Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$12,095.97

Service Code	MSDRG 624
Min. Negotiated Rate	$8,207.98
Max. Negotiated Rate	$12,095.97
Rate for Payer: Anthem Medicaid	$8,207.98
Rate for Payer: Anthem Medicare Advantage/PPO	$8,639.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,095.97
Rate for Payer: CareSource Just4Me Medicare	$11,663.97
Rate for Payer: Humana KY Medicaid	$8,207.98
Rate for Payer: Humana Medicare Advantage	$8,639.98
Rate for Payer: Kentucky WC Medicaid	$8,290.06
Rate for Payer: Molina Healthcare Benefit Exchange	$10,367.98
Rate for Payer: Molina Healthcare Medicaid	$8,372.14

MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$46,559.34

Service Code	MSDRG 904
Min. Negotiated Rate	$31,593.84
Max. Negotiated Rate	$46,559.34
Rate for Payer: Anthem Medicaid	$31,593.84
Rate for Payer: Anthem Medicare Advantage/PPO	$33,256.67
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$46,559.34
Rate for Payer: CareSource Just4Me Medicare	$44,896.50
Rate for Payer: Humana KY Medicaid	$31,593.84
Rate for Payer: Humana Medicare Advantage	$33,256.67
Rate for Payer: Kentucky WC Medicaid	$31,909.77
Rate for Payer: Molina Healthcare Benefit Exchange	$39,908.00
Rate for Payer: Molina Healthcare Medicaid	$32,225.71

MS-DRG 42.00: SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$19,874.93

Service Code	MSDRG 905
Min. Negotiated Rate	$13,486.56
Max. Negotiated Rate	$19,874.93
Rate for Payer: Anthem Medicaid	$13,486.56
Rate for Payer: Anthem Medicare Advantage/PPO	$14,196.38
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,874.93
Rate for Payer: CareSource Just4Me Medicare	$19,165.11
Rate for Payer: Humana KY Medicaid	$13,486.56
Rate for Payer: Humana Medicare Advantage	$14,196.38
Rate for Payer: Kentucky WC Medicaid	$13,621.43
Rate for Payer: Molina Healthcare Benefit Exchange	$17,035.66
Rate for Payer: Molina Healthcare Medicaid	$13,756.29

MS-DRG 42.00: SKIN ULCERS WITH CC

Facility

$14,744.02

Service Code	MSDRG 593
Min. Negotiated Rate	$10,004.87
Max. Negotiated Rate	$14,744.02
Rate for Payer: Anthem Medicaid	$10,004.87
Rate for Payer: Anthem Medicare Advantage/PPO	$10,531.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,744.02
Rate for Payer: CareSource Just4Me Medicare	$14,217.44
Rate for Payer: Humana KY Medicaid	$10,004.87
Rate for Payer: Humana Medicare Advantage	$10,531.44
Rate for Payer: Kentucky WC Medicaid	$10,104.92
Rate for Payer: Molina Healthcare Benefit Exchange	$12,637.73
Rate for Payer: Molina Healthcare Medicaid	$10,204.97

MS-DRG 42.00: SKIN ULCERS WITH MCC

Facility

$24,796.04

Service Code	MSDRG 592
Min. Negotiated Rate	$16,825.89
Max. Negotiated Rate	$24,796.04
Rate for Payer: Anthem Medicaid	$16,825.89
Rate for Payer: Anthem Medicare Advantage/PPO	$17,711.46
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,796.04
Rate for Payer: CareSource Just4Me Medicare	$23,910.47
Rate for Payer: Humana KY Medicaid	$16,825.89
Rate for Payer: Humana Medicare Advantage	$17,711.46
Rate for Payer: Kentucky WC Medicaid	$16,994.15
Rate for Payer: Molina Healthcare Benefit Exchange	$21,253.75
Rate for Payer: Molina Healthcare Medicaid	$17,162.40

