Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 2040: LEVEL I DRUG SCREENING AND DEFINITIVE TESTS

Facility

$26.37

Service Code	EAPG 02040
Min. Negotiated Rate	$26.37
Max. Negotiated Rate	$26.37
Rate for Payer: Aetna CHP/Medicