Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC

Facility

$21,217.03

Service Code	MSDRG 717
Min. Negotiated Rate	$14,397.27
Max. Negotiated Rate	$21,217.03
Rate for Payer: Anthem Medicaid	$14,397.27
Rate for Payer: Anthem Medicare Advantage/PPO	$15,155.02
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,217.03
Rate for Payer: CareSource Just4Me Medicare	$20,459.28
Rate for Payer: Humana KY Medicaid	$14,397.27
Rate for Payer: Humana Medicare Advantage	$15,155.02
Rate for Payer: Kentucky WC Medicaid	$14,541.24
Rate for Payer: Molina Healthcare Benefit Exchange	$18,186.02
Rate for Payer: Molina Healthcare Medicaid	$14,685.21

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$13,754.75

Service Code	MSDRG 718
Min. Negotiated Rate	$9,333.58
Max. Negotiated Rate	$13,754.75
Rate for Payer: Anthem Medicaid	$9,333.58
Rate for Payer: Anthem Medicare Advantage/PPO	$9,824.82
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,754.75
Rate for Payer: CareSource Just4Me Medicare	$13,263.51
Rate for Payer: Humana KY Medicaid	$9,333.58
Rate for Payer: Humana Medicare Advantage	$9,824.82
Rate for Payer: Kentucky WC Medicaid	$9,426.91
Rate for Payer: Molina Healthcare Benefit Exchange	$11,789.78
Rate for Payer: Molina Healthcare Medicaid	$9,520.25

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC

Facility

$25,823.78

Service Code	MSDRG 715
Min. Negotiated Rate	$17,523.28
Max. Negotiated Rate	$25,823.78
Rate for Payer: Anthem Medicaid	$17,523.28
Rate for Payer: Anthem Medicare Advantage/PPO	$18,445.56
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$25,823.78
Rate for Payer: CareSource Just4Me Medicare	$24,901.51
Rate for Payer: Humana KY Medicaid	$17,523.28
Rate for Payer: Humana Medicare Advantage	$18,445.56
Rate for Payer: Kentucky WC Medicaid	$17,698.51
Rate for Payer: Molina Healthcare Benefit Exchange	$22,134.67
Rate for Payer: Molina Healthcare Medicaid	$17,873.75

OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC

Facility

$16,637.19

Service Code	MSDRG 716
Min. Negotiated Rate	$11,289.52
Max. Negotiated Rate	$16,637.19
Rate for Payer: Anthem Medicaid	$11,289.52
Rate for Payer: Anthem Medicare Advantage/PPO	$11,883.71
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,637.19
Rate for Payer: CareSource Just4Me Medicare	$16,043.01
Rate for Payer: Humana KY Medicaid	$11,289.52
Rate for Payer: Humana Medicare Advantage	$11,883.71
Rate for Payer: Kentucky WC Medicaid	$11,402.42
Rate for Payer: Molina Healthcare Benefit Exchange	$14,260.45
Rate for Payer: Molina Healthcare Medicaid	$11,515.31

OTHER MENTAL DISORDER DIAGNOSES

Facility

$15,156.19

Service Code	MSDRG 887
Min. Negotiated Rate	$10,284.56
Max. Negotiated Rate	$15,156.19
Rate for Payer: Anthem Medicaid	$10,284.56
Rate for Payer: Anthem Medicare Advantage/PPO	$10,825.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,156.19
Rate for Payer: CareSource Just4Me Medicare	$14,614.90
Rate for Payer: Humana KY Medicaid	$10,284.56
Rate for Payer: Humana Medicare Advantage	$10,825.85
Rate for Payer: Kentucky WC Medicaid	$10,387.40
Rate for Payer: Molina Healthcare Benefit Exchange	$12,991.02
Rate for Payer: Molina Healthcare Medicaid	$10,490.25

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$17,559.01

Service Code	MSDRG 964
Min. Negotiated Rate	$11,915.04
Max. Negotiated Rate	$17,559.01
Rate for Payer: Anthem Medicaid	$11,915.04
Rate for Payer: Anthem Medicare Advantage/PPO	$12,542.15
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,559.01
Rate for Payer: CareSource Just4Me Medicare	$16,931.90
Rate for Payer: Humana KY Medicaid	$11,915.04
Rate for Payer: Humana Medicare Advantage	$12,542.15
Rate for Payer: Kentucky WC Medicaid	$12,034.19
Rate for Payer: Molina Healthcare Benefit Exchange	$15,050.58
Rate for Payer: Molina Healthcare Medicaid	$12,153.34

OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$31,986.42

Service Code	MSDRG 963
Min. Negotiated Rate	$21,705.07
Max. Negotiated Rate	$31,986.42
Rate for Payer: Anthem Medicaid	$21,705.07
Rate for Payer: Anthem Medicare Advantage/PPO	$22,847.44
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$31,986.42
Rate for Payer: CareSource Just4Me Medicare	$30,844.04
Rate for Payer: Humana KY Medicaid	$21,705.07
Rate for Payer: Humana Medicare Advantage	$22,847.44
Rate for Payer: Kentucky WC Medicaid	$21,922.12
Rate for Payer: Molina Healthcare Benefit Exchange	$27,416.93
Rate for Payer: Molina Healthcare Medicaid	$22,139.17

OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$11,182.29

Service Code	MSDRG 965
Min. Negotiated Rate	$7,587.98
Max. Negotiated Rate	$11,182.29
Rate for Payer: Anthem Medicaid	$7,587.98
Rate for Payer: Anthem Medicare Advantage/PPO	$7,987.35
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,182.29
Rate for Payer: CareSource Just4Me Medicare	$10,782.92
Rate for Payer: Humana KY Medicaid	$7,587.98
Rate for Payer: Humana Medicare Advantage	$7,987.35
Rate for Payer: Kentucky WC Medicaid	$7,663.86
Rate for Payer: Molina Healthcare Benefit Exchange	$9,584.82
Rate for Payer: Molina Healthcare Medicaid	$7,739.74

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC

Facility

$11,691.19

Service Code	MSDRG 565
Min. Negotiated Rate	$7,933.31
Max. Negotiated Rate	$11,691.19
Rate for Payer: Anthem Medicaid	$7,933.31
Rate for Payer: Anthem Medicare Advantage/PPO	$8,350.85
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$11,691.19
Rate for Payer: CareSource Just4Me Medicare	$11,273.65
Rate for Payer: Humana KY Medicaid	$7,933.31
Rate for Payer: Humana Medicare Advantage	$8,350.85
Rate for Payer: Kentucky WC Medicaid	$8,012.64
Rate for Payer: Molina Healthcare Benefit Exchange	$10,021.02
Rate for Payer: Molina Healthcare Medicaid	$8,091.97

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC

Facility

$18,271.41

Service Code	MSDRG 564
Min. Negotiated Rate	$12,398.46
Max. Negotiated Rate	$18,271.41
Rate for Payer: Anthem Medicaid	$12,398.46
Rate for Payer: Anthem Medicare Advantage/PPO	$13,051.01
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$18,271.41
Rate for Payer: CareSource Just4Me Medicare	$17,618.86
Rate for Payer: Humana KY Medicaid	$12,398.46
Rate for Payer: Humana Medicare Advantage	$13,051.01
Rate for Payer: Kentucky WC Medicaid	$12,522.44
Rate for Payer: Molina Healthcare Benefit Exchange	$15,661.21
Rate for Payer: Molina Healthcare Medicaid	$12,646.43

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC

Facility

$8,779.50

Service Code	MSDRG 566
Min. Negotiated Rate	$5,957.52
Max. Negotiated Rate	$8,779.50
Rate for Payer: Anthem Medicaid	$5,957.52
Rate for Payer: Anthem Medicare Advantage/PPO	$6,271.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,779.50
Rate for Payer: CareSource Just4Me Medicare	$8,465.94
Rate for Payer: Humana KY Medicaid	$5,957.52
Rate for Payer: Humana Medicare Advantage	$6,271.07
Rate for Payer: Kentucky WC Medicaid	$6,017.09
Rate for Payer: Molina Healthcare Benefit Exchange	$7,525.28
Rate for Payer: Molina Healthcare Medicaid	$6,076.67

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$23,873.68

Service Code	MSDRG 516
Min. Negotiated Rate	$16,200.00
Max. Negotiated Rate	$23,873.68
Rate for Payer: Anthem Medicaid	$16,200.00
Rate for Payer: Anthem Medicare Advantage/PPO	$17,052.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,873.68
Rate for Payer: CareSource Just4Me Medicare	$23,021.05
Rate for Payer: Humana KY Medicaid	$16,200.00
Rate for Payer: Humana Medicare Advantage	$17,052.63
Rate for Payer: Kentucky WC Medicaid	$16,362.00
Rate for Payer: Molina Healthcare Benefit Exchange	$20,463.16
Rate for Payer: Molina Healthcare Medicaid	$16,524.00

