Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$9,281.48

Service Code	MSDRG 179
Min. Negotiated Rate	$6,298.15
Max. Negotiated Rate	$9,281.48
Rate for Payer: Anthem Medicaid	$6,298.15
Rate for Payer: Anthem Medicare Advantage/PPO	$6,629.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,281.48
Rate for Payer: CareSource Just4Me Medicare	$8,950.00
Rate for Payer: Humana KY Medicaid	$6,298.15
Rate for Payer: Humana Medicare Advantage	$6,629.63
Rate for Payer: Kentucky WC Medicaid	$6,361.13
Rate for Payer: Molina Healthcare Benefit Exchange	$7,955.56
Rate for Payer: Molina Healthcare Medicaid	$6,424.11

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH CC

Facility

$13,388.63

Service Code	MSDRG 181
Min. Negotiated Rate	$9,085.14
Max. Negotiated Rate	$13,388.63
Rate for Payer: Anthem Medicaid	$9,085.14
Rate for Payer: Anthem Medicare Advantage/PPO	$9,563.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,388.63
Rate for Payer: CareSource Just4Me Medicare	$12,910.47
Rate for Payer: Humana KY Medicaid	$9,085.14
Rate for Payer: Humana Medicare Advantage	$9,563.31
Rate for Payer: Kentucky WC Medicaid	$9,176.00
Rate for Payer: Molina Healthcare Benefit Exchange	$11,475.97
Rate for Payer: Molina Healthcare Medicaid	$9,266.85

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITH MCC

Facility

$21,075.98

Service Code	MSDRG 180
Min. Negotiated Rate	$14,301.56
Max. Negotiated Rate	$21,075.98
Rate for Payer: Anthem Medicaid	$14,301.56
Rate for Payer: Anthem Medicare Advantage/PPO	$15,054.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,075.98
Rate for Payer: CareSource Just4Me Medicare	$20,323.26
Rate for Payer: Humana KY Medicaid	$14,301.56
Rate for Payer: Humana Medicare Advantage	$15,054.27
Rate for Payer: Kentucky WC Medicaid	$14,444.57
Rate for Payer: Molina Healthcare Benefit Exchange	$18,065.12
Rate for Payer: Molina Healthcare Medicaid	$14,587.59

MS-DRG 42.00: RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$10,099.05

Service Code	MSDRG 182
Min. Negotiated Rate	$6,852.93
Max. Negotiated Rate	$10,099.05
Rate for Payer: Anthem Medicaid	$6,852.93
Rate for Payer: Anthem Medicare Advantage/PPO	$7,213.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,099.05
Rate for Payer: CareSource Just4Me Medicare	$9,738.37
Rate for Payer: Humana KY Medicaid	$6,852.93
Rate for Payer: Humana Medicare Advantage	$7,213.61
Rate for Payer: Kentucky WC Medicaid	$6,921.46
Rate for Payer: Molina Healthcare Benefit Exchange	$8,656.33
Rate for Payer: Molina Healthcare Medicaid	$6,989.99

MS-DRG 42.00: RESPIRATORY SIGNS AND SYMPTOMS

Facility

$9,779.50

Service Code	MSDRG 204
Min. Negotiated Rate	$6,636.09
Max. Negotiated Rate	$9,779.50
Rate for Payer: Anthem Medicaid	$6,636.09
Rate for Payer: Anthem Medicare Advantage/PPO	$6,985.36
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,779.50
Rate for Payer: CareSource Just4Me Medicare	$9,430.24
Rate for Payer: Humana KY Medicaid	$6,636.09
Rate for Payer: Humana Medicare Advantage	$6,985.36
Rate for Payer: Kentucky WC Medicaid	$6,702.45
Rate for Payer: Molina Healthcare Benefit Exchange	$8,382.43
Rate for Payer: Molina Healthcare Medicaid	$6,768.81

MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$32,362.79

Service Code	MSDRG 208
Min. Negotiated Rate	$21,960.47
Max. Negotiated Rate	$32,362.79
Rate for Payer: Anthem Medicaid	$21,960.47
Rate for Payer: Anthem Medicare Advantage/PPO	$23,116.28
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$32,362.79
Rate for Payer: CareSource Just4Me Medicare	$31,206.98
Rate for Payer: Humana KY Medicaid	$21,960.47
Rate for Payer: Humana Medicare Advantage	$23,116.28
Rate for Payer: Kentucky WC Medicaid	$22,180.07
Rate for Payer: Molina Healthcare Benefit Exchange	$27,739.54
Rate for Payer: Molina Healthcare Medicaid	$22,399.68

MS-DRG 42.00: RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$77,985.18

Service Code	MSDRG 207
Min. Negotiated Rate	$52,918.51
Max. Negotiated Rate	$77,985.18
Rate for Payer: Anthem Medicaid	$52,918.51
Rate for Payer: Anthem Medicare Advantage/PPO	$55,703.70
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$77,985.18
Rate for Payer: CareSource Just4Me Medicare	$75,199.99
Rate for Payer: Humana KY Medicaid	$52,918.51
Rate for Payer: Humana Medicare Advantage	$55,703.70
Rate for Payer: Kentucky WC Medicaid	$53,447.70
Rate for Payer: Molina Healthcare Benefit Exchange	$66,844.44
Rate for Payer: Molina Healthcare Medicaid	$53,976.89

MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$12,252.72

Service Code	MSDRG 815
Min. Negotiated Rate	$8,314.34
Max. Negotiated Rate	$12,252.72
Rate for Payer: Anthem Medicaid	$8,314.34
Rate for Payer: Anthem Medicare Advantage/PPO	$8,751.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,252.72
Rate for Payer: CareSource Just4Me Medicare	$11,815.12
Rate for Payer: Humana KY Medicaid	$8,314.34
Rate for Payer: Humana Medicare Advantage	$8,751.94
Rate for Payer: Kentucky WC Medicaid	$8,397.49
Rate for Payer: Molina Healthcare Benefit Exchange	$10,502.33
Rate for Payer: Molina Healthcare Medicaid	$8,480.63

MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$25,208.46

Service Code	MSDRG 814
Min. Negotiated Rate	$17,105.74
Max. Negotiated Rate	$25,208.46
Rate for Payer: Anthem Medicaid	$17,105.74
Rate for Payer: Anthem Medicare Advantage/PPO	$18,006.04
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,208.46
Rate for Payer: CareSource Just4Me Medicare	$24,308.15
Rate for Payer: Humana KY Medicaid	$17,105.74
Rate for Payer: Humana Medicare Advantage	$18,006.04
Rate for Payer: Kentucky WC Medicaid	$17,276.80
Rate for Payer: Molina Healthcare Benefit Exchange	$21,607.25
Rate for Payer: Molina Healthcare Medicaid	$17,447.85

MS-DRG 42.00: RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$7,951.43

Service Code	MSDRG 816
Min. Negotiated Rate	$5,395.61
Max. Negotiated Rate	$7,951.43
Rate for Payer: Anthem Medicaid	$5,395.61
Rate for Payer: Anthem Medicare Advantage/PPO	$5,679.59
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,951.43
Rate for Payer: CareSource Just4Me Medicare	$7,667.45
Rate for Payer: Humana KY Medicaid	$5,395.61
Rate for Payer: Humana Medicare Advantage	$5,679.59
Rate for Payer: Kentucky WC Medicaid	$5,449.57
Rate for Payer: Molina Healthcare Benefit Exchange	$6,815.51
Rate for Payer: Molina Healthcare Medicaid	$5,503.52

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$41,303.00

Service Code	MSDRG 467
Min. Negotiated Rate	$28,027.03
Max. Negotiated Rate	$41,303.00
Rate for Payer: Anthem Medicaid	$28,027.03
Rate for Payer: Anthem Medicare Advantage/PPO	$29,502.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$41,303.00
Rate for Payer: CareSource Just4Me Medicare	$39,827.89
Rate for Payer: Humana KY Medicaid	$28,027.03
Rate for Payer: Humana Medicare Advantage	$29,502.14
Rate for Payer: Kentucky WC Medicaid	$28,307.30
Rate for Payer: Molina Healthcare Benefit Exchange	$35,402.57
Rate for Payer: Molina Healthcare Medicaid	$28,587.57

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$61,433.58

Service Code	MSDRG 466
Min. Negotiated Rate	$41,687.07
Max. Negotiated Rate	$61,433.58
Rate for Payer: Anthem Medicaid	$41,687.07
Rate for Payer: Anthem Medicare Advantage/PPO	$43,881.13
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$61,433.58
Rate for Payer: CareSource Just4Me Medicare	$59,239.53
Rate for Payer: Humana KY Medicaid	$41,687.07
Rate for Payer: Humana Medicare Advantage	$43,881.13
Rate for Payer: Kentucky WC Medicaid	$42,103.94
Rate for Payer: Molina Healthcare Benefit Exchange	$52,657.36
Rate for Payer: Molina Healthcare Medicaid	$42,520.81

MS-DRG 42.00: REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$31,633.24

Service Code	MSDRG 468
Min. Negotiated Rate	$21,465.41
Max. Negotiated Rate	$31,633.24
Rate for Payer: Anthem Medicaid	$21,465.41
Rate for Payer: Anthem Medicare Advantage/PPO	$22,595.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$31,633.24
Rate for Payer: CareSource Just4Me Medicare	$30,503.48
Rate for Payer: Humana KY Medicaid	$21,465.41
Rate for Payer: Humana Medicare Advantage	$22,595.17
Rate for Payer: Kentucky WC Medicaid	$21,680.07
Rate for Payer: Molina Healthcare Benefit Exchange	$27,114.20
Rate for Payer: Molina Healthcare Medicaid	$21,894.72

