Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$16,238.05

Service Code	MSDRG 555
Min. Negotiated Rate	$11,018.68
Max. Negotiated Rate	$16,238.05
Rate for Payer: Anthem Medicaid	$11,018.68
Rate for Payer: Anthem Medicare Advantage/PPO	$11,598.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,238.05
Rate for Payer: CareSource Just4Me Medicare	$15,658.12
Rate for Payer: Humana KY Medicaid	$11,018.68
Rate for Payer: Humana Medicare Advantage	$11,598.61
Rate for Payer: Kentucky WC Medicaid	$11,128.87
Rate for Payer: Molina Healthcare Benefit Exchange	$13,918.33
Rate for Payer: Molina Healthcare Medicaid	$11,239.05

MS-DRG 42.00: SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC

Facility

$9,845.84

Service Code	MSDRG 556
Min. Negotiated Rate	$6,681.10
Max. Negotiated Rate	$9,845.84
Rate for Payer: Anthem Medicaid	$6,681.10
Rate for Payer: Anthem Medicare Advantage/PPO	$7,032.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,845.84
Rate for Payer: CareSource Just4Me Medicare	$9,494.20
Rate for Payer: Humana KY Medicaid	$6,681.10
Rate for Payer: Humana Medicare Advantage	$7,032.74
Rate for Payer: Kentucky WC Medicaid	$6,747.91
Rate for Payer: Molina Healthcare Benefit Exchange	$8,439.29
Rate for Payer: Molina Healthcare Medicaid	$6,814.73

MS-DRG 42.00: SIGNS AND SYMPTOMS WITH MCC

Facility

$15,509.73

Service Code	MSDRG 947
Min. Negotiated Rate	$10,524.46
Max. Negotiated Rate	$15,509.73
Rate for Payer: Anthem Medicaid	$10,524.46
Rate for Payer: Anthem Medicare Advantage/PPO	$11,078.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,509.73
Rate for Payer: CareSource Just4Me Medicare	$14,955.81
Rate for Payer: Humana KY Medicaid	$10,524.46
Rate for Payer: Humana Medicare Advantage	$11,078.38
Rate for Payer: Kentucky WC Medicaid	$10,629.71
Rate for Payer: Molina Healthcare Benefit Exchange	$13,294.06
Rate for Payer: Molina Healthcare Medicaid	$10,734.95

MS-DRG 42.00: SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$9,580.52

Service Code	MSDRG 948
Min. Negotiated Rate	$6,501.07
Max. Negotiated Rate	$9,580.52
Rate for Payer: Anthem Medicaid	$6,501.07
Rate for Payer: Anthem Medicare Advantage/PPO	$6,843.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,580.52
Rate for Payer: CareSource Just4Me Medicare	$9,238.36
Rate for Payer: Humana KY Medicaid	$6,501.07
Rate for Payer: Humana Medicare Advantage	$6,843.23
Rate for Payer: Kentucky WC Medicaid	$6,566.08
Rate for Payer: Molina Healthcare Benefit Exchange	$8,211.88
Rate for Payer: Molina Healthcare Medicaid	$6,631.09

MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH CC

Facility

$9,888.03

Service Code	MSDRG 194
Min. Negotiated Rate	$6,709.74
Max. Negotiated Rate	$9,888.03
Rate for Payer: Anthem Medicaid	$6,709.74
Rate for Payer: Anthem Medicare Advantage/PPO	$7,062.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,888.03
Rate for Payer: CareSource Just4Me Medicare	$9,534.89
Rate for Payer: Humana KY Medicaid	$6,709.74
Rate for Payer: Humana Medicare Advantage	$7,062.88
Rate for Payer: Kentucky WC Medicaid	$6,776.83
Rate for Payer: Molina Healthcare Benefit Exchange	$8,475.46
Rate for Payer: Molina Healthcare Medicaid	$6,843.93

MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITH MCC

Facility

$15,889.57

Service Code	MSDRG 193
Min. Negotiated Rate	$10,782.21
Max. Negotiated Rate	$15,889.57
Rate for Payer: Anthem Medicaid	$10,782.21
Rate for Payer: Anthem Medicare Advantage/PPO	$11,349.69
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,889.57
Rate for Payer: CareSource Just4Me Medicare	$15,322.08
Rate for Payer: Humana KY Medicaid	$10,782.21
Rate for Payer: Humana Medicare Advantage	$11,349.69
Rate for Payer: Kentucky WC Medicaid	$10,890.03
Rate for Payer: Molina Healthcare Benefit Exchange	$13,619.63
Rate for Payer: Molina Healthcare Medicaid	$10,997.85

