer: Kentucky WC Medicaid	$8,847.89
Rate for Payer: Molina Healthcare Benefit Exchange	$11,065.63
Rate for Payer: Molina Healthcare Medicaid	$8,935.50

MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$19,505.95

Service Code	MSDRG 299
Min. Negotiated Rate	$13,236.18
Max. Negotiated Rate	$19,505.95
Rate for Payer: Anthem Medicaid	$13,236.18
Rate for Payer: Anthem Medicare Advantage/PPO	$13,932.82
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,505.95
Rate for Payer: CareSource Just4Me Medicare	$18,809.31
Rate for Payer: Humana KY Medicaid	$13,236.18
Rate for Payer: Humana Medicare Advantage	$13,932.82
Rate for Payer: Kentucky WC Medicaid	$13,368.54
Rate for Payer: Molina Healthcare Benefit Exchange	$16,719.38
Rate for Payer: Molina Healthcare Medicaid	$13,500.90

MS-DRG 42.00: PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$8,602.59

Service Code	MSDRG 301
Min. Negotiated Rate	$5,837.47
Max. Negotiated Rate	$8,602.59
Rate for Payer: Anthem Medicaid	$5,837.47
Rate for Payer: Anthem Medicare Advantage/PPO	$6,144.71
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,602.59
Rate for Payer: CareSource Just4Me Medicare	$8,295.36
Rate for Payer: Humana KY Medicaid	$5,837.47
Rate for Payer: Humana Medicare Advantage	$6,144.71
Rate for Payer: Kentucky WC Medicaid	$5,895.85
Rate for Payer: Molina Healthcare Benefit Exchange	$7,373.65
Rate for Payer: Molina Healthcare Medicaid	$5,954.22

MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH CC

Facility

$25,471.31

Service Code	MSDRG 336
Min. Negotiated Rate	$17,284.10
Max. Negotiated Rate	$25,471.31
Rate for Payer: Anthem Medicaid	$17,284.10
Rate for Payer: Anthem Medicare Advantage/PPO	$18,193.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,471.31
Rate for Payer: CareSource Just4Me Medicare	$24,561.62
Rate for Payer: Humana KY Medicaid	$17,284.10
Rate for Payer: Humana Medicare Advantage	$18,193.79
Rate for Payer: Kentucky WC Medicaid	$17,456.94
Rate for Payer: Molina Healthcare Benefit Exchange	$21,832.55
Rate for Payer: Molina Healthcare Medicaid	$17,629.78

MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$43,693.01

Service Code	MSDRG 335
Min. Negotiated Rate	$29,648.83
Max. Negotiated Rate	$43,693.01
Rate for Payer: Anthem Medicaid	$29,648.83
Rate for Payer: Anthem Medicare Advantage/PPO	$31,209.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$43,693.01
Rate for Payer: CareSource Just4Me Medicare	$42,132.54
Rate for Payer: Humana KY Medicaid	$29,648.83
Rate for Payer: Humana Medicare Advantage	$31,209.29
Rate for Payer: Kentucky WC Medicaid	$29,945.31
Rate for Payer: Molina Healthcare Benefit Exchange	$37,451.15
Rate for Payer: Molina Healthcare Medicaid	$30,241.80

MS-DRG 42.00: PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$18,511.11

Service Code	MSDRG 337
Min. Negotiated Rate	$12,561.11
Max. Negotiated Rate	$18,511.11
Rate for Payer: Anthem Medicaid	$12,561.11
Rate for Payer: Anthem Medicare Advantage/PPO	$13,222.22
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,511.11
Rate for Payer: CareSource Just4Me Medicare	$17,850.00
Rate for Payer: Humana KY Medicaid	$12,561.11
Rate for Payer: Humana Medicare Advantage	$13,222.22
Rate for Payer: Kentucky WC Medicaid	$12,686.72
Rate for Payer: Molina Healthcare Benefit Exchange	$15,866.66
Rate for Payer: Molina Healthcare Medicaid	$12,812.33