MS-DRG 42.00: SKIN ULCERS WITHOUT CC/MCC

Facility

$10,234.08

Service Code	MSDRG 594
Min. Negotiated Rate	$6,944.56
Max. Negotiated Rate	$10,234.08
Rate for Payer: Anthem Medicaid	$6,944.56
Rate for Payer: Anthem Medicare Advantage/PPO	$7,310.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,234.08
Rate for Payer: CareSource Just4Me Medicare	$9,868.58
Rate for Payer: Humana KY Medicaid	$6,944.56
Rate for Payer: Humana Medicare Advantage	$7,310.06
Rate for Payer: Kentucky WC Medicaid	$7,014.00
Rate for Payer: Molina Healthcare Benefit Exchange	$8,772.07
Rate for Payer: Molina Healthcare Medicaid	$7,083.45

MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH CC

Facility

$21,520.93

Service Code	MSDRG 501
Min. Negotiated Rate	$14,603.49
Max. Negotiated Rate	$21,520.93
Rate for Payer: Anthem Medicaid	$14,603.49
Rate for Payer: Anthem Medicare Advantage/PPO	$15,372.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,520.93
Rate for Payer: CareSource Just4Me Medicare	$20,752.32
Rate for Payer: Humana KY Medicaid	$14,603.49
Rate for Payer: Humana Medicare Advantage	$15,372.09
Rate for Payer: Kentucky WC Medicaid	$14,749.52
Rate for Payer: Molina Healthcare Benefit Exchange	$18,446.51
Rate for Payer: Molina Healthcare Medicaid	$14,895.56

MS-DRG 42.00: SOFT TISSUE PROCEDURES WITH MCC

Facility

$38,209.99

Service Code	MSDRG 500
Min. Negotiated Rate	$25,928.21
Max. Negotiated Rate	$38,209.99
Rate for Payer: Anthem Medicaid	$25,928.21
Rate for Payer: Anthem Medicare Advantage/PPO	$27,292.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,209.99
Rate for Payer: CareSource Just4Me Medicare	$36,845.35
Rate for Payer: Humana KY Medicaid	$25,928.21
Rate for Payer: Humana Medicare Advantage	$27,292.85
Rate for Payer: Kentucky WC Medicaid	$26,187.49
Rate for Payer: Molina Healthcare Benefit Exchange	$32,751.42
Rate for Payer: Molina Healthcare Medicaid	$26,446.77

MS-DRG 42.00: SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$16,848.23

Service Code	MSDRG 502
Min. Negotiated Rate	$11,432.73
Max. Negotiated Rate	$16,848.23
Rate for Payer: Anthem Medicaid	$11,432.73
Rate for Payer: Anthem Medicare Advantage/PPO	$12,034.45
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,848.23
Rate for Payer: CareSource Just4Me Medicare	$16,246.51
Rate for Payer: Humana KY Medicaid	$11,432.73
Rate for Payer: Humana Medicare Advantage	$12,034.45
Rate for Payer: Kentucky WC Medicaid	$11,547.05
Rate for Payer: Molina Healthcare Benefit Exchange	$14,441.34
Rate for Payer: Molina Healthcare Medicaid	$11,661.38

MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$24,267.88

Service Code	MSDRG 052
Min. Negotiated Rate	$16,467.49
Max. Negotiated Rate	$24,267.88
Rate for Payer: Anthem Medicaid	$16,467.49
Rate for Payer: Anthem Medicare Advantage/PPO	$17,334.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,267.88
Rate for Payer: CareSource Just4Me Medicare	$23,401.17
Rate for Payer: Humana KY Medicaid	$16,467.49
Rate for Payer: Humana Medicare Advantage	$17,334.20
Rate for Payer: Kentucky WC Medicaid	$16,632.16
Rate for Payer: Molina Healthcare Benefit Exchange	$20,801.04
Rate for Payer: Molina Healthcare Medicaid	$16,796.84

