Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$37,195.63

Service Code	MSDRG 229
Min. Negotiated Rate	$25,239.89
Max. Negotiated Rate	$37,195.63
Rate for Payer: Anthem Medicaid	$25,239.89
Rate for Payer: Anthem Medicare Advantage/PPO	$26,568.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$37,195.63
Rate for Payer: CareSource Just4Me Medicare	$35,867.22
Rate for Payer: Humana KY Medicaid	$25,239.89
Rate for Payer: Humana Medicare Advantage	$26,568.31
Rate for Payer: Kentucky WC Medicaid	$25,492.29
Rate for Payer: Molina Healthcare Benefit Exchange	$31,881.97
Rate for Payer: Molina Healthcare Medicaid	$25,744.69

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$11,315.68

Service Code	MSDRG 315
Min. Negotiated Rate	$7,678.50
Max. Negotiated Rate	$11,315.68
Rate for Payer: Anthem Medicaid	$7,678.50
Rate for Payer: Anthem Medicare Advantage/PPO	$8,082.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,315.68
Rate for Payer: CareSource Just4Me Medicare	$10,911.55
Rate for Payer: Humana KY Medicaid	$7,678.50
Rate for Payer: Humana Medicare Advantage	$8,082.63
Rate for Payer: Kentucky WC Medicaid	$7,755.28
Rate for Payer: Molina Healthcare Benefit Exchange	$9,699.16
Rate for Payer: Molina Healthcare Medicaid	$7,832.07

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$24,490.20

Service Code	MSDRG 314
Min. Negotiated Rate	$16,618.35
Max. Negotiated Rate	$24,490.20
Rate for Payer: Anthem Medicaid	$16,618.35
Rate for Payer: Anthem Medicare Advantage/PPO	$17,493.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$24,490.20
Rate for Payer: CareSource Just4Me Medicare	$23,615.55
Rate for Payer: Humana KY Medicaid	$16,618.35
Rate for Payer: Humana Medicare Advantage	$17,493.00
Rate for Payer: Kentucky WC Medicaid	$16,784.53
Rate for Payer: Molina Healthcare Benefit Exchange	$20,991.60
Rate for Payer: Molina Healthcare Medicaid	$16,950.72

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$8,103.33

Service Code	MSDRG 316
Min. Negotiated Rate	$5,498.69
Max. Negotiated Rate	$8,103.33
Rate for Payer: Anthem Medicaid	$5,498.69
Rate for Payer: Anthem Medicare Advantage/PPO	$5,788.09
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,103.33
Rate for Payer: CareSource Just4Me Medicare	$7,813.92
Rate for Payer: Humana KY Medicaid	$5,498.69
Rate for Payer: Humana Medicare Advantage	$5,788.09
Rate for Payer: Kentucky WC Medicaid	$5,553.67
Rate for Payer: Molina Healthcare Benefit Exchange	$6,945.71
Rate for Payer: Molina Healthcare Medicaid	$5,608.66

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$38,206.35

Service Code	MSDRG 264
Min. Negotiated Rate	$25,925.74
Max. Negotiated Rate	$38,206.35
Rate for Payer: Anthem Medicaid	$25,925.74
Rate for Payer: Anthem Medicare Advantage/PPO	$27,290.25
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,206.35
Rate for Payer: CareSource Just4Me Medicare	$36,841.84
Rate for Payer: Humana KY Medicaid	$25,925.74
Rate for Payer: Humana Medicare Advantage	$27,290.25
Rate for Payer: Kentucky WC Medicaid	$26,184.99
Rate for Payer: Molina Healthcare Benefit Exchange	$32,748.30
Rate for Payer: Molina Healthcare Medicaid	$26,444.25

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$10,960.05

Service Code	MSDRG 394
Min. Negotiated Rate	$7,437.18
Max. Negotiated Rate	$10,960.05
Rate for Payer: Anthem Medicaid	$7,437.18
Rate for Payer: Anthem Medicare Advantage/PPO	$7,828.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,960.05
Rate for Payer: CareSource Just4Me Medicare	$10,568.62
Rate for Payer: Humana KY Medicaid	$7,437.18
Rate for Payer: Humana Medicare Advantage	$7,828.61
Rate for Payer: Kentucky WC Medicaid	$7,511.55
Rate for Payer: Molina Healthcare Benefit Exchange	$9,394.33
Rate for Payer: Molina Healthcare Medicaid	$7,585.92

