Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

MS-DRG 42.00: TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$11,529.17

Service Code	MSDRG 084
Min. Negotiated Rate	$7,823.36
Max. Negotiated Rate	$11,529.17
Rate for Payer: Anthem Medicaid	$7,823.36
Rate for Payer: Anthem Medicare Advantage/PPO	$8,235.12
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,529.17
Rate for Payer: CareSource Just4Me Medicare	$11,117.41
Rate for Payer: Humana KY Medicaid	$7,823.36
Rate for Payer: Humana Medicare Advantage	$8,235.12
Rate for Payer: Kentucky WC Medicaid	$7,901.60
Rate for Payer: Molina Healthcare Benefit Exchange	$9,882.14
Rate for Payer: Molina Healthcare Medicaid	$7,979.83

MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$17,915.41

Service Code	MSDRG 604
Min. Negotiated Rate	$12,156.88
Max. Negotiated Rate	$17,915.41
Rate for Payer: Anthem Medicaid	$12,156.88
Rate for Payer: Anthem Medicare Advantage/PPO	$12,796.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,915.41
Rate for Payer: CareSource Just4Me Medicare	$17,275.57
Rate for Payer: Humana KY Medicaid	$12,156.88
Rate for Payer: Humana Medicare Advantage	$12,796.72
Rate for Payer: Kentucky WC Medicaid	$12,278.45
Rate for Payer: Molina Healthcare Benefit Exchange	$15,356.06
Rate for Payer: Molina Healthcare Medicaid	$12,400.02

MS-DRG 42.00: TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$11,138.48

Service Code	MSDRG 605
Min. Negotiated Rate	$7,558.26
Max. Negotiated Rate	$11,138.48
Rate for Payer: Anthem Medicaid	$7,558.26
Rate for Payer: Anthem Medicare Advantage/PPO	$7,956.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,138.48
Rate for Payer: CareSource Just4Me Medicare	$10,740.68
Rate for Payer: Humana KY Medicaid	$7,558.26
Rate for Payer: Humana Medicare Advantage	$7,956.06
Rate for Payer: Kentucky WC Medicaid	$7,633.84
Rate for Payer: Molina Healthcare Benefit Exchange	$9,547.27
Rate for Payer: Molina Healthcare Medicaid	$7,709.42

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$60,332.64

Service Code	MSDRG 278
Min. Negotiated Rate	$40,940.00
Max. Negotiated Rate	$60,332.64
Rate for Payer: Anthem Medicaid	$40,940.00
Rate for Payer: Anthem Medicare Advantage/PPO	$43,094.74
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$60,332.64
Rate for Payer: CareSource Just4Me Medicare	$58,177.90
Rate for Payer: Humana KY Medicaid	$40,940.00
Rate for Payer: Humana Medicare Advantage	$43,094.74
Rate for Payer: Kentucky WC Medicaid	$41,349.40
Rate for Payer: Molina Healthcare Benefit Exchange	$51,713.69
Rate for Payer: Molina Healthcare Medicaid	$41,758.80

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$38,640.48

Service Code	MSDRG 279
Min. Negotiated Rate	$26,220.32
Max. Negotiated Rate	$38,640.48
Rate for Payer: Anthem Medicaid	$26,220.32
Rate for Payer: Anthem Medicare Advantage/PPO	$27,600.34
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,640.48
Rate for Payer: CareSource Just4Me Medicare	$37,260.46
Rate for Payer: Humana KY Medicaid	$26,220.32
Rate for Payer: Humana Medicare Advantage	$27,600.34
Rate for Payer: Kentucky WC Medicaid	$26,482.53
Rate for Payer: Molina Healthcare Benefit Exchange	$33,120.41
Rate for Payer: Molina Healthcare Medicaid	$26,744.73

MS-DRG 42.00: ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM

Facility

$37,002.90

Service Code	MSDRG 173
Min. Negotiated Rate	$25,109.11
Max. Negotiated Rate	$37,002.90
Rate for Payer: Anthem Medicaid	$25,109.11
Rate for Payer: Anthem Medicare Advantage/PPO	$26,430.64
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,002.90
Rate for Payer: CareSource Just4Me Medicare	$35,681.36
Rate for Payer: Humana KY Medicaid	$25,109.11
Rate for Payer: Humana Medicare Advantage	$26,430.64
Rate for Payer: Kentucky WC Medicaid	$25,360.20
Rate for Payer: Molina Healthcare Benefit Exchange	$31,716.77
Rate for Payer: Molina Healthcare Medicaid	$25,611.29

MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$15,244.43

Service Code	MSDRG 383
Min. Negotiated Rate	$10,344.44
Max. Negotiated Rate	$15,244.43
Rate for Payer: Anthem Medicaid	$10,344.44
Rate for Payer: Anthem Medicare Advantage/PPO	$10,888.88
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,244.43
Rate for Payer: CareSource Just4Me Medicare	$14,699.99
Rate for Payer: Humana KY Medicaid	$10,344.44
Rate for Payer: Humana Medicare Advantage	$10,888.88
Rate for Payer: Kentucky WC Medicaid	$10,447.88
Rate for Payer: Molina Healthcare Benefit Exchange	$13,066.66
Rate for Payer: Molina Healthcare Medicaid	$10,551.32

MS-DRG 42.00: UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$10,486.14

Service Code	MSDRG 384
Min. Negotiated Rate	$7,115.60
Max. Negotiated Rate	$10,486.14
Rate for Payer: Anthem Medicaid	$7,115.60
Rate for Payer: Anthem Medicare Advantage/PPO	$7,490.10
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,486.14
Rate for Payer: CareSource Just4Me Medicare	$10,111.64
Rate for Payer: Humana KY Medicaid	$7,115.60
Rate for Payer: Humana Medicare Advantage	$7,490.10
Rate for Payer: Kentucky WC Medicaid	$7,186.75
Rate for Payer: Molina Healthcare Benefit Exchange	$8,988.12
Rate for Payer: Molina Healthcare Medicaid	$7,257.91

MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$20,423.59

Service Code	MSDRG 256
Min. Negotiated Rate	$13,858.87
Max. Negotiated Rate	$20,423.59
Rate for Payer: Anthem Medicaid	$13,858.87
Rate for Payer: Anthem Medicare Advantage/PPO	$14,588.28
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,423.59
Rate for Payer: CareSource Just4Me Medicare	$19,694.18
Rate for Payer: Humana KY Medicaid	$13,858.87
Rate for Payer: Humana Medicare Advantage	$14,588.28
Rate for Payer: Kentucky WC Medicaid	$13,997.45
Rate for Payer: Molina Healthcare Benefit Exchange	$17,505.94
Rate for Payer: Molina Healthcare Medicaid	$14,136.04

MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$31,551.25

Service Code	MSDRG 255
Min. Negotiated Rate	$21,409.78
Max. Negotiated Rate	$31,551.25
Rate for Payer: Anthem Medicaid	$21,409.78
Rate for Payer: Anthem Medicare Advantage/PPO	$22,536.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$31,551.25
Rate for Payer: CareSource Just4Me Medicare	$30,424.42
Rate for Payer: Humana KY Medicaid	$21,409.78
Rate for Payer: Humana Medicare Advantage	$22,536.61
Rate for Payer: Kentucky WC Medicaid	$21,623.88
Rate for Payer: Molina Healthcare Benefit Exchange	$27,043.93
Rate for Payer: Molina Healthcare Medicaid	$21,837.98

MS-DRG 42.00: UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$10,755.04

Service Code	MSDRG 257
Min. Negotiated Rate	$7,298.06
Max. Negotiated Rate	$10,755.04
Rate for Payer: Anthem Medicaid	$7,298.06
Rate for Payer: Anthem Medicare Advantage/PPO	$7,682.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,755.04
Rate for Payer: CareSource Just4Me Medicare	$10,370.93
Rate for Payer: Humana KY Medicaid	$7,298.06
Rate for Payer: Humana Medicare Advantage	$7,682.17
Rate for Payer: Kentucky WC Medicaid	$7,371.04
Rate for Payer: Molina Healthcare Benefit Exchange	$9,218.60
Rate for Payer: Molina Healthcare Medicaid	$7,444.02

MS-DRG 42.00: URETHRAL PROCEDURES WITH CC/MCC

Facility

$20,785.35

Service Code	MSDRG 671
Min. Negotiated Rate	$14,104.35
Max. Negotiated Rate	$20,785.35
Rate for Payer: Anthem Medicaid	$14,104.35
Rate for Payer: Anthem Medicare Advantage/PPO	$14,846.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,785.35
Rate for Payer: CareSource Just4Me Medicare	$20,043.02
Rate for Payer: Humana KY Medicaid	$14,104.35
Rate for Payer: Humana Medicare Advantage	$14,846.68
Rate for Payer: Kentucky WC Medicaid	$14,245.39
Rate for Payer: Molina Healthcare Benefit Exchange	$17,816.02
Rate for Payer: Molina Healthcare Medicaid	$14,386.43

MS-DRG 42.00: URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$13,196.89

Service Code	MSDRG 672
Min. Negotiated Rate	$8,955.03
Max. Negotiated Rate	$13,196.89
Rate for Payer: Anthem Medicaid	$8,955.03
Rate for Payer: Anthem Medicare Advantage/PPO	$9,426.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,196.89
Rate for Payer: CareSource Just4Me Medicare	$12,725.57
Rate for Payer: Humana KY Medicaid	$8,955.03
Rate for Payer: Humana Medicare Advantage	$9,426.35
Rate for Payer: Kentucky WC Medicaid	$9,044.58
Rate for Payer: Molina Healthcare Benefit Exchange	$11,311.62
Rate for Payer: Molina Healthcare Medicaid	$9,134.13

