Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 151: LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$1,193.68

Service Code	EAPG 00151
Min. Negotiated Rate	$1,193.68
Max. Negotiated Rate	$1,193.68
Rate for Payer: Aetna CHP/Medicaid	$1,193.68
Rate for Payer: Humana OH Medicaid	$1,193.68

EAPG 152: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$3,039.26

Service Code	EAPG 00152
Min. Negotiated Rate	$3,039.26
Max. Negotiated Rate	$3,039.26
Rate for Payer: Aetna CHP/Medicaid	$3,039.26
Rate for Payer: Humana OH Medicaid	$3,039.26

EAPG 153: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$2,506.24

Service Code	EAPG 00153
Min. Negotiated Rate	$2,506.24
Max. Negotiated Rate	$2,506.24
Rate for Payer: Aetna CHP/Medicaid	$2,506.24
Rate for Payer: Humana OH Medicaid	$2,506.24

EAPG 154: LEVEL III UPPER GI ENDOSCOPY

Facility

$2,762.20

Service Code	EAPG 00154
Min. Negotiated Rate	$2,762.20
Max. Negotiated Rate	$2,762.20
Rate for Payer: Aetna CHP/Medicaid	$2,762.20
Rate for Payer: Humana OH Medicaid	$2,762.20

EAPG 155: LEVEL III BLOOD PRODUCT EXCHANGE SERVICES

Facility

$1,513.87

Service Code	EAPG 00155
Min. Negotiated Rate	$1,513.87
Max. Negotiated Rate	$1,513.87
Rate for Payer: Aetna CHP/Medicaid	$1,513.87
Rate for Payer: Humana OH Medicaid	$1,513.87

EAPG 156: OCULAR IMAGING AND RELATED SERVICES

Facility

$41.78

Service Code	EAPG 00156
Min. Negotiated Rate	$41.78
Max. Negotiated Rate	$41.78
Rate for Payer: Aetna CHP/Medicaid	$41.78
Rate for Payer: Humana OH Medicaid	$41.78

EAPG 157: REPRODUCTIVE PATHOLOGY TESTS

Facility

$21.76

Service Code	EAPG 00157
Min. Negotiated Rate	$21.76
Max. Negotiated Rate	$21.76
Rate for Payer: Aetna CHP/Medicaid	$21.76
Rate for Payer: Humana OH Medicaid	$21.76

EAPG 158: PATHOLOGY CONSULTATION AND INTERPRETATION

Facility

$30.39

Service Code	EAPG 00158
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$30.39
Rate for Payer: Aetna CHP/Medicaid	$30.39
Rate for Payer: Humana OH Medicaid	$30.39

EAPG 159: MINOR UROLOGY SERVICES

Facility

$43.49

Service Code	EAPG 00159
Min. Negotiated Rate	$43.49
Max. Negotiated Rate	$43.49
Rate for Payer: Aetna CHP/Medicaid	$43.49
Rate for Payer: Humana OH Medicaid	$43.49

EAPG 161: URINARY STUDIES AND PROCEDURES

Facility

$249.28

Service Code	EAPG 00161
Min. Negotiated Rate	$249.28
Max. Negotiated Rate	$249.28
Rate for Payer: Aetna CHP/Medicaid	$249.28
Rate for Payer: Humana OH Medicaid	$249.28

EAPG 166: LEVEL I URETHRAL PROCEDURES

Facility

$1,848.68

Service Code	EAPG 00166
Min. Negotiated Rate	$1,848.68
Max. Negotiated Rate	$1,848.68
Rate for Payer: Aetna CHP/Medicaid	$1,848.68
Rate for Payer: Humana OH Medicaid	$1,848.68

EAPG 167: LEVEL II URETHRAL PROCEDURES

Facility

$3,182.08

Service Code	EAPG 00167
Min. Negotiated Rate	$3,182.08
Max. Negotiated Rate	$3,182.08
Rate for Payer: Aetna CHP/Medicaid	$3,182.08
Rate for Payer: Humana OH Medicaid	$3,182.08

EAPG 168: DIALYSIS PROCEDURES

Facility

$326.60

Service Code	EAPG 00168
Min. Negotiated Rate	$326.60
Max. Negotiated Rate	$326.60
Rate for Payer: Aetna CHP/Medicaid	$326.60
Rate for Payer: Humana OH Medicaid	$326.60