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$36,983.88

Service Code	MSDRG 515
Min. Negotiated Rate	$25,096.21
Max. Negotiated Rate	$36,983.88
Rate for Payer: Anthem Medicaid	$25,096.21
Rate for Payer: Anthem Medicare Advantage/PPO	$26,417.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$36,983.88
Rate for Payer: CareSource Just4Me Medicare	$35,663.03
Rate for Payer: Humana KY Medicaid	$25,096.21
Rate for Payer: Humana Medicare Advantage	$26,417.06
Rate for Payer: Kentucky WC Medicaid	$25,347.17
Rate for Payer: Molina Healthcare Benefit Exchange	$31,700.47
Rate for Payer: Molina Healthcare Medicaid	$25,598.13

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$17,481.80

Service Code	MSDRG 517
Min. Negotiated Rate	$11,862.65
Max. Negotiated Rate	$17,481.80
Rate for Payer: Anthem Medicaid	$11,862.65
Rate for Payer: Anthem Medicare Advantage/PPO	$12,487.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$17,481.80
Rate for Payer: CareSource Just4Me Medicare	$16,857.45
Rate for Payer: Humana KY Medicaid	$11,862.65
Rate for Payer: Humana Medicare Advantage	$12,487.00
Rate for Payer: Kentucky WC Medicaid	$11,981.28
Rate for Payer: Molina Healthcare Benefit Exchange	$14,984.40
Rate for Payer: Molina Healthcare Medicaid	$12,099.90

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$13,537.15

Service Code	MSDRG 844
Min. Negotiated Rate	$9,185.92
Max. Negotiated Rate	$13,537.15
Rate for Payer: Anthem Medicaid	$9,185.92
Rate for Payer: Anthem Medicare Advantage/PPO	$9,669.39
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$13,537.15
Rate for Payer: CareSource Just4Me Medicare	$13,053.68
Rate for Payer: Humana KY Medicaid	$9,185.92
Rate for Payer: Humana Medicare Advantage	$9,669.39
Rate for Payer: Kentucky WC Medicaid	$9,277.78
Rate for Payer: Molina Healthcare Benefit Exchange	$11,603.27
Rate for Payer: Molina Healthcare Medicaid	$9,369.64

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$21,765.67

Service Code	MSDRG 843
Min. Negotiated Rate	$14,769.56
Max. Negotiated Rate	$21,765.67
Rate for Payer: Anthem Medicaid	$14,769.56
Rate for Payer: Anthem Medicare Advantage/PPO	$15,546.91
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,765.67
Rate for Payer: CareSource Just4Me Medicare	$20,988.33
Rate for Payer: Humana KY Medicaid	$14,769.56
Rate for Payer: Humana Medicare Advantage	$15,546.91
Rate for Payer: Kentucky WC Medicaid	$14,917.26
Rate for Payer: Molina Healthcare Benefit Exchange	$18,656.29
Rate for Payer: Molina Healthcare Medicaid	$15,064.96

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$10,117.79

Service Code	MSDRG 845
Min. Negotiated Rate	$6,865.64
Max. Negotiated Rate	$10,117.79
Rate for Payer: Anthem Medicaid	$6,865.64
Rate for Payer: Anthem Medicare Advantage/PPO	$7,226.99
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$10,117.79
Rate for Payer: CareSource Just4Me Medicare	$9,756.44
Rate for Payer: Humana KY Medicaid	$6,865.64
Rate for Payer: Humana Medicare Advantage	$7,226.99
Rate for Payer: Kentucky WC Medicaid	$6,934.30
Rate for Payer: Molina Healthcare Benefit Exchange	$8,672.39
Rate for Payer: Molina Healthcare Medicaid	$7,002.95

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$23,444.37

Service Code	MSDRG 908
Min. Negotiated Rate	$15,908.68
Max. Negotiated Rate	$23,444.37
Rate for Payer: Anthem Medicaid	$15,908.68
Rate for Payer: Anthem Medicare Advantage/PPO	$16,745.98
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$23,444.37
Rate for Payer: CareSource Just4Me Medicare	$22,607.07
Rate for Payer: Humana KY Medicaid	$15,908.68
Rate for Payer: Humana Medicare Advantage	$16,745.98
Rate for Payer: Kentucky WC Medicaid	$16,067.77
Rate for Payer: Molina Healthcare Benefit Exchange	$20,095.18
Rate for Payer: Molina Healthcare Medicaid	$16,226.85

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$43,511.48

Service Code	MSDRG 907
Min. Negotiated Rate	$29,525.65
Max. Negotiated Rate	$43,511.48
Rate for Payer: Anthem Medicaid	$29,525.65
Rate for Payer: Anthem Medicare Advantage/PPO	$31,079.63
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$43,511.48
Rate for Payer: CareSource Just4Me Medicare	$41,957.50
Rate for Payer: Humana KY Medicaid	$29,525.65
Rate for Payer: Humana Medicare Advantage	$31,079.63
Rate for Payer: Kentucky WC Medicaid	$29,820.90
Rate for Payer: Molina Healthcare Benefit Exchange	$37,295.56
Rate for Payer: Molina Healthcare Medicaid	$30,116.16