MS-DRG 42.00: SALIVARY GLAND PROCEDURES

Facility

$16,556.41

Service Code	MSDRG 139
Min. Negotiated Rate	$11,234.71
Max. Negotiated Rate	$16,556.41
Rate for Payer: Anthem Medicaid	$11,234.71
Rate for Payer: Anthem Medicare Advantage/PPO	$11,826.01
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,556.41
Rate for Payer: CareSource Just4Me Medicare	$15,965.11
Rate for Payer: Humana KY Medicaid	$11,234.71
Rate for Payer: Humana Medicare Advantage	$11,826.01
Rate for Payer: Kentucky WC Medicaid	$11,347.06
Rate for Payer: Molina Healthcare Benefit Exchange	$14,191.21
Rate for Payer: Molina Healthcare Medicaid	$11,459.40

MS-DRG 42.00: SEIZURES WITH MCC

Facility

$23,939.87

Service Code	MSDRG 100
Min. Negotiated Rate	$16,244.91
Max. Negotiated Rate	$23,939.87
Rate for Payer: Anthem Medicaid	$16,244.91
Rate for Payer: Anthem Medicare Advantage/PPO	$17,099.91
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,939.87
Rate for Payer: CareSource Just4Me Medicare	$23,084.88
Rate for Payer: Humana KY Medicaid	$16,244.91
Rate for Payer: Humana Medicare Advantage	$17,099.91
Rate for Payer: Kentucky WC Medicaid	$16,407.36
Rate for Payer: Molina Healthcare Benefit Exchange	$20,519.89
Rate for Payer: Molina Healthcare Medicaid	$16,569.81

MS-DRG 42.00: SEIZURES WITHOUT MCC

Facility

$11,114.36

Service Code	MSDRG 101
Min. Negotiated Rate	$7,541.89
Max. Negotiated Rate	$11,114.36
Rate for Payer: Anthem Medicaid	$7,541.89
Rate for Payer: Anthem Medicare Advantage/PPO	$7,938.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,114.36
Rate for Payer: CareSource Just4Me Medicare	$10,717.42
Rate for Payer: Humana KY Medicaid	$7,541.89
Rate for Payer: Humana Medicare Advantage	$7,938.83
Rate for Payer: Kentucky WC Medicaid	$7,617.31
Rate for Payer: Molina Healthcare Benefit Exchange	$9,526.60
Rate for Payer: Molina Healthcare Medicaid	$7,692.73

MS-DRG 42.00: SEPTIC ARTHRITIS WITH CC

Facility

$14,531.79

Service Code	MSDRG 549
Min. Negotiated Rate	$9,860.86
Max. Negotiated Rate	$14,531.79
Rate for Payer: Anthem Medicaid	$9,860.86
Rate for Payer: Anthem Medicare Advantage/PPO	$10,379.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,531.79
Rate for Payer: CareSource Just4Me Medicare	$14,012.80
Rate for Payer: Humana KY Medicaid	$9,860.86
Rate for Payer: Humana Medicare Advantage	$10,379.85
Rate for Payer: Kentucky WC Medicaid	$9,959.47
Rate for Payer: Molina Healthcare Benefit Exchange	$12,455.82
Rate for Payer: Molina Healthcare Medicaid	$10,058.07

MS-DRG 42.00: SEPTIC ARTHRITIS WITH MCC

Facility

$24,293.21

Service Code	MSDRG 548
Min. Negotiated Rate	$16,484.68
Max. Negotiated Rate	$24,293.21
Rate for Payer: Anthem Medicaid	$16,484.68
Rate for Payer: Anthem Medicare Advantage/PPO	$17,352.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,293.21
Rate for Payer: CareSource Just4Me Medicare	$23,425.59
Rate for Payer: Humana KY Medicaid	$16,484.68
Rate for Payer: Humana Medicare Advantage	$17,352.29
Rate for Payer: Kentucky WC Medicaid	$16,649.52
Rate for Payer: Molina Healthcare Benefit Exchange	$20,822.75
Rate for Payer: Molina Healthcare Medicaid	$16,814.37

MS-DRG 42.00: SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$10,395.69

Service Code	MSDRG 550
Min. Negotiated Rate	$7,054.22
Max. Negotiated Rate	$10,395.69
Rate for Payer: Anthem Medicaid	$7,054.22
Rate for Payer: Anthem Medicare Advantage/PPO	$7,425.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,395.69
Rate for Payer: CareSource Just4Me Medicare	$10,024.41
Rate for Payer: Humana KY Medicaid	$7,054.22
Rate for Payer: Humana Medicare Advantage	$7,425.49
Rate for Payer: Kentucky WC Medicaid	$7,124.76
Rate for Payer: Molina Healthcare Benefit Exchange	$8,910.59
Rate for Payer: Molina Healthcare Medicaid	$7,195.30

MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$83,885.44

Service Code	MSDRG 870
Min. Negotiated Rate	$56,922.26
Max. Negotiated Rate	$83,885.44
Rate for Payer: Anthem Medicaid	$56,922.26
Rate for Payer: Anthem Medicare Advantage/PPO	$59,918.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$83,885.44
Rate for Payer: CareSource Just4Me Medicare	$80,889.53
Rate for Payer: Humana KY Medicaid	$56,922.26
Rate for Payer: Humana Medicare Advantage	$59,918.17
Rate for Payer: Kentucky WC Medicaid	$57,491.48
Rate for Payer: Molina Healthcare Benefit Exchange	$71,901.80
Rate for Payer: Molina Healthcare Medicaid	$58,060.71

MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$23,660.11

Service Code	MSDRG 871
Min. Negotiated Rate	$16,055.08
Max. Negotiated Rate	$23,660.11
Rate for Payer: Anthem Medicaid	$16,055.08
Rate for Payer: Anthem Medicare Advantage/PPO	$16,900.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,660.11
Rate for Payer: CareSource Just4Me Medicare	$22,815.11
Rate for Payer: Humana KY Medicaid	$16,055.08
Rate for Payer: Humana Medicare Advantage	$16,900.08
Rate for Payer: Kentucky WC Medicaid	$16,215.63
Rate for Payer: Molina Healthcare Benefit Exchange	$20,280.10
Rate for Payer: Molina Healthcare Medicaid	$16,376.18

MS-DRG 42.00: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$12,432.38

Service Code	MSDRG 872
Min. Negotiated Rate	$8,436.26
Max. Negotiated Rate	$12,432.38
Rate for Payer: Anthem Medicaid	$8,436.26
Rate for Payer: Anthem Medicare Advantage/PPO	$8,880.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,432.38
Rate for Payer: CareSource Just4Me Medicare	$11,988.36
Rate for Payer: Humana KY Medicaid	$8,436.26
Rate for Payer: Humana Medicare Advantage	$8,880.27
Rate for Payer: Kentucky WC Medicaid	$8,520.62
Rate for Payer: Molina Healthcare Benefit Exchange	$10,656.32
Rate for Payer: Molina Healthcare Medicaid	$8,604.98

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$23,649.26

Service Code	MSDRG 511
Min. Negotiated Rate	$16,047.71
Max. Negotiated Rate	$23,649.26
Rate for Payer: Anthem Medicaid	$16,047.71
Rate for Payer: Anthem Medicare Advantage/PPO	$16,892.33
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,649.26
Rate for Payer: CareSource Just4Me Medicare	$22,804.65
Rate for Payer: Humana KY Medicaid	$16,047.71
Rate for Payer: Humana Medicare Advantage	$16,892.33
Rate for Payer: Kentucky WC Medicaid	$16,208.19
Rate for Payer: Molina Healthcare Benefit Exchange	$20,270.80
Rate for Payer: Molina Healthcare Medicaid	$16,368.67

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$34,464.60

Service Code	MSDRG 510
Min. Negotiated Rate	$23,386.69
Max. Negotiated Rate	$34,464.60
Rate for Payer: Anthem Medicaid	$23,386.69
Rate for Payer: Anthem Medicare Advantage/PPO	$24,617.57
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$34,464.60
Rate for Payer: CareSource Just4Me Medicare	$33,233.72
Rate for Payer: Humana KY Medicaid	$23,386.69
Rate for Payer: Humana Medicare Advantage	$24,617.57
Rate for Payer: Kentucky WC Medicaid	$23,620.56
Rate for Payer: Molina Healthcare Benefit Exchange	$29,541.08
Rate for Payer: Molina Healthcare Medicaid	$23,854.43

MS-DRG 42.00: SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$19,387.76

Service Code	MSDRG 512
Min. Negotiated Rate	$13,155.98
Max. Negotiated Rate	$19,387.76
Rate for Payer: Anthem Medicaid	$13,155.98
Rate for Payer: Anthem Medicare Advantage/PPO	$13,848.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,387.76
Rate for Payer: CareSource Just4Me Medicare	$18,695.34
Rate for Payer: Humana KY Medicaid	$13,155.98
Rate for Payer: Humana Medicare Advantage	$13,848.40
Rate for Payer: Kentucky WC Medicaid	$13,287.54
Rate for Payer: Molina Healthcare Benefit Exchange	$16,618.08
Rate for Payer: Molina Healthcare Medicaid	$13,419.10

Know your out-of-pocket cost for care.

All Charges