Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 182: INSERTION OF PENILE PROSTHESIS

Facility

$10,990.87

Service Code	EAPG 00182
Min. Negotiated Rate	$10,990.87
Max. Negotiated Rate	$10,990.87
Rate for Payer: Aetna CHP/Medicaid	$10,990.87
Rate for Payer: Humana OH Medicaid	$10,990.87

EAPG 183: LEVEL I PENILE PROCEDURES

Facility

$1,044.18

Service Code	EAPG 00183
Min. Negotiated Rate	$1,044.18
Max. Negotiated Rate	$1,044.18
Rate for Payer: Aetna CHP/Medicaid	$1,044.18
Rate for Payer: Humana OH Medicaid	$1,044.18

EAPG 184: LEVEL II PROSTATE PROCEDURES

Facility

$2,875.33

Service Code	EAPG 00184
Min. Negotiated Rate	$2,875.33
Max. Negotiated Rate	$2,875.33
Rate for Payer: Aetna CHP/Medicaid	$2,875.33
Rate for Payer: Humana OH Medicaid	$2,875.33

EAPG 187: LEVEL II PENILE PROCEDURES

Facility

$2,461.79

Service Code	EAPG 00187
Min. Negotiated Rate	$2,461.79
Max. Negotiated Rate	$2,461.79
Rate for Payer: Aetna CHP/Medicaid	$2,461.79
Rate for Payer: Humana OH Medicaid	$2,461.79

EAPG 188: LEVEL I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$1,286.23

Service Code	EAPG 00188
Min. Negotiated Rate	$1,286.23
Max. Negotiated Rate	$1,286.23
Rate for Payer: Aetna CHP/Medicaid	$1,286.23
Rate for Payer: Humana OH Medicaid	$1,286.23

EAPG 189: LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$3,525.98

Service Code	EAPG 00189
Min. Negotiated Rate	$3,525.98
Max. Negotiated Rate	$3,525.98
Rate for Payer: Aetna CHP/Medicaid	$3,525.98
Rate for Payer: Humana OH Medicaid	$3,525.98

EAPG 18: COMPLEX WOUND REPAIR AND TREATMENT

Facility

$489.88

Service Code	EAPG 00018
Min. Negotiated Rate	$489.88
Max. Negotiated Rate	$489.88
Rate for Payer: Aetna CHP/Medicaid	$489.88
Rate for Payer: Humana OH Medicaid	$489.88

EAPG 190: ARTIFICIAL FERTILIZATION

Facility

$89.07

Service Code	EAPG 00190
Min. Negotiated Rate	$89.07
Max. Negotiated Rate	$89.07
Rate for Payer: Aetna CHP/Medicaid	$89.07
Rate for Payer: Humana OH Medicaid	$89.07

EAPG 191: LEVEL I FETAL PROCEDURES

Facility

$151.43

Service Code	EAPG 00191
Min. Negotiated Rate	$151.43
Max. Negotiated Rate	$151.43
Rate for Payer: Aetna CHP/Medicaid	$151.43
Rate for Payer: Humana OH Medicaid	$151.43

EAPG 192: LEVEL II FETAL PROCEDURES

Facility

$1,391.32

Service Code	EAPG 00192
Min. Negotiated Rate	$1,391.32
Max. Negotiated Rate	$1,391.32
Rate for Payer: Aetna CHP/Medicaid	$1,391.32
Rate for Payer: Humana OH Medicaid	$1,391.32

EAPG 194: ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES

Facility

$1,205.63

Service Code	EAPG 00194
Min. Negotiated Rate	$1,205.63
Max. Negotiated Rate	$1,205.63
Rate for Payer: Aetna CHP/Medicaid	$1,205.63
Rate for Payer: Humana OH Medicaid	$1,205.63

EAPG 195: VAGINAL DELIVERY PROCEDURES

Facility

$1,354.12

Service Code	EAPG 00195
Min. Negotiated Rate	$1,354.12
Max. Negotiated Rate	$1,354.12
Rate for Payer: Aetna CHP/Medicaid	$1,354.12
Rate for Payer: Humana OH Medicaid	$1,354.12

EAPG 19: MOHS MICROGRAPHIC SURGERY

Facility

$211.42

Service Code	EAPG 00019
Min. Negotiated Rate	$211.42
Max. Negotiated Rate	$211.42
Rate for Payer: Aetna CHP/Medicaid	$211.42
Rate for Payer: Humana OH Medicaid	$211.42

EAPG 2000: DIAGNOSTIC RADIOPHARMACEUTICAL

Facility

$113.37

Service Code	EAPG 02000
Min. Negotiated Rate	$113.37
Max. Negotiated Rate	$113.37
Rate for Payer: Aetna CHP/Medicaid	$113.37
Rate for Payer: Humana OH Medicaid	$113.37

EAPG 2001: DIAGNOSTIC CONTRAST MEDIA

Facility

$21.87

Service Code	EAPG 02001
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$21.87
Rate for Payer: Aetna CHP/Medicaid	$21.87
Rate for Payer: Humana OH Medicaid	$21.87

EAPG 2002: INCIDENTAL IMAGING SERVICES

Facility

$76.00

Service Code	EAPG 02002
Min. Negotiated Rate	$76.00
Max. Negotiated Rate	$76.00
Rate for Payer: Aetna CHP/Medicaid	$76.00
Rate for Payer: Humana OH Medicaid	$76.00

EAPG 2003: INCIDENTAL PHYSICIAN REPORT OR TECHNICAL SERVICES

Facility

$355.07

Service Code	EAPG 02003
Min. Negotiated Rate	$355.07
Max. Negotiated Rate	$355.07
Rate for Payer: Aetna CHP/Medicaid	$355.07
Rate for Payer: Humana OH Medicaid	$355.07

EAPG 2004: INCIDENTAL MINOR DIAGNOSTIC TESTS

Facility

$29.39

Service Code	EAPG 02004
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$29.39
Rate for Payer: Aetna CHP/Medicaid	$29.39
Rate for Payer: Humana OH Medicaid	$29.39

EAPG 2005: INCIDENTAL MEDICAL VISIT SERVICES

Facility

$55.82

Service Code	EAPG 02005
Min. Negotiated Rate	$55.82
Max. Negotiated Rate	$55.82
Rate for Payer: Aetna CHP/Medicaid	$55.82
Rate for Payer: Humana OH Medicaid	$55.82

EAPG 2006: INCIDENTAL IMPLANTABLE OR OTHER RELATED DEVICES

Facility

$175.90

Service Code	EAPG 02006
Min. Negotiated Rate	$175.90
Max. Negotiated Rate	$175.90
Rate for Payer: Aetna CHP/Medicaid	$175.90
Rate for Payer: Humana OH Medicaid	$175.90

EAPG 2008: INCIDENTAL INTRAOPERATIVE PROCEDURES

Facility

$589.48

Service Code	EAPG 02008
Min. Negotiated Rate	$589.48
Max. Negotiated Rate	$589.48
Rate for Payer: Aetna CHP/Medicaid	$589.48
Rate for Payer: Humana OH Medicaid	$589.48

EAPG 2020: NONINVASIVE VENTILATION SUPPORT

Facility

$71.04

Service Code	EAPG 02020
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$71.04
Rate for Payer: Aetna CHP/Medicaid	$71.04
Rate for Payer: Humana OH Medicaid	$71.04

EAPG 202: CESAREAN DELIVERY PROCEDURES

Facility

$940.52

Service Code	EAPG 00202
Min. Negotiated Rate	$940.52
Max. Negotiated Rate	$940.52
Rate for Payer: Aetna CHP/Medicaid	$940.52
Rate for Payer: Humana OH Medicaid	$940.52

EAPG 2030: MINOR MUSCULOSKELETAL PROCEDURES

Facility

$220.23

Service Code	EAPG 02030
Min. Negotiated Rate	$220.23
Max. Negotiated Rate	$220.23
Rate for Payer: Aetna CHP/Medicaid	$220.23
Rate for Payer: Humana OH Medicaid	$220.23

EAPG 203: GLOBAL ANTEPARTUM AND POSTPARTUM VISITS

Facility

$75.41

Service Code	EAPG 00203
Min. Negotiated Rate	$75.41
Max. Negotiated Rate	$75.41
Rate for Payer: Aetna CHP/Medicaid	$75.41
Rate for Payer: Humana OH Medicaid	$75.41

Know your out-of-pocket cost for care.

All Charges