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$27,165.53

Service Code	MSDRG 243
Min. Negotiated Rate	$18,433.75
Max. Negotiated Rate	$27,165.53
Rate for Payer: Anthem Medicaid	$18,433.75
Rate for Payer: Anthem Medicare Advantage/PPO	$19,403.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$27,165.53
Rate for Payer: CareSource Just4Me Medicare	$26,195.33
Rate for Payer: Humana KY Medicaid	$18,433.75
Rate for Payer: Humana Medicare Advantage	$19,403.95
Rate for Payer: Kentucky WC Medicaid	$18,618.09
Rate for Payer: Molina Healthcare Benefit Exchange	$23,284.74
Rate for Payer: Molina Healthcare Medicaid	$18,802.43

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$40,902.68

Service Code	MSDRG 242
Min. Negotiated Rate	$27,755.39
Max. Negotiated Rate	$40,902.68
Rate for Payer: Anthem Medicaid	$27,755.39
Rate for Payer: Anthem Medicare Advantage/PPO	$29,216.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$40,902.68
Rate for Payer: CareSource Just4Me Medicare	$39,441.87
Rate for Payer: Humana KY Medicaid	$27,755.39
Rate for Payer: Humana Medicare Advantage	$29,216.20
Rate for Payer: Kentucky WC Medicaid	$28,032.94
Rate for Payer: Molina Healthcare Benefit Exchange	$35,059.44
Rate for Payer: Molina Healthcare Medicaid	$28,310.50

MS-DRG 42.00: PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$21,762.10

Service Code	MSDRG 244
Min. Negotiated Rate	$14,767.14
Max. Negotiated Rate	$21,762.10
Rate for Payer: Anthem Medicaid	$14,767.14
Rate for Payer: Anthem Medicare Advantage/PPO	$15,544.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,762.10
Rate for Payer: CareSource Just4Me Medicare	$20,984.89
Rate for Payer: Humana KY Medicaid	$14,767.14
Rate for Payer: Humana Medicare Advantage	$15,544.36
Rate for Payer: Kentucky WC Medicaid	$14,914.81
Rate for Payer: Molina Healthcare Benefit Exchange	$18,653.23
Rate for Payer: Molina Healthcare Medicaid	$15,062.48

MS-DRG 42.00: PLEURAL EFFUSION WITH CC

Facility

$12,106.81

Service Code	MSDRG 187
Min. Negotiated Rate	$8,215.33
Max. Negotiated Rate	$12,106.81
Rate for Payer: Anthem Medicaid	$8,215.33
Rate for Payer: Anthem Medicare Advantage/PPO	$8,647.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,106.81
Rate for Payer: CareSource Just4Me Medicare	$11,674.42
Rate for Payer: Humana KY Medicaid	$8,215.33
Rate for Payer: Humana Medicare Advantage	$8,647.72
Rate for Payer: Kentucky WC Medicaid	$8,297.49
Rate for Payer: Molina Healthcare Benefit Exchange	$10,377.26
Rate for Payer: Molina Healthcare Medicaid	$8,379.64

MS-DRG 42.00: PLEURAL EFFUSION WITH MCC

Facility

$19,052.54

Service Code	MSDRG 186
Min. Negotiated Rate	$12,928.51
Max. Negotiated Rate	$19,052.54
Rate for Payer: Anthem Medicaid	$12,928.51
Rate for Payer: Anthem Medicare Advantage/PPO	$13,608.96
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,052.54
Rate for Payer: CareSource Just4Me Medicare	$18,372.10
Rate for Payer: Humana KY Medicaid	$12,928.51
Rate for Payer: Humana Medicare Advantage	$13,608.96
Rate for Payer: Kentucky WC Medicaid	$13,057.80
Rate for Payer: Molina Healthcare Benefit Exchange	$16,330.75
Rate for Payer: Molina Healthcare Medicaid	$13,187.08