EAPG 16: SIMPLE WOUND REPAIR AND TREATMENT

Facility

$163.04

Service Code	EAPG 00016
Min. Negotiated Rate	$163.04
Max. Negotiated Rate	$163.04
Rate for Payer: Aetna CHP/Medicaid	$163.04
Rate for Payer: Humana OH Medicaid	$163.04

EAPG 170: LEVEL I KIDNEY AND URETERAL PROCEDURES

Facility

$879.14

Service Code	EAPG 00170
Min. Negotiated Rate	$879.14
Max. Negotiated Rate	$879.14
Rate for Payer: Aetna CHP/Medicaid	$879.14
Rate for Payer: Humana OH Medicaid	$879.14

EAPG 171: LEVEL II KIDNEY AND URETERAL PROCEDURES

Facility

$1,853.40

Service Code	EAPG 00171
Min. Negotiated Rate	$1,853.40
Max. Negotiated Rate	$1,853.40
Rate for Payer: Aetna CHP/Medicaid	$1,853.40
Rate for Payer: Humana OH Medicaid	$1,853.40

EAPG 172: LEVEL III KIDNEY AND URETERAL PROCEDURES

Facility

$4,966.73

Service Code	EAPG 00172
Min. Negotiated Rate	$4,966.73
Max. Negotiated Rate	$4,966.73
Rate for Payer: Aetna CHP/Medicaid	$4,966.73
Rate for Payer: Humana OH Medicaid	$4,966.73

EAPG 173: LEVEL I BLADDER AND URETERAL PROCEDURES

Facility

$933.53

Service Code	EAPG 00173
Min. Negotiated Rate	$933.53
Max. Negotiated Rate	$933.53
Rate for Payer: Aetna CHP/Medicaid	$933.53
Rate for Payer: Humana OH Medicaid	$933.53

EAPG 174: LEVEL II BLADDER AND URETERAL PROCEDURES

Facility

$2,479.27

Service Code	EAPG 00174
Min. Negotiated Rate	$2,479.27
Max. Negotiated Rate	$2,479.27
Rate for Payer: Aetna CHP/Medicaid	$2,479.27
Rate for Payer: Humana OH Medicaid	$2,479.27

EAPG 176: LEVEL I PROSTATE PROCEDURES

Facility

$987.35

Service Code	EAPG 00176
Min. Negotiated Rate	$987.35
Max. Negotiated Rate	$987.35
Rate for Payer: Aetna CHP/Medicaid	$987.35
Rate for Payer: Humana OH Medicaid	$987.35

EAPG 177: MINOR DERMATOLOGY SERVICES

Facility

$8.08

Service Code	EAPG 00177
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$8.08
Rate for Payer: Aetna CHP/Medicaid	$8.08
Rate for Payer: Humana OH Medicaid	$8.08

EAPG 178: ANTEPARTUM PROCEDURES

Facility

$388.95

Service Code	EAPG 00178
Min. Negotiated Rate	$388.95
Max. Negotiated Rate	$388.95
Rate for Payer: Aetna CHP/Medicaid	$388.95
Rate for Payer: Humana OH Medicaid	$388.95

EAPG 179: ECTOPIC PREGNANCY PROCEDURES

Facility

$3,311.75

Service Code	EAPG 00179
Min. Negotiated Rate	$3,311.75
Max. Negotiated Rate	$3,311.75
Rate for Payer: Aetna CHP/Medicaid	$3,311.75
Rate for Payer: Humana OH Medicaid	$3,311.75

EAPG 17: INTERMEDIATE WOUND REPAIR AND TREATMENT

Facility

$209.33

Service Code	EAPG 00017
Min. Negotiated Rate	$209.33
Max. Negotiated Rate	$209.33
Rate for Payer: Aetna CHP/Medicaid	$209.33
Rate for Payer: Humana OH Medicaid	$209.33

EAPG 180: TESTICULAR AND EPIDIDYMAL PROCEDURES

Facility

$1,308.47

Service Code	EAPG 00180
Min. Negotiated Rate	$1,308.47
Max. Negotiated Rate	$1,308.47
Rate for Payer: Aetna CHP/Medicaid	$1,308.47
Rate for Payer: Humana OH Medicaid	$1,308.47

Know your out-of-pocket cost for care.

All Charges