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$18,946.42

Service Code	MSDRG 393
Min. Negotiated Rate	$12,856.50
Max. Negotiated Rate	$18,946.42
Rate for Payer: Anthem Medicaid	$12,856.50
Rate for Payer: Anthem Medicare Advantage/PPO	$13,533.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,946.42
Rate for Payer: CareSource Just4Me Medicare	$18,269.77
Rate for Payer: Humana KY Medicaid	$12,856.50
Rate for Payer: Humana Medicare Advantage	$13,533.16
Rate for Payer: Kentucky WC Medicaid	$12,985.07
Rate for Payer: Molina Healthcare Benefit Exchange	$16,239.79
Rate for Payer: Molina Healthcare Medicaid	$13,113.63

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$7,574.57

Service Code	MSDRG 395
Min. Negotiated Rate	$5,139.89
Max. Negotiated Rate	$7,574.57
Rate for Payer: Anthem Medicaid	$5,139.89
Rate for Payer: Anthem Medicare Advantage/PPO	$5,410.41
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,574.57
Rate for Payer: CareSource Just4Me Medicare	$7,304.05
Rate for Payer: Humana KY Medicaid	$5,139.89
Rate for Payer: Humana Medicare Advantage	$5,410.41
Rate for Payer: Kentucky WC Medicaid	$5,191.29
Rate for Payer: Molina Healthcare Benefit Exchange	$6,492.49
Rate for Payer: Molina Healthcare Medicaid	$5,242.69

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$25,698.62

Service Code	MSDRG 357
Min. Negotiated Rate	$17,438.35
Max. Negotiated Rate	$25,698.62
Rate for Payer: Anthem Medicaid	$17,438.35
Rate for Payer: Anthem Medicare Advantage/PPO	$18,356.16
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,698.62
Rate for Payer: CareSource Just4Me Medicare	$24,780.82
Rate for Payer: Humana KY Medicaid	$17,438.35
Rate for Payer: Humana Medicare Advantage	$18,356.16
Rate for Payer: Kentucky WC Medicaid	$17,612.74
Rate for Payer: Molina Healthcare Benefit Exchange	$22,027.39
Rate for Payer: Molina Healthcare Medicaid	$17,787.12

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$50,053.12

Service Code	MSDRG 356
Min. Negotiated Rate	$33,964.62
Max. Negotiated Rate	$50,053.12
Rate for Payer: Anthem Medicaid	$33,964.62
Rate for Payer: Anthem Medicare Advantage/PPO	$35,752.23
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$50,053.12
Rate for Payer: CareSource Just4Me Medicare	$48,265.51
Rate for Payer: Humana KY Medicaid	$33,964.62
Rate for Payer: Humana Medicare Advantage	$35,752.23
Rate for Payer: Kentucky WC Medicaid	$34,304.26
Rate for Payer: Molina Healthcare Benefit Exchange	$42,902.68
Rate for Payer: Molina Healthcare Medicaid	$34,643.91

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$14,986.57

Service Code	MSDRG 358
Min. Negotiated Rate	$10,169.46
Max. Negotiated Rate	$14,986.57
Rate for Payer: Anthem Medicaid	$10,169.46
Rate for Payer: Anthem Medicare Advantage/PPO	$10,704.69
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,986.57
Rate for Payer: CareSource Just4Me Medicare	$14,451.33
Rate for Payer: Humana KY Medicaid	$10,169.46
Rate for Payer: Humana Medicare Advantage	$10,704.69
Rate for Payer: Kentucky WC Medicaid	$10,271.15
Rate for Payer: Molina Healthcare Benefit Exchange	$12,845.63
Rate for Payer: Molina Healthcare Medicaid	$10,372.84

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$12,003.53

Service Code	MSDRG 092
Min. Negotiated Rate	$8,145.25
Max. Negotiated Rate	$12,003.53
Rate for Payer: Anthem Medicaid	$8,145.25
Rate for Payer: Anthem Medicare Advantage/PPO	$8,573.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$12,003.53
Rate for Payer: CareSource Just4Me Medicare	$11,574.83
Rate for Payer: Humana KY Medicaid	$8,145.25
Rate for Payer: Humana Medicare Advantage	$8,573.95
Rate for Payer: Kentucky WC Medicaid	$8,226.71
Rate for Payer: Molina Healthcare Benefit Exchange	$10,288.74
Rate for Payer: Molina Healthcare Medicaid	$8,308.16

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$20,930.43

Service Code	MSDRG 091
Min. Negotiated Rate	$14,202.79
Max. Negotiated Rate	$20,930.43
Rate for Payer: Anthem Medicaid	$14,202.79
Rate for Payer: Anthem Medicare Advantage/PPO	$14,950.31
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,930.43
Rate for Payer: CareSource Just4Me Medicare	$20,182.92
Rate for Payer: Humana KY Medicaid	$14,202.79
Rate for Payer: Humana Medicare Advantage	$14,950.31
Rate for Payer: Kentucky WC Medicaid	$14,344.82
Rate for Payer: Molina Healthcare Benefit Exchange	$17,940.37
Rate for Payer: Molina Healthcare Medicaid	$14,486.85

OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$9,059.09

Service Code	MSDRG 093
Min. Negotiated Rate	$6,147.24
Max. Negotiated Rate	$9,059.09
Rate for Payer: Anthem Medicaid	$6,147.24
Rate for Payer: Anthem Medicare Advantage/PPO	$6,470.78
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,059.09
Rate for Payer: CareSource Just4Me Medicare	$8,735.55
Rate for Payer: Humana KY Medicaid	$6,147.24
Rate for Payer: Humana Medicare Advantage	$6,470.78
Rate for Payer: Kentucky WC Medicaid	$6,208.71
Rate for Payer: Molina Healthcare Benefit Exchange	$7,764.94
Rate for Payer: Molina Healthcare Medicaid	$6,270.19

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$15,463.88

Service Code	MSDRG 124
Min. Negotiated Rate	$10,493.35
Max. Negotiated Rate	$15,463.88
Rate for Payer: Anthem Medicaid	$10,493.35
Rate for Payer: Anthem Medicare Advantage/PPO	$11,045.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,463.88
Rate for Payer: CareSource Just4Me Medicare	$14,911.60
Rate for Payer: Humana KY Medicaid	$10,493.35
Rate for Payer: Humana Medicare Advantage	$11,045.63
Rate for Payer: Kentucky WC Medicaid	$10,598.28
Rate for Payer: Molina Healthcare Benefit Exchange	$13,254.76
Rate for Payer: Molina Healthcare Medicaid	$10,703.22

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$9,329.33

Service Code	MSDRG 125
Min. Negotiated Rate	$6,330.62
Max. Negotiated Rate	$9,329.33
Rate for Payer: Anthem Medicaid	$6,330.62
Rate for Payer: Anthem Medicare Advantage/PPO	$6,663.81
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,329.33
Rate for Payer: CareSource Just4Me Medicare	$8,996.14
Rate for Payer: Humana KY Medicaid	$6,330.62
Rate for Payer: Humana Medicare Advantage	$6,663.81
Rate for Payer: Kentucky WC Medicaid	$6,393.93
Rate for Payer: Molina Healthcare Benefit Exchange	$7,996.57
Rate for Payer: Molina Healthcare Medicaid	$6,457.23

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC

Facility

$11,073.52

Service Code	MSDRG 155
Min. Negotiated Rate	$7,514.18
Max. Negotiated Rate	$11,073.52
Rate for Payer: Anthem Medicaid	$7,514.18
Rate for Payer: Anthem Medicare Advantage/PPO	$7,909.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,073.52
Rate for Payer: CareSource Just4Me Medicare	$10,678.04
Rate for Payer: Humana KY Medicaid	$7,514.18
Rate for Payer: Humana Medicare Advantage	$7,909.66
Rate for Payer: Kentucky WC Medicaid	$7,589.32
Rate for Payer: Molina Healthcare Benefit Exchange	$9,491.59
Rate for Payer: Molina Healthcare Medicaid	$7,664.46

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC

Facility

$17,994.17

Service Code	MSDRG 154
Min. Negotiated Rate	$12,210.33
Max. Negotiated Rate	$17,994.17
Rate for Payer: Anthem Medicaid	$12,210.33
Rate for Payer: Anthem Medicare Advantage/PPO	$12,852.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,994.17
Rate for Payer: CareSource Just4Me Medicare	$17,351.52
Rate for Payer: Humana KY Medicaid	$12,210.33
Rate for Payer: Humana Medicare Advantage	$12,852.98
Rate for Payer: Kentucky WC Medicaid	$12,332.43
Rate for Payer: Molina Healthcare Benefit Exchange	$15,423.58
Rate for Payer: Molina Healthcare Medicaid	$12,454.54

OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC

Facility

$7,668.18

Service Code	MSDRG 156
Min. Negotiated Rate	$5,203.41
Max. Negotiated Rate	$7,668.18
Rate for Payer: Anthem Medicaid	$5,203.41
Rate for Payer: Anthem Medicare Advantage/PPO	$5,477.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,668.18
Rate for Payer: CareSource Just4Me Medicare	$7,394.31
Rate for Payer: Humana KY Medicaid	$5,203.41
Rate for Payer: Humana Medicare Advantage	$5,477.27
Rate for Payer: Kentucky WC Medicaid	$5,255.44
Rate for Payer: Molina Healthcare Benefit Exchange	$6,572.72
Rate for Payer: Molina Healthcare Medicaid	$5,307.47