MS-DRG 42.00: SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$11,110.76

Service Code	MSDRG 053
Min. Negotiated Rate	$7,539.45
Max. Negotiated Rate	$11,110.76
Rate for Payer: Anthem Medicaid	$7,539.45
Rate for Payer: Anthem Medicare Advantage/PPO	$7,936.26
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,110.76
Rate for Payer: CareSource Just4Me Medicare	$10,713.95
Rate for Payer: Humana KY Medicaid	$7,539.45
Rate for Payer: Humana Medicare Advantage	$7,936.26
Rate for Payer: Kentucky WC Medicaid	$7,614.84
Rate for Payer: Molina Healthcare Benefit Exchange	$9,523.51
Rate for Payer: Molina Healthcare Medicaid	$7,690.24

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$69,208.94

Service Code	MSDRG 457
Min. Negotiated Rate	$46,963.21
Max. Negotiated Rate	$69,208.94
Rate for Payer: Anthem Medicaid	$46,963.21
Rate for Payer: Anthem Medicare Advantage/PPO	$49,434.96
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$69,208.94
Rate for Payer: CareSource Just4Me Medicare	$66,737.20
Rate for Payer: Humana KY Medicaid	$46,963.21
Rate for Payer: Humana Medicare Advantage	$49,434.96
Rate for Payer: Kentucky WC Medicaid	$47,432.84
Rate for Payer: Molina Healthcare Benefit Exchange	$59,321.95
Rate for Payer: Molina Healthcare Medicaid	$47,902.48

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$102,126.42

Service Code	MSDRG 456
Min. Negotiated Rate	$69,300.07
Max. Negotiated Rate	$102,126.42
Rate for Payer: Anthem Medicaid	$69,300.07
Rate for Payer: Anthem Medicare Advantage/PPO	$72,947.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$102,126.42
Rate for Payer: CareSource Just4Me Medicare	$98,479.04
Rate for Payer: Humana KY Medicaid	$69,300.07
Rate for Payer: Humana Medicare Advantage	$72,947.44
Rate for Payer: Kentucky WC Medicaid	$69,993.07
Rate for Payer: Molina Healthcare Benefit Exchange	$87,536.93
Rate for Payer: Molina Healthcare Medicaid	$70,686.07

MS-DRG 42.00: SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$52,068.91

Service Code	MSDRG 458
Min. Negotiated Rate	$35,332.48
Max. Negotiated Rate	$52,068.91
Rate for Payer: Anthem Medicaid	$35,332.48
Rate for Payer: Anthem Medicare Advantage/PPO	$37,192.08
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$52,068.91
Rate for Payer: CareSource Just4Me Medicare	$50,209.31
Rate for Payer: Humana KY Medicaid	$35,332.48
Rate for Payer: Humana Medicare Advantage	$37,192.08
Rate for Payer: Kentucky WC Medicaid	$35,685.80
Rate for Payer: Molina Healthcare Benefit Exchange	$44,630.50
Rate for Payer: Molina Healthcare Medicaid	$36,039.13

MS-DRG 42.00: SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$40,477.00

Service Code	MSDRG 029
Min. Negotiated Rate	$27,466.53
Max. Negotiated Rate	$40,477.00
Rate for Payer: Anthem Medicaid	$27,466.53
Rate for Payer: Anthem Medicare Advantage/PPO	$28,912.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$40,477.00
Rate for Payer: CareSource Just4Me Medicare	$39,031.39
Rate for Payer: Humana KY Medicaid	$27,466.53
Rate for Payer: Humana Medicare Advantage	$28,912.14
Rate for Payer: Kentucky WC Medicaid	$27,741.20
Rate for Payer: Molina Healthcare Benefit Exchange	$34,694.57
Rate for Payer: Molina Healthcare Medicaid	$28,015.86