MS-DRG 42.00: URETHRAL STRICTURE

Facility

$12,080.26

Service Code	MSDRG 697
Min. Negotiated Rate	$8,197.32
Max. Negotiated Rate	$12,080.26
Rate for Payer: Anthem Medicaid	$8,197.32
Rate for Payer: Anthem Medicare Advantage/PPO	$8,628.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,080.26
Rate for Payer: CareSource Just4Me Medicare	$11,648.83
Rate for Payer: Humana KY Medicaid	$8,197.32
Rate for Payer: Humana Medicare Advantage	$8,628.76
Rate for Payer: Kentucky WC Medicaid	$8,279.30
Rate for Payer: Molina Healthcare Benefit Exchange	$10,354.51
Rate for Payer: Molina Healthcare Medicaid	$8,361.27

MS-DRG 42.00: URINARY STONES WITH MCC

Facility

$17,730.92

Service Code	MSDRG 693
Min. Negotiated Rate	$12,031.69
Max. Negotiated Rate	$17,730.92
Rate for Payer: Anthem Medicaid	$12,031.69
Rate for Payer: Anthem Medicare Advantage/PPO	$12,664.94
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,730.92
Rate for Payer: CareSource Just4Me Medicare	$17,097.67
Rate for Payer: Humana KY Medicaid	$12,031.69
Rate for Payer: Humana Medicare Advantage	$12,664.94
Rate for Payer: Kentucky WC Medicaid	$12,152.01
Rate for Payer: Molina Healthcare Benefit Exchange	$15,197.93
Rate for Payer: Molina Healthcare Medicaid	$12,272.33

MS-DRG 42.00: URINARY STONES WITHOUT MCC

Facility

$9,422.56

Service Code	MSDRG 694
Min. Negotiated Rate	$6,393.88
Max. Negotiated Rate	$9,422.56
Rate for Payer: Anthem Medicaid	$6,393.88
Rate for Payer: Anthem Medicare Advantage/PPO	$6,730.40
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,422.56
Rate for Payer: CareSource Just4Me Medicare	$9,086.04
Rate for Payer: Humana KY Medicaid	$6,393.88
Rate for Payer: Humana Medicare Advantage	$6,730.40
Rate for Payer: Kentucky WC Medicaid	$6,457.82
Rate for Payer: Molina Healthcare Benefit Exchange	$8,076.48
Rate for Payer: Molina Healthcare Medicaid	$6,521.76

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$22,027.39

Service Code	MSDRG 742
Min. Negotiated Rate	$14,947.16
Max. Negotiated Rate	$22,027.39
Rate for Payer: Anthem Medicaid	$14,947.16
Rate for Payer: Anthem Medicare Advantage/PPO	$15,733.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,027.39
Rate for Payer: CareSource Just4Me Medicare	$21,240.70
Rate for Payer: Humana KY Medicaid	$14,947.16
Rate for Payer: Humana Medicare Advantage	$15,733.85
Rate for Payer: Kentucky WC Medicaid	$15,096.63
Rate for Payer: Molina Healthcare Benefit Exchange	$18,880.62
Rate for Payer: Molina Healthcare Medicaid	$15,246.10

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$14,454.61

Service Code	MSDRG 743
Min. Negotiated Rate	$9,808.48
Max. Negotiated Rate	$14,454.61
Rate for Payer: Anthem Medicaid	$9,808.48
Rate for Payer: Anthem Medicare Advantage/PPO	$10,324.72
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,454.61
Rate for Payer: CareSource Just4Me Medicare	$13,938.37
Rate for Payer: Humana KY Medicaid	$9,808.48
Rate for Payer: Humana Medicare Advantage	$10,324.72
Rate for Payer: Kentucky WC Medicaid	$9,906.57
Rate for Payer: Molina Healthcare Benefit Exchange	$12,389.66
Rate for Payer: Molina Healthcare Medicaid	$10,004.65

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$21,926.07

Service Code	MSDRG 740
Min. Negotiated Rate	$14,878.41
Max. Negotiated Rate	$21,926.07
Rate for Payer: Anthem Medicaid	$14,878.41
Rate for Payer: Anthem Medicare Advantage/PPO	$15,661.48
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,926.07
Rate for Payer: CareSource Just4Me Medicare	$21,143.00
Rate for Payer: Humana KY Medicaid	$14,878.41
Rate for Payer: Humana Medicare Advantage	$15,661.48
Rate for Payer: Kentucky WC Medicaid	$15,027.19
Rate for Payer: Molina Healthcare Benefit Exchange	$18,793.78
Rate for Payer: Molina Healthcare Medicaid	$15,175.97

