Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 1001: DURABLE MEDICAL EQUIPMENT AND SUPPLIES - LEVEL 1

Facility

$14.85

Service Code	EAPG 01001
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Aetna CHP/Medicaid	$14.85
Rate for Payer: Humana OH Medicaid	$14.85

EAPG 1002: DURABLE MEDICAL EQUIPMENT AND SUPPLIES - LEVEL 2

Facility

$9.76

Service Code	EAPG 01002
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$9.76
Rate for Payer: Aetna CHP/Medicaid	$9.76
Rate for Payer: Humana OH Medicaid	$9.76

EAPG 1003: DURABLE MEDICAL EQUIPMENT AND SUPPLIES - LEVEL 3

Facility

$31.97

Service Code	EAPG 01003
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$31.97
Rate for Payer: Aetna CHP/Medicaid	$31.97
Rate for Payer: Humana OH Medicaid	$31.97

EAPG 1004: DURABLE MEDICAL EQUIPMENT - LEVEL 4

Facility

$27.74

Service Code	EAPG 01004
Min. Negotiated Rate	$27.74
Max. Negotiated Rate	$27.74
Rate for Payer: Aetna CHP/Medicaid	$27.74
Rate for Payer: Humana OH Medicaid	$27.74

EAPG 1005: DURABLE MEDICAL EQUIPMENT - LEVEL 5

Facility

$51.23

Service Code	EAPG 01005
Min. Negotiated Rate	$51.23
Max. Negotiated Rate	$51.23
Rate for Payer: Aetna CHP/Medicaid	$51.23
Rate for Payer: Humana OH Medicaid	$51.23

EAPG 1006: DURABLE MEDICAL EQUIPMENT - LEVEL 6

Facility

$307.61

Service Code	EAPG 01006
Min. Negotiated Rate	$307.61
Max. Negotiated Rate	$307.61
Rate for Payer: Aetna CHP/Medicaid	$307.61
Rate for Payer: Humana OH Medicaid	$307.61

EAPG 1007: DURABLE MEDICAL EQUIPMENT - LEVEL 7

Facility

$79.91

Service Code	EAPG 01007
Min. Negotiated Rate	$79.91
Max. Negotiated Rate	$79.91
Rate for Payer: Aetna CHP/Medicaid	$79.91
Rate for Payer: Humana OH Medicaid	$79.91

EAPG 1008: DURABLE MEDICAL EQUIPMENT - LEVEL 8

Facility

$741.12

Service Code	EAPG 01008
Min. Negotiated Rate	$741.12
Max. Negotiated Rate	$741.12
Rate for Payer: Aetna CHP/Medicaid	$741.12
Rate for Payer: Humana OH Medicaid	$741.12

EAPG 1009: DURABLE MEDICAL EQUIPMENT - LEVEL 9

Facility

$291.55

Service Code	EAPG 01009
Min. Negotiated Rate	$291.55
Max. Negotiated Rate	$291.55
Rate for Payer: Aetna CHP/Medicaid	$291.55
Rate for Payer: Humana OH Medicaid	$291.55

EAPG 1010: DURABLE MEDICAL EQUIPMENT - LEVEL 10

Facility

$1,127.59

Service Code	EAPG 01010
Min. Negotiated Rate	$1,127.59
Max. Negotiated Rate	$1,127.59
Rate for Payer: Aetna CHP/Medicaid	$1,127.59
Rate for Payer: Humana OH Medicaid	$1,127.59

EAPG 1011: DURABLE MEDICAL EQUIPMENT - LEVEL 11

Facility

$586.27

Service Code	EAPG 01011
Min. Negotiated Rate	$586.27
Max. Negotiated Rate	$586.27
Rate for Payer: Aetna CHP/Medicaid	$586.27
Rate for Payer: Humana OH Medicaid	$586.27

EAPG 1012: DURABLE MEDICAL EQUIPMENT - LEVEL 12

Facility

$3,926.91

Service Code	EAPG 01012
Min. Negotiated Rate	$3,926.91
Max. Negotiated Rate	$3,926.91
Rate for Payer: Aetna CHP/Medicaid	$3,926.91
Rate for Payer: Humana OH Medicaid	$3,926.91

EAPG 1015: DURABLE MEDICAL EQUIPMENT - LEVEL 15

Facility

$3,492.62

Service Code	EAPG 01015
Min. Negotiated Rate	$3,492.62
Max. Negotiated Rate	$3,492.62
Rate for Payer: Aetna CHP/Medicaid	$3,492.62
Rate for Payer: Humana OH Medicaid	$3,492.62

EAPG 1020: DURABLE MEDICAL EQUIPMENT - LEVEL 20

Facility

$14,813.88

Service Code	EAPG 01020
Min. Negotiated Rate	$14,813.88
Max. Negotiated Rate	$14,813.88
Rate for Payer: Aetna CHP/Medicaid	$14,813.88
Rate for Payer: Humana OH Medicaid	$14,813.88

EAPG 103: LEVEL II VARICOSE VEIN AND RELATED PROCEDURES

Facility

$1,873.60

Service Code	EAPG 00103
Min. Negotiated Rate	$1,873.60
Max. Negotiated Rate	$1,873.60
Rate for Payer: Aetna CHP/Medicaid	$1,873.60
Rate for Payer: Humana OH Medicaid	$1,873.60

EAPG 104: MAJOR OPEN CORONARY ARTERY PROCEDURES INCLUDING CABG

Facility

$4,204.11

Service Code	EAPG 00104
Min. Negotiated Rate	$4,204.11
Max. Negotiated Rate	$4,204.11
Rate for Payer: Aetna CHP/Medicaid	$4,204.11
Rate for Payer: Humana OH Medicaid	$4,204.11

EAPG 105: MAJOR OPEN CARDIAC AND CARDIAC VALVE PROCEDURES

Facility

$2,665.52

Service Code	EAPG 00105
Min. Negotiated Rate	$2,665.52
Max. Negotiated Rate	$2,665.52
Rate for Payer: Aetna CHP/Medicaid	$2,665.52
Rate for Payer: Humana OH Medicaid	$2,665.52

EAPG 106: MAJOR OPEN ABDOMINAL AND THORACIC VASCULAR PROCEDURES

Facility

$2,296.21

Service Code	EAPG 00106
Min. Negotiated Rate	$2,296.21
Max. Negotiated Rate	$2,296.21
Rate for Payer: Aetna CHP/Medicaid	$2,296.21
Rate for Payer: Humana OH Medicaid	$2,296.21

EAPG 107: CHOLECYSTECTOMY AND RELATED BILIARY PROCEDURES

Facility

$2,646.23

Service Code	EAPG 00107
Min. Negotiated Rate	$2,646.23
Max. Negotiated Rate	$2,646.23
Rate for Payer: Aetna CHP/Medicaid	$2,646.23
Rate for Payer: Humana OH Medicaid	$2,646.23

EAPG 108: OTHER INTRA-ABDOMINAL AND INTRAPERITONEAL SURGICAL PROCEDURES

Facility

$1,776.97

Service Code	EAPG 00108
Min. Negotiated Rate	$1,776.97
Max. Negotiated Rate	$1,776.97
Rate for Payer: Aetna CHP/Medicaid	$1,776.97
Rate for Payer: Humana OH Medicaid	$1,776.97

EAPG 109: ANCILLARY DRUG ADMINISTRATION

Facility

$39.87

Service Code	EAPG 00109
Min. Negotiated Rate	$39.87
Max. Negotiated Rate	$39.87
Rate for Payer: Aetna CHP/Medicaid	$39.87
Rate for Payer: Humana OH Medicaid	$39.87

EAPG 10: LEVEL II SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$928.36

Service Code	EAPG 00010
Min. Negotiated Rate	$928.36
Max. Negotiated Rate	$928.36
Rate for Payer: Aetna CHP/Medicaid	$928.36
Rate for Payer: Humana OH Medicaid	$928.36

EAPG 110: PHARMACOTHERAPY BY EXTENDED INFUSION

Facility

$342.28

Service Code	EAPG 00110
Min. Negotiated Rate	$342.28
Max. Negotiated Rate	$342.28
Rate for Payer: Aetna CHP/Medicaid	$342.28
Rate for Payer: Humana OH Medicaid	$342.28

EAPG 111: PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION

Facility

$242.98

Service Code	EAPG 00111
Min. Negotiated Rate	$242.98
Max. Negotiated Rate	$242.98
Rate for Payer: Aetna CHP/Medicaid	$242.98
Rate for Payer: Humana OH Medicaid	$242.98

EAPG 113: LEVEL I BLOOD PRODUCT EXCHANGE SERVICES

Facility

$397.38

Service Code	EAPG 00113
Min. Negotiated Rate	$397.38
Max. Negotiated Rate	$397.38
Rate for Payer: Aetna CHP/Medicaid	$397.38
Rate for Payer: Humana OH Medicaid	$397.38

Know your out-of-pocket cost for care.

All Charges