MS-DRG 42.00: SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC

Facility

$7,508.86

Service Code	MSDRG 195
Min. Negotiated Rate	$5,095.30
Max. Negotiated Rate	$7,508.86
Rate for Payer: Anthem Medicaid	$5,095.30
Rate for Payer: Anthem Medicare Advantage/PPO	$5,363.47
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,508.86
Rate for Payer: CareSource Just4Me Medicare	$7,240.68
Rate for Payer: Humana KY Medicaid	$5,095.30
Rate for Payer: Humana Medicare Advantage	$5,363.47
Rate for Payer: Kentucky WC Medicaid	$5,146.25
Rate for Payer: Molina Healthcare Benefit Exchange	$6,436.16
Rate for Payer: Molina Healthcare Medicaid	$5,197.20

MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility

$65,611.87

Service Code	MSDRG 008
Min. Negotiated Rate	$44,522.34
Max. Negotiated Rate	$65,611.87
Rate for Payer: Anthem Medicaid	$44,522.34
Rate for Payer: Anthem Medicare Advantage/PPO	$46,865.62
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$65,611.87
Rate for Payer: CareSource Just4Me Medicare	$63,268.59
Rate for Payer: Humana KY Medicaid	$44,522.34
Rate for Payer: Humana Medicare Advantage	$46,865.62
Rate for Payer: Kentucky WC Medicaid	$44,967.56
Rate for Payer: Molina Healthcare Benefit Exchange	$56,238.74
Rate for Payer: Molina Healthcare Medicaid	$45,412.79

MS-DRG 42.00: SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

Facility

$95,591.89

Service Code	MSDRG 019
Min. Negotiated Rate	$64,865.92
Max. Negotiated Rate	$95,591.89
Rate for Payer: Anthem Medicaid	$64,865.92
Rate for Payer: Anthem Medicare Advantage/PPO	$68,279.92
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$95,591.89
Rate for Payer: CareSource Just4Me Medicare	$92,177.89
Rate for Payer: Humana KY Medicaid	$64,865.92
Rate for Payer: Humana Medicare Advantage	$68,279.92
Rate for Payer: Kentucky WC Medicaid	$65,514.58
Rate for Payer: Molina Healthcare Benefit Exchange	$81,935.90
Rate for Payer: Molina Healthcare Medicaid	$66,163.24

MS-DRG 42.00: SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$47,175.53

Service Code	MSDRG 402
Min. Negotiated Rate	$32,011.97
Max. Negotiated Rate	$47,175.53
Rate for Payer: Anthem Medicaid	$32,011.97
Rate for Payer: Anthem Medicare Advantage/PPO	$33,696.81
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,175.53
Rate for Payer: CareSource Just4Me Medicare	$45,490.69
Rate for Payer: Humana KY Medicaid	$32,011.97
Rate for Payer: Humana Medicare Advantage	$33,696.81
Rate for Payer: Kentucky WC Medicaid	$32,332.09
Rate for Payer: Molina Healthcare Benefit Exchange	$40,436.17
Rate for Payer: Molina Healthcare Medicaid	$32,652.21

MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$62,102.84

Service Code	MSDRG 450
Min. Negotiated Rate	$42,141.21
Max. Negotiated Rate	$62,102.84
Rate for Payer: Anthem Medicaid	$42,141.21
Rate for Payer: Anthem Medicare Advantage/PPO	$44,359.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$62,102.84
Rate for Payer: CareSource Just4Me Medicare	$59,884.88
Rate for Payer: Humana KY Medicaid	$42,141.21
Rate for Payer: Humana Medicare Advantage	$44,359.17
Rate for Payer: Kentucky WC Medicaid	$42,562.62
Rate for Payer: Molina Healthcare Benefit Exchange	$53,231.00
Rate for Payer: Molina Healthcare Medicaid	$42,984.04

MS-DRG 42.00: SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$37,212.73

Service Code	MSDRG 451
Min. Negotiated Rate	$25,251.49
Max. Negotiated Rate	$37,212.73
Rate for Payer: Anthem Medicaid	$25,251.49
Rate for Payer: Anthem Medicare Advantage/PPO	$26,580.52
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,212.73
Rate for Payer: CareSource Just4Me Medicare	$35,883.70
Rate for Payer: Humana KY Medicaid	$25,251.49
Rate for Payer: Humana Medicare Advantage	$26,580.52
Rate for Payer: Kentucky WC Medicaid	$25,504.01
Rate for Payer: Molina Healthcare Benefit Exchange	$31,896.62
Rate for Payer: Molina Healthcare Medicaid	$25,756.52

MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$29,074.43

Service Code	MSDRG 135
Min. Negotiated Rate	$19,729.08
Max. Negotiated Rate	$29,074.43
Rate for Payer: Anthem Medicaid	$19,729.08
Rate for Payer: Anthem Medicare Advantage/PPO	$20,767.45
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,074.43
Rate for Payer: CareSource Just4Me Medicare	$28,036.06
Rate for Payer: Humana KY Medicaid	$19,729.08
Rate for Payer: Humana Medicare Advantage	$20,767.45
Rate for Payer: Kentucky WC Medicaid	$19,926.37
Rate for Payer: Molina Healthcare Benefit Exchange	$24,920.94
Rate for Payer: Molina Healthcare Medicaid	$20,123.66

MS-DRG 42.00: SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$11,795.69

Service Code	MSDRG 136
Min. Negotiated Rate	$8,004.22
Max. Negotiated Rate	$11,795.69
Rate for Payer: Anthem Medicaid	$8,004.22
Rate for Payer: Anthem Medicare Advantage/PPO	$8,425.49
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,795.69
Rate for Payer: CareSource Just4Me Medicare	$11,374.41
Rate for Payer: Humana KY Medicaid	$8,004.22
Rate for Payer: Humana Medicare Advantage	$8,425.49
Rate for Payer: Kentucky WC Medicaid	$8,084.26
Rate for Payer: Molina Healthcare Benefit Exchange	$10,110.59
Rate for Payer: Molina Healthcare Medicaid	$8,164.30

MS-DRG 42.00: SKIN DEBRIDEMENT WITH CC

Facility

$20,189.67

Service Code	MSDRG 571
Min. Negotiated Rate	$13,700.13
Max. Negotiated Rate	$20,189.67
Rate for Payer: Anthem Medicaid	$13,700.13
Rate for Payer: Anthem Medicare Advantage/PPO	$14,421.19
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,189.67
Rate for Payer: CareSource Just4Me Medicare	$19,468.61
Rate for Payer: Humana KY Medicaid	$13,700.13
Rate for Payer: Humana Medicare Advantage	$14,421.19
Rate for Payer: Kentucky WC Medicaid	$13,837.13
Rate for Payer: Molina Healthcare Benefit Exchange	$17,305.43
Rate for Payer: Molina Healthcare Medicaid	$13,974.13

MS-DRG 42.00: SKIN DEBRIDEMENT WITH MCC

Facility

$36,298.71

Service Code	MSDRG 570
Min. Negotiated Rate	$24,631.27
Max. Negotiated Rate	$36,298.71
Rate for Payer: Anthem Medicaid	$24,631.27
Rate for Payer: Anthem Medicare Advantage/PPO	$25,927.65
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$36,298.71
Rate for Payer: CareSource Just4Me Medicare	$35,002.33
Rate for Payer: Humana KY Medicaid	$24,631.27
Rate for Payer: Humana Medicare Advantage	$25,927.65
Rate for Payer: Kentucky WC Medicaid	$24,877.58
Rate for Payer: Molina Healthcare Benefit Exchange	$31,113.18
Rate for Payer: Molina Healthcare Medicaid	$25,123.89

MS-DRG 42.00: SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$13,775.69

Service Code	MSDRG 572
Min. Negotiated Rate	$9,347.79
Max. Negotiated Rate	$13,775.69
Rate for Payer: Anthem Medicaid	$9,347.79
Rate for Payer: Anthem Medicare Advantage/PPO	$9,839.78
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,775.69
Rate for Payer: CareSource Just4Me Medicare	$13,283.70
Rate for Payer: Humana KY Medicaid	$9,347.79
Rate for Payer: Humana Medicare Advantage	$9,839.78
Rate for Payer: Kentucky WC Medicaid	$9,441.27
Rate for Payer: Molina Healthcare Benefit Exchange	$11,807.74
Rate for Payer: Molina Healthcare Medicaid	$9,534.75

MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$32,109.57

Service Code	MSDRG 577
Min. Negotiated Rate	$21,788.64
Max. Negotiated Rate	$32,109.57
Rate for Payer: Anthem Medicaid	$21,788.64
Rate for Payer: Anthem Medicare Advantage/PPO	$22,935.41
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$32,109.57
Rate for Payer: CareSource Just4Me Medicare	$30,962.80
Rate for Payer: Humana KY Medicaid	$21,788.64
Rate for Payer: Humana Medicare Advantage	$22,935.41
Rate for Payer: Kentucky WC Medicaid	$22,006.53
Rate for Payer: Molina Healthcare Benefit Exchange	$27,522.49
Rate for Payer: Molina Healthcare Medicaid	$22,224.41

MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$65,059.60

Service Code	MSDRG 576
Min. Negotiated Rate	$44,147.58
Max. Negotiated Rate	$65,059.60
Rate for Payer: Anthem Medicaid	$44,147.58
Rate for Payer: Anthem Medicare Advantage/PPO	$46,471.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$65,059.60
Rate for Payer: CareSource Just4Me Medicare	$62,736.04
Rate for Payer: Humana KY Medicaid	$44,147.58
Rate for Payer: Humana Medicare Advantage	$46,471.14
Rate for Payer: Kentucky WC Medicaid	$44,589.06
Rate for Payer: Molina Healthcare Benefit Exchange	$55,765.37
Rate for Payer: Molina Healthcare Medicaid	$45,030.53