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$48,003.94

Service Code	MSDRG 739
Min. Negotiated Rate	$32,574.10
Max. Negotiated Rate	$48,003.94
Rate for Payer: Anthem Medicaid	$32,574.10
Rate for Payer: Anthem Medicare Advantage/PPO	$34,288.53
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$48,003.94
Rate for Payer: CareSource Just4Me Medicare	$46,289.52
Rate for Payer: Humana KY Medicaid	$32,574.10
Rate for Payer: Humana Medicare Advantage	$34,288.53
Rate for Payer: Kentucky WC Medicaid	$32,899.84
Rate for Payer: Molina Healthcare Benefit Exchange	$41,146.24
Rate for Payer: Molina Healthcare Medicaid	$33,225.59

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$16,563.64

Service Code	MSDRG 741
Min. Negotiated Rate	$11,239.61
Max. Negotiated Rate	$16,563.64
Rate for Payer: Anthem Medicaid	$11,239.61
Rate for Payer: Anthem Medicare Advantage/PPO	$11,831.17
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,563.64
Rate for Payer: CareSource Just4Me Medicare	$15,972.08
Rate for Payer: Humana KY Medicaid	$11,239.61
Rate for Payer: Humana Medicare Advantage	$11,831.17
Rate for Payer: Kentucky WC Medicaid	$11,352.01
Rate for Payer: Molina Healthcare Benefit Exchange	$14,197.40
Rate for Payer: Molina Healthcare Medicaid	$11,464.40

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$24,097.86

Service Code	MSDRG 737
Min. Negotiated Rate	$16,352.12
Max. Negotiated Rate	$24,097.86
Rate for Payer: Anthem Medicaid	$16,352.12
Rate for Payer: Anthem Medicare Advantage/PPO	$17,212.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,097.86
Rate for Payer: CareSource Just4Me Medicare	$23,237.23
Rate for Payer: Humana KY Medicaid	$16,352.12
Rate for Payer: Humana Medicare Advantage	$17,212.76
Rate for Payer: Kentucky WC Medicaid	$16,515.64
Rate for Payer: Molina Healthcare Benefit Exchange	$20,655.31
Rate for Payer: Molina Healthcare Medicaid	$16,679.16

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$47,481.81

Service Code	MSDRG 736
Min. Negotiated Rate	$32,219.80
Max. Negotiated Rate	$47,481.81
Rate for Payer: Anthem Medicaid	$32,219.80
Rate for Payer: Anthem Medicare Advantage/PPO	$33,915.58
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,481.81
Rate for Payer: CareSource Just4Me Medicare	$45,786.03
Rate for Payer: Humana KY Medicaid	$32,219.80
Rate for Payer: Humana Medicare Advantage	$33,915.58
Rate for Payer: Kentucky WC Medicaid	$32,542.00
Rate for Payer: Molina Healthcare Benefit Exchange	$40,698.70
Rate for Payer: Molina Healthcare Medicaid	$32,864.20

MS-DRG 42.00: UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$18,291.63

Service Code	MSDRG 738
Min. Negotiated Rate	$12,412.18
Max. Negotiated Rate	$18,291.63
Rate for Payer: Anthem Medicaid	$12,412.18
Rate for Payer: Anthem Medicare Advantage/PPO	$13,065.45
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,291.63
Rate for Payer: CareSource Just4Me Medicare	$17,638.36
Rate for Payer: Humana KY Medicaid	$12,412.18
Rate for Payer: Humana Medicare Advantage	$13,065.45
Rate for Payer: Kentucky WC Medicaid	$12,536.30
Rate for Payer: Molina Healthcare Benefit Exchange	$15,678.54
Rate for Payer: Molina Healthcare Medicaid	$12,660.42

MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$20,193.28

Service Code	MSDRG 746
Min. Negotiated Rate	$13,702.58
Max. Negotiated Rate	$20,193.28
Rate for Payer: Anthem Medicaid	$13,702.58
Rate for Payer: Anthem Medicare Advantage/PPO	$14,423.77
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,193.28
Rate for Payer: CareSource Just4Me Medicare	$19,472.09
Rate for Payer: Humana KY Medicaid	$13,702.58
Rate for Payer: Humana Medicare Advantage	$14,423.77
Rate for Payer: Kentucky WC Medicaid	$13,839.61
Rate for Payer: Molina Healthcare Benefit Exchange	$17,308.52
Rate for Payer: Molina Healthcare Medicaid	$13,976.63

Know your out-of-pocket cost for care.

All Charges