MS-DRG 42.00: PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$8,853.39

Service Code	MSDRG 188
Min. Negotiated Rate	$6,007.66
Max. Negotiated Rate	$8,853.39
Rate for Payer: Anthem Medicaid	$6,007.66
Rate for Payer: Anthem Medicare Advantage/PPO	$6,323.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,853.39
Rate for Payer: CareSource Just4Me Medicare	$8,537.20
Rate for Payer: Humana KY Medicaid	$6,007.66
Rate for Payer: Humana Medicare Advantage	$6,323.85
Rate for Payer: Kentucky WC Medicaid	$6,067.73
Rate for Payer: Molina Healthcare Benefit Exchange	$7,588.62
Rate for Payer: Molina Healthcare Medicaid	$6,127.81

MS-DRG 42.00: PNEUMOTHORAX WITH CC

Facility

$13,354.87

Service Code	MSDRG 200
Min. Negotiated Rate	$9,062.23
Max. Negotiated Rate	$13,354.87
Rate for Payer: Anthem Medicaid	$9,062.23
Rate for Payer: Anthem Medicare Advantage/PPO	$9,539.19
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,354.87
Rate for Payer: CareSource Just4Me Medicare	$12,877.91
Rate for Payer: Humana KY Medicaid	$9,062.23
Rate for Payer: Humana Medicare Advantage	$9,539.19
Rate for Payer: Kentucky WC Medicaid	$9,152.85
Rate for Payer: Molina Healthcare Benefit Exchange	$11,447.03
Rate for Payer: Molina Healthcare Medicaid	$9,243.48

MS-DRG 42.00: PNEUMOTHORAX WITH MCC

Facility

$21,286.97

Service Code	MSDRG 199
Min. Negotiated Rate	$14,444.73
Max. Negotiated Rate	$21,286.97
Rate for Payer: Anthem Medicaid	$14,444.73
Rate for Payer: Anthem Medicare Advantage/PPO	$15,204.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,286.97
Rate for Payer: CareSource Just4Me Medicare	$20,526.72
Rate for Payer: Humana KY Medicaid	$14,444.73
Rate for Payer: Humana Medicare Advantage	$15,204.98
Rate for Payer: Kentucky WC Medicaid	$14,589.18
Rate for Payer: Molina Healthcare Benefit Exchange	$18,245.98
Rate for Payer: Molina Healthcare Medicaid	$14,733.63

MS-DRG 42.00: PNEUMOTHORAX WITHOUT CC/MCC

Facility

$8,164.86

Service Code	MSDRG 201
Min. Negotiated Rate	$5,540.44
Max. Negotiated Rate	$8,164.86
Rate for Payer: Anthem Medicaid	$5,540.44
Rate for Payer: Anthem Medicare Advantage/PPO	$5,832.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,164.86
Rate for Payer: CareSource Just4Me Medicare	$7,873.25
Rate for Payer: Humana KY Medicaid	$5,540.44
Rate for Payer: Humana Medicare Advantage	$5,832.04
Rate for Payer: Kentucky WC Medicaid	$5,595.84
Rate for Payer: Molina Healthcare Benefit Exchange	$6,998.45
Rate for Payer: Molina Healthcare Medicaid	$5,651.25

MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$19,772.45

Service Code	MSDRG 917
Min. Negotiated Rate	$13,417.02
Max. Negotiated Rate	$19,772.45
Rate for Payer: Anthem Medicaid	$13,417.02
Rate for Payer: Anthem Medicare Advantage/PPO	$14,123.18
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,772.45
Rate for Payer: CareSource Just4Me Medicare	$19,066.29
Rate for Payer: Humana KY Medicaid	$13,417.02
Rate for Payer: Humana Medicare Advantage	$14,123.18
Rate for Payer: Kentucky WC Medicaid	$13,551.19
Rate for Payer: Molina Healthcare Benefit Exchange	$16,947.82
Rate for Payer: Molina Healthcare Medicaid	$13,685.36