MS-DRG 42.00: SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$20,383.79

Service Code	MSDRG 578
Min. Negotiated Rate	$13,831.86
Max. Negotiated Rate	$20,383.79
Rate for Payer: Anthem Medicaid	$13,831.86
Rate for Payer: Anthem Medicare Advantage/PPO	$14,559.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,383.79
Rate for Payer: CareSource Just4Me Medicare	$19,655.80
Rate for Payer: Humana KY Medicaid	$13,831.86
Rate for Payer: Humana Medicare Advantage	$14,559.85
Rate for Payer: Kentucky WC Medicaid	$13,970.18
Rate for Payer: Molina Healthcare Benefit Exchange	$17,471.82
Rate for Payer: Molina Healthcare Medicaid	$14,108.49

MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$41,781.73

Service Code	MSDRG 574
Min. Negotiated Rate	$28,351.89
Max. Negotiated Rate	$41,781.73
Rate for Payer: Anthem Medicaid	$28,351.89
Rate for Payer: Anthem Medicare Advantage/PPO	$29,844.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$41,781.73
Rate for Payer: CareSource Just4Me Medicare	$40,289.52
Rate for Payer: Humana KY Medicaid	$28,351.89
Rate for Payer: Humana Medicare Advantage	$29,844.09
Rate for Payer: Kentucky WC Medicaid	$28,635.40
Rate for Payer: Molina Healthcare Benefit Exchange	$35,812.91
Rate for Payer: Molina Healthcare Medicaid	$28,918.92

MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$74,259.07

Service Code	MSDRG 573
Min. Negotiated Rate	$50,390.08
Max. Negotiated Rate	$74,259.07
Rate for Payer: Anthem Medicaid	$50,390.08
Rate for Payer: Anthem Medicare Advantage/PPO	$53,042.19
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$74,259.07
Rate for Payer: CareSource Just4Me Medicare	$71,606.96
Rate for Payer: Humana KY Medicaid	$50,390.08
Rate for Payer: Humana Medicare Advantage	$53,042.19
Rate for Payer: Kentucky WC Medicaid	$50,893.98
Rate for Payer: Molina Healthcare Benefit Exchange	$63,650.63
Rate for Payer: Molina Healthcare Medicaid	$51,397.88

MS-DRG 42.00: SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$24,077.33

Service Code	MSDRG 575
Min. Negotiated Rate	$16,338.19
Max. Negotiated Rate	$24,077.33
Rate for Payer: Anthem Medicaid	$16,338.19
Rate for Payer: Anthem Medicare Advantage/PPO	$17,198.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,077.33
Rate for Payer: CareSource Just4Me Medicare	$23,217.42
Rate for Payer: Humana KY Medicaid	$16,338.19
Rate for Payer: Humana Medicare Advantage	$17,198.09
Rate for Payer: Kentucky WC Medicaid	$16,501.57
Rate for Payer: Molina Healthcare Benefit Exchange	$20,637.71
Rate for Payer: Molina Healthcare Medicaid	$16,664.95

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$23,065.63

Service Code	MSDRG 623
Min. Negotiated Rate	$15,651.68
Max. Negotiated Rate	$23,065.63
Rate for Payer: Anthem Medicaid	$15,651.68
Rate for Payer: Anthem Medicare Advantage/PPO	$16,475.45
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,065.63
Rate for Payer: CareSource Just4Me Medicare	$22,241.86
Rate for Payer: Humana KY Medicaid	$15,651.68
Rate for Payer: Humana Medicare Advantage	$16,475.45
Rate for Payer: Kentucky WC Medicaid	$15,808.19
Rate for Payer: Molina Healthcare Benefit Exchange	$19,770.54
Rate for Payer: Molina Healthcare Medicaid	$15,964.71

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$45,123.16

Service Code	MSDRG 622
Min. Negotiated Rate	$30,619.29
Max. Negotiated Rate	$45,123.16
Rate for Payer: Anthem Medicaid	$30,619.29
Rate for Payer: Anthem Medicare Advantage/PPO	$32,230.83
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$45,123.16
Rate for Payer: CareSource Just4Me Medicare	$43,511.62
Rate for Payer: Humana KY Medicaid	$30,619.29
Rate for Payer: Humana Medicare Advantage	$32,230.83
Rate for Payer: Kentucky WC Medicaid	$30,925.48
Rate for Payer: Molina Healthcare Benefit Exchange	$38,677.00
Rate for Payer: Molina Healthcare Medicaid	$31,231.67

Know your out-of-pocket cost for care.

All Charges