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$15,866.28

Service Code	MSDRG 909
Min. Negotiated Rate	$10,766.41
Max. Negotiated Rate	$15,866.28
Rate for Payer: Anthem Medicaid	$10,766.41
Rate for Payer: Anthem Medicare Advantage/PPO	$11,333.06
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,866.28
Rate for Payer: CareSource Just4Me Medicare	$15,299.63
Rate for Payer: Humana KY Medicaid	$10,766.41
Rate for Payer: Humana Medicare Advantage	$11,333.06
Rate for Payer: Kentucky WC Medicaid	$10,874.07
Rate for Payer: Molina Healthcare Benefit Exchange	$13,599.67
Rate for Payer: Molina Healthcare Medicaid	$10,981.74

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$47,316.91

Service Code	MSDRG 958
Min. Negotiated Rate	$32,107.90
Max. Negotiated Rate	$47,316.91
Rate for Payer: Anthem Medicaid	$32,107.90
Rate for Payer: Anthem Medicare Advantage/PPO	$33,797.79
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$47,316.91
Rate for Payer: CareSource Just4Me Medicare	$45,627.02
Rate for Payer: Humana KY Medicaid	$32,107.90
Rate for Payer: Humana Medicare Advantage	$33,797.79
Rate for Payer: Kentucky WC Medicaid	$32,428.98
Rate for Payer: Molina Healthcare Benefit Exchange	$40,557.35
Rate for Payer: Molina Healthcare Medicaid	$32,750.06

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$84,607.26

Service Code	MSDRG 957
Min. Negotiated Rate	$57,412.07
Max. Negotiated Rate	$84,607.26
Rate for Payer: Anthem Medicaid	$57,412.07
Rate for Payer: Anthem Medicare Advantage/PPO	$60,433.76
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$84,607.26
Rate for Payer: CareSource Just4Me Medicare	$81,585.58
Rate for Payer: Humana KY Medicaid	$57,412.07
Rate for Payer: Humana Medicare Advantage	$60,433.76
Rate for Payer: Kentucky WC Medicaid	$57,986.19
Rate for Payer: Molina Healthcare Benefit Exchange	$72,520.51
Rate for Payer: Molina Healthcare Medicaid	$58,560.31

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$29,624.52

Service Code	MSDRG 959
Min. Negotiated Rate	$20,102.35
Max. Negotiated Rate	$29,624.52
Rate for Payer: Anthem Medicaid	$20,102.35
Rate for Payer: Anthem Medicare Advantage/PPO	$21,160.37
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$29,624.52
Rate for Payer: CareSource Just4Me Medicare	$28,566.50
Rate for Payer: Humana KY Medicaid	$20,102.35
Rate for Payer: Humana Medicare Advantage	$21,160.37
Rate for Payer: Kentucky WC Medicaid	$20,303.38
Rate for Payer: Molina Healthcare Benefit Exchange	$25,392.44
Rate for Payer: Molina Healthcare Medicaid	$20,504.40

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$21,737.62

Service Code	MSDRG 803
Min. Negotiated Rate	$14,750.53
Max. Negotiated Rate	$21,737.62
Rate for Payer: Anthem Medicaid	$14,750.53
Rate for Payer: Anthem Medicare Advantage/PPO	$15,526.87
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$21,737.62
Rate for Payer: CareSource Just4Me Medicare	$20,961.27
Rate for Payer: Humana KY Medicaid	$14,750.53
Rate for Payer: Humana Medicare Advantage	$15,526.87
Rate for Payer: Kentucky WC Medicaid	$14,898.03
Rate for Payer: Molina Healthcare Benefit Exchange	$18,632.24
Rate for Payer: Molina Healthcare Medicaid	$15,045.54

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$40,134.21

Service Code	MSDRG 802
Min. Negotiated Rate	$27,233.93
Max. Negotiated Rate	$40,134.21
Rate for Payer: Anthem Medicaid	$27,233.93
Rate for Payer: Anthem Medicare Advantage/PPO	$28,667.29
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$40,134.21
Rate for Payer: CareSource Just4Me Medicare	$38,700.84
Rate for Payer: Humana KY Medicaid	$27,233.93
Rate for Payer: Humana Medicare Advantage	$28,667.29
Rate for Payer: Kentucky WC Medicaid	$27,506.26
Rate for Payer: Molina Healthcare Benefit Exchange	$34,400.75
Rate for Payer: Molina Healthcare Medicaid	$27,778.60

Know your out-of-pocket cost for care.

All Charges