MS-DRG 42.00: SPINAL PROCEDURES WITH MCC

Facility

$73,310.06

Service Code	MSDRG 028
Min. Negotiated Rate	$49,746.11
Max. Negotiated Rate	$73,310.06
Rate for Payer: Anthem Medicaid	$49,746.11
Rate for Payer: Anthem Medicare Advantage/PPO	$52,364.33
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$73,310.06
Rate for Payer: CareSource Just4Me Medicare	$70,691.85
Rate for Payer: Humana KY Medicaid	$49,746.11
Rate for Payer: Humana Medicare Advantage	$52,364.33
Rate for Payer: Kentucky WC Medicaid	$50,243.57
Rate for Payer: Molina Healthcare Benefit Exchange	$62,837.20
Rate for Payer: Molina Healthcare Medicaid	$50,741.04

MS-DRG 42.00: SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$26,835.13

Service Code	MSDRG 030
Min. Negotiated Rate	$18,209.55
Max. Negotiated Rate	$26,835.13
Rate for Payer: Anthem Medicaid	$18,209.55
Rate for Payer: Anthem Medicare Advantage/PPO	$19,167.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$26,835.13
Rate for Payer: CareSource Just4Me Medicare	$25,876.73
Rate for Payer: Humana KY Medicaid	$18,209.55
Rate for Payer: Humana Medicare Advantage	$19,167.95
Rate for Payer: Kentucky WC Medicaid	$18,391.65
Rate for Payer: Molina Healthcare Benefit Exchange	$23,001.54
Rate for Payer: Molina Healthcare Medicaid	$18,573.74

MS-DRG 42.00: SPLENIC PROCEDURES WITH CC

Facility

$35,136.26

Service Code	MSDRG 800
Min. Negotiated Rate	$23,842.46
Max. Negotiated Rate	$35,136.26
Rate for Payer: Anthem Medicaid	$23,842.46
Rate for Payer: Anthem Medicare Advantage/PPO	$25,097.33
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$35,136.26
Rate for Payer: CareSource Just4Me Medicare	$33,881.40
Rate for Payer: Humana KY Medicaid	$23,842.46
Rate for Payer: Humana Medicare Advantage	$25,097.33
Rate for Payer: Kentucky WC Medicaid	$24,080.89
Rate for Payer: Molina Healthcare Benefit Exchange	$30,116.80
Rate for Payer: Molina Healthcare Medicaid	$24,319.31

MS-DRG 42.00: SPLENIC PROCEDURES WITH MCC

Facility

$57,336.09

Service Code	MSDRG 799
Min. Negotiated Rate	$38,906.63
Max. Negotiated Rate	$57,336.09
Rate for Payer: Anthem Medicaid	$38,906.63
Rate for Payer: Anthem Medicare Advantage/PPO	$40,954.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$57,336.09
Rate for Payer: CareSource Just4Me Medicare	$55,288.37
Rate for Payer: Humana KY Medicaid	$38,906.63
Rate for Payer: Humana Medicare Advantage	$40,954.35
Rate for Payer: Kentucky WC Medicaid	$39,295.70
Rate for Payer: Molina Healthcare Benefit Exchange	$49,145.22
Rate for Payer: Molina Healthcare Medicaid	$39,684.77

MS-DRG 42.00: SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$19,796.55

Service Code	MSDRG 801
Min. Negotiated Rate	$13,433.37
Max. Negotiated Rate	$19,796.55
Rate for Payer: Anthem Medicaid	$13,433.37
Rate for Payer: Anthem Medicare Advantage/PPO	$14,140.39
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,796.55
Rate for Payer: CareSource Just4Me Medicare	$19,089.53
Rate for Payer: Humana KY Medicaid	$13,433.37
Rate for Payer: Humana Medicare Advantage	$14,140.39
Rate for Payer: Kentucky WC Medicaid	$13,567.70
Rate for Payer: Molina Healthcare Benefit Exchange	$16,968.47
Rate for Payer: Molina Healthcare Medicaid	$13,702.04

MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC

Facility

$11,081.81

Service Code	MSDRG 537
Min. Negotiated Rate	$7,519.80
Max. Negotiated Rate	$11,081.81
Rate for Payer: Anthem Medicaid	$7,519.80
Rate for Payer: Anthem Medicare Advantage/PPO	$7,915.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,081.81
Rate for Payer: CareSource Just4Me Medicare	$10,686.03
Rate for Payer: Humana KY Medicaid	$7,519.80
Rate for Payer: Humana Medicare Advantage	$7,915.58
Rate for Payer: Kentucky WC Medicaid	$7,595.00
Rate for Payer: Molina Healthcare Benefit Exchange	$9,498.70
Rate for Payer: Molina Healthcare Medicaid	$7,670.20

MS-DRG 42.00: SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC

Facility

$8,097.35

Service Code	MSDRG 538
Min. Negotiated Rate	$5,494.63
Max. Negotiated Rate	$8,097.35
Rate for Payer: Anthem Medicaid	$5,494.63
Rate for Payer: Anthem Medicare Advantage/PPO	$5,783.82
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,097.35
Rate for Payer: CareSource Just4Me Medicare	$7,808.16
Rate for Payer: Humana KY Medicaid	$5,494.63
Rate for Payer: Humana Medicare Advantage	$5,783.82
Rate for Payer: Kentucky WC Medicaid	$5,549.58
Rate for Payer: Molina Healthcare Benefit Exchange	$6,940.58
Rate for Payer: Molina Healthcare Medicaid	$5,604.52

MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$29,279.40

Service Code	MSDRG 327
Min. Negotiated Rate	$19,868.17
Max. Negotiated Rate	$29,279.40
Rate for Payer: Anthem Medicaid	$19,868.17
Rate for Payer: Anthem Medicare Advantage/PPO	$20,913.86
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,279.40
Rate for Payer: CareSource Just4Me Medicare	$28,233.71
Rate for Payer: Humana KY Medicaid	$19,868.17
Rate for Payer: Humana Medicare Advantage	$20,913.86
Rate for Payer: Kentucky WC Medicaid	$20,066.85
Rate for Payer: Molina Healthcare Benefit Exchange	$25,096.63
Rate for Payer: Molina Healthcare Medicaid	$20,265.53

MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$61,245.46

Service Code	MSDRG 326
Min. Negotiated Rate	$41,559.42
Max. Negotiated Rate	$61,245.46
Rate for Payer: Anthem Medicaid	$41,559.42
Rate for Payer: Anthem Medicare Advantage/PPO	$43,746.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$61,245.46
Rate for Payer: CareSource Just4Me Medicare	$59,058.13
Rate for Payer: Humana KY Medicaid	$41,559.42
Rate for Payer: Humana Medicare Advantage	$43,746.76
Rate for Payer: Kentucky WC Medicaid	$41,975.02
Rate for Payer: Molina Healthcare Benefit Exchange	$52,496.11
Rate for Payer: Molina Healthcare Medicaid	$42,390.61

MS-DRG 42.00: STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$19,215.31

Service Code	MSDRG 328
Min. Negotiated Rate	$13,038.96
Max. Negotiated Rate	$19,215.31
Rate for Payer: Anthem Medicaid	$13,038.96
Rate for Payer: Anthem Medicare Advantage/PPO	$13,725.22
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$19,215.31
Rate for Payer: CareSource Just4Me Medicare	$18,529.05
Rate for Payer: Humana KY Medicaid	$13,038.96
Rate for Payer: Humana Medicare Advantage	$13,725.22
Rate for Payer: Kentucky WC Medicaid	$13,169.35
Rate for Payer: Molina Healthcare Benefit Exchange	$16,470.26
Rate for Payer: Molina Healthcare Medicaid	$13,299.74

Know your out-of-pocket cost for care.

All Charges