MS-DRG 42.00: POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$10,667.02

Service Code	MSDRG 918
Min. Negotiated Rate	$7,238.34
Max. Negotiated Rate	$10,667.02
Rate for Payer: Anthem Medicaid	$7,238.34
Rate for Payer: Anthem Medicare Advantage/PPO	$7,619.30
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,667.02
Rate for Payer: CareSource Just4Me Medicare	$10,286.06
Rate for Payer: Humana KY Medicaid	$7,238.34
Rate for Payer: Humana Medicare Advantage	$7,619.30
Rate for Payer: Kentucky WC Medicaid	$7,310.72
Rate for Payer: Molina Healthcare Benefit Exchange	$9,143.16
Rate for Payer: Molina Healthcare Medicaid	$7,383.10

MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$22,172.11

Service Code	MSDRG 862
Min. Negotiated Rate	$15,045.36
Max. Negotiated Rate	$22,172.11
Rate for Payer: Anthem Medicaid	$15,045.36
Rate for Payer: Anthem Medicare Advantage/PPO	$15,837.22
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,172.11
Rate for Payer: CareSource Just4Me Medicare	$21,380.25
Rate for Payer: Humana KY Medicaid	$15,045.36
Rate for Payer: Humana Medicare Advantage	$15,837.22
Rate for Payer: Kentucky WC Medicaid	$15,195.81
Rate for Payer: Molina Healthcare Benefit Exchange	$19,004.66
Rate for Payer: Molina Healthcare Medicaid	$15,346.27

MS-DRG 42.00: POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$12,057.33

Service Code	MSDRG 863
Min. Negotiated Rate	$8,181.76
Max. Negotiated Rate	$12,057.33
Rate for Payer: Anthem Medicaid	$8,181.76
Rate for Payer: Anthem Medicare Advantage/PPO	$8,612.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,057.33
Rate for Payer: CareSource Just4Me Medicare	$11,626.71
Rate for Payer: Humana KY Medicaid	$8,181.76
Rate for Payer: Humana Medicare Advantage	$8,612.38
Rate for Payer: Kentucky WC Medicaid	$8,263.58
Rate for Payer: Molina Healthcare Benefit Exchange	$10,334.86
Rate for Payer: Molina Healthcare Medicaid	$8,345.40

MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$26,274.42

Service Code	MSDRG 857
Min. Negotiated Rate	$17,829.07
Max. Negotiated Rate	$26,274.42
Rate for Payer: Anthem Medicaid	$17,829.07
Rate for Payer: Anthem Medicare Advantage/PPO	$18,767.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$26,274.42
Rate for Payer: CareSource Just4Me Medicare	$25,336.04
Rate for Payer: Humana KY Medicaid	$17,829.07
Rate for Payer: Humana Medicare Advantage	$18,767.44
Rate for Payer: Kentucky WC Medicaid	$18,007.36
Rate for Payer: Molina Healthcare Benefit Exchange	$22,520.93
Rate for Payer: Molina Healthcare Medicaid	$18,185.65

MS-DRG 42.00: POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$54,403.45

Service Code	MSDRG 856
Min. Negotiated Rate	$36,916.63
Max. Negotiated Rate	$54,403.45
Rate for Payer: Anthem Medicaid	$36,916.63
Rate for Payer: Anthem Medicare Advantage/PPO	$38,859.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$54,403.45
Rate for Payer: CareSource Just4Me Medicare	$52,460.47
Rate for Payer: Humana KY Medicaid	$36,916.63
Rate for Payer: Humana Medicare Advantage	$38,859.61
Rate for Payer: Kentucky WC Medicaid	$37,285.80
Rate for Payer: Molina Healthcare Benefit Exchange	$46,631.53
Rate for Payer: Molina Healthcare Medicaid	$37,654.96

Know your out-of-pocket cost for care.

All Charges