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

Facility

$20,243.75

Service Code	MSDRG 144
Min. Negotiated Rate	$13,736.83
Max. Negotiated Rate	$20,243.75
Rate for Payer: Anthem Medicaid	$13,736.83
Rate for Payer: Anthem Medicare Advantage/PPO	$14,459.82
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$20,243.75
Rate for Payer: CareSource Just4Me Medicare	$19,520.76
Rate for Payer: Humana KY Medicaid	$13,736.83
Rate for Payer: Humana Medicare Advantage	$14,459.82
Rate for Payer: Kentucky WC Medicaid	$13,874.20
Rate for Payer: Molina Healthcare Benefit Exchange	$17,351.78
Rate for Payer: Molina Healthcare Medicaid	$14,011.57

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$38,903.58

Service Code	MSDRG 143
Min. Negotiated Rate	$26,398.86
Max. Negotiated Rate	$38,903.58
Rate for Payer: Anthem Medicaid	$26,398.86
Rate for Payer: Anthem Medicare Advantage/PPO	$27,788.27
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$38,903.58
Rate for Payer: CareSource Just4Me Medicare	$37,514.16
Rate for Payer: Humana KY Medicaid	$26,398.86
Rate for Payer: Humana Medicare Advantage	$27,788.27
Rate for Payer: Kentucky WC Medicaid	$26,662.85
Rate for Payer: Molina Healthcare Benefit Exchange	$33,345.92
Rate for Payer: Molina Healthcare Medicaid	$26,926.83

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$14,284.68

Service Code	MSDRG 145
Min. Negotiated Rate	$9,693.17
Max. Negotiated Rate	$14,284.68
Rate for Payer: Anthem Medicaid	$9,693.17
Rate for Payer: Anthem Medicare Advantage/PPO	$10,203.34
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$14,284.68
Rate for Payer: CareSource Just4Me Medicare	$13,774.51
Rate for Payer: Humana KY Medicaid	$9,693.17
Rate for Payer: Humana Medicare Advantage	$10,203.34
Rate for Payer: Kentucky WC Medicaid	$9,790.10
Rate for Payer: Molina Healthcare Benefit Exchange	$12,244.01
Rate for Payer: Molina Healthcare Medicaid	$9,887.04

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$26,470.71

Service Code	MSDRG 629
Min. Negotiated Rate	$17,962.27
Max. Negotiated Rate	$26,470.71
Rate for Payer: Anthem Medicaid	$17,962.27
Rate for Payer: Anthem Medicare Advantage/PPO	$18,907.65
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$26,470.71
Rate for Payer: CareSource Just4Me Medicare	$25,525.33
Rate for Payer: Humana KY Medicaid	$17,962.27
Rate for Payer: Humana Medicare Advantage	$18,907.65
Rate for Payer: Kentucky WC Medicaid	$18,141.89
Rate for Payer: Molina Healthcare Benefit Exchange	$22,689.18
Rate for Payer: Molina Healthcare Medicaid	$18,321.51

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$46,962.45

Service Code	MSDRG 628
Min. Negotiated Rate	$31,867.38
Max. Negotiated Rate	$46,962.45
Rate for Payer: Anthem Medicaid	$31,867.38
Rate for Payer: Anthem Medicare Advantage/PPO	$33,544.61
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$46,962.45
Rate for Payer: CareSource Just4Me Medicare	$45,285.22
Rate for Payer: Humana KY Medicaid	$31,867.38
Rate for Payer: Humana Medicare Advantage	$33,544.61
Rate for Payer: Kentucky WC Medicaid	$32,186.05
Rate for Payer: Molina Healthcare Benefit Exchange	$40,253.53
Rate for Payer: Molina Healthcare Medicaid	$32,504.73

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$16,334.21

Service Code	MSDRG 630
Min. Negotiated Rate	$11,083.93
Max. Negotiated Rate	$16,334.21
Rate for Payer: Anthem Medicaid	$11,083.93
Rate for Payer: Anthem Medicare Advantage/PPO	$11,667.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,334.21
Rate for Payer: CareSource Just4Me Medicare	$15,750.84
Rate for Payer: Humana KY Medicaid	$11,083.93
Rate for Payer: Humana Medicare Advantage	$11,667.29
Rate for Payer: Kentucky WC Medicaid	$11,194.76
Rate for Payer: Molina Healthcare Benefit Exchange	$14,000.75
Rate for Payer: Molina Healthcare Medicaid	$11,305.60

Know your out-of-pocket cost for care.

All Charges