Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 114: LEVEL II BLOOD PRODUCT EXCHANGE SERVICES

Facility

$1,383.90

Service Code	EAPG 00114
Min. Negotiated Rate	$1,383.90
Max. Negotiated Rate	$1,383.90
Rate for Payer: Aetna CHP/Medicaid	$1,383.90
Rate for Payer: Humana OH Medicaid	$1,383.90

EAPG 115: DEEP LYMPH STRUCTURE PROCEDURES

Facility

$1,980.60

Service Code	EAPG 00115
Min. Negotiated Rate	$1,980.60
Max. Negotiated Rate	$1,980.60
Rate for Payer: Aetna CHP/Medicaid	$1,980.60
Rate for Payer: Humana OH Medicaid	$1,980.60

EAPG 116: LEVEL I ALLERGY TESTS

Facility

$135.20

Service Code	EAPG 00116
Min. Negotiated Rate	$135.20
Max. Negotiated Rate	$135.20
Rate for Payer: Aetna CHP/Medicaid	$135.20
Rate for Payer: Humana OH Medicaid	$135.20

EAPG 118: NUTRITION THERAPY

Facility

$72.86

Service Code	EAPG 00118
Min. Negotiated Rate	$72.86
Max. Negotiated Rate	$72.86
Rate for Payer: Aetna CHP/Medicaid	$72.86
Rate for Payer: Humana OH Medicaid	$72.86

EAPG 119: CAR T-CELL IMMUNOTHERAPY PREPARATION SERVICES

Facility

$130.62

Service Code	EAPG 00119
Min. Negotiated Rate	$130.62
Max. Negotiated Rate	$130.62
Rate for Payer: Aetna CHP/Medicaid	$130.62
Rate for Payer: Humana OH Medicaid	$130.62

EAPG 11: LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$1,500.23

Service Code	EAPG 00011
Min. Negotiated Rate	$1,500.23
Max. Negotiated Rate	$1,500.23
Rate for Payer: Aetna CHP/Medicaid	$1,500.23
Rate for Payer: Humana OH Medicaid	$1,500.23

EAPG 120: CAR T-CELL IMMUNOTHERAPY

Facility

$9,778.02

Service Code	EAPG 00120
Min. Negotiated Rate	$9,778.02
Max. Negotiated Rate	$9,778.02
Rate for Payer: Aetna CHP/Medicaid	$9,778.02
Rate for Payer: Humana OH Medicaid	$9,778.02

EAPG 121: LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$12,509.97

Service Code	EAPG 00121
Min. Negotiated Rate	$12,509.97
Max. Negotiated Rate	$12,509.97
Rate for Payer: Aetna CHP/Medicaid	$12,509.97
Rate for Payer: Humana OH Medicaid	$12,509.97

EAPG 122: PERCUTANEOUS INTRA-ABDOMINAL OR INTRATHORACIC VASCULAR PROCEDURES

Facility

$9,143.53

Service Code	EAPG 00122
Min. Negotiated Rate	$9,143.53
Max. Negotiated Rate	$9,143.53
Rate for Payer: Aetna CHP/Medicaid	$9,143.53
Rate for Payer: Humana OH Medicaid	$9,143.53

EAPG 123: PERIPHERAL VASCULAR BYPASS PROCEDURES

Facility

$3,405.52

Service Code	EAPG 00123
Min. Negotiated Rate	$3,405.52
Max. Negotiated Rate	$3,405.52
Rate for Payer: Aetna CHP/Medicaid	$3,405.52
Rate for Payer: Humana OH Medicaid	$3,405.52

EAPG 124: BONE MARROW BIOPSIES

Facility

$1,157.33

Service Code	EAPG 00124
Min. Negotiated Rate	$1,157.33
Max. Negotiated Rate	$1,157.33
Rate for Payer: Aetna CHP/Medicaid	$1,157.33
Rate for Payer: Humana OH Medicaid	$1,157.33

EAPG 125: LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$2,634.38

Service Code	EAPG 00125
Min. Negotiated Rate	$2,634.38
Max. Negotiated Rate	$2,634.38
Rate for Payer: Aetna CHP/Medicaid	$2,634.38
Rate for Payer: Humana OH Medicaid	$2,634.38

EAPG 126: LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$2,762.73

Service Code	EAPG 00126
Min. Negotiated Rate	$2,762.73
Max. Negotiated Rate	$2,762.73
Rate for Payer: Aetna CHP/Medicaid	$2,762.73
Rate for Payer: Humana OH Medicaid	$2,762.73

EAPG 127: LEVEL I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$1,392.98

Service Code	EAPG 00127
Min. Negotiated Rate	$1,392.98
Max. Negotiated Rate	$1,392.98
Rate for Payer: Aetna CHP/Medicaid	$1,392.98
Rate for Payer: Humana OH Medicaid	$1,392.98

EAPG 128: LEVEL II SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$3,034.14

Service Code	EAPG 00128
Min. Negotiated Rate	$3,034.14
Max. Negotiated Rate	$3,034.14
Rate for Payer: Aetna CHP/Medicaid	$3,034.14
Rate for Payer: Humana OH Medicaid	$3,034.14

EAPG 129: ESOPHAGOGASTRIC RESTRICTIVE PROCEDURES AND GASTRIC FUNDOPLICATION

Facility

$4,178.14

Service Code	EAPG 00129
Min. Negotiated Rate	$4,178.14
Max. Negotiated Rate	$4,178.14
Rate for Payer: Aetna CHP/Medicaid	$4,178.14
Rate for Payer: Humana OH Medicaid	$4,178.14

EAPG 130: MINOR GASTROINTESTINAL PROCEDURES INCLUDING TUBE INSERTION OR PLACEMENT

Facility

$262.10

Service Code	EAPG 00130
Min. Negotiated Rate	$262.10
Max. Negotiated Rate	$262.10
Rate for Payer: Aetna CHP/Medicaid	$262.10
Rate for Payer: Humana OH Medicaid	$262.10

EAPG 134: LEVEL I UPPER GI ENDOSCOPY

Facility

$683.04

Service Code	EAPG 00134
Min. Negotiated Rate	$683.04
Max. Negotiated Rate	$683.04
Rate for Payer: Aetna CHP/Medicaid	$683.04
Rate for Payer: Humana OH Medicaid	$683.04

EAPG 135: LEVEL II UPPER GI ENDOSCOPY

Facility

$1,313.61

Service Code	EAPG 00135
Min. Negotiated Rate	$1,313.61
Max. Negotiated Rate	$1,313.61
Rate for Payer: Aetna CHP/Medicaid	$1,313.61
Rate for Payer: Humana OH Medicaid	$1,313.61

EAPG 136: LEVEL I LOWER GI ENDOSCOPY

Facility

$779.27

Service Code	EAPG 00136
Min. Negotiated Rate	$779.27
Max. Negotiated Rate	$779.27
Rate for Payer: Aetna CHP/Medicaid	$779.27
Rate for Payer: Humana OH Medicaid	$779.27

EAPG 137: LEVEL II LOWER GI ENDOSCOPY

Facility

$1,284.24

Service Code	EAPG 00137
Min. Negotiated Rate	$1,284.24
Max. Negotiated Rate	$1,284.24
Rate for Payer: Aetna CHP/Medicaid	$1,284.24
Rate for Payer: Humana OH Medicaid	$1,284.24

EAPG 138: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$1,725.67

Service Code	EAPG 00138
Min. Negotiated Rate	$1,725.67
Max. Negotiated Rate	$1,725.67
Rate for Payer: Aetna CHP/Medicaid	$1,725.67
Rate for Payer: Humana OH Medicaid	$1,725.67

EAPG 141: LEVEL I ANAL AND RECTAL PROCEDURES

Facility

$951.91

Service Code	EAPG 00141
Min. Negotiated Rate	$951.91
Max. Negotiated Rate	$951.91
Rate for Payer: Aetna CHP/Medicaid	$951.91
Rate for Payer: Humana OH Medicaid	$951.91

EAPG 142: LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$1,607.74

Service Code	EAPG 00142
Min. Negotiated Rate	$1,607.74
Max. Negotiated Rate	$1,607.74
Rate for Payer: Aetna CHP/Medicaid	$1,607.74
Rate for Payer: Humana OH Medicaid	$1,607.74

EAPG 150: ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES

Facility

$404.31

Service Code	EAPG 00150
Min. Negotiated Rate	$404.31
Max. Negotiated Rate	$404.31
Rate for Payer: Aetna CHP/Medicaid	$404.31
Rate for Payer: Humana OH Medicaid	$404.31

Know your out-of-pocket cost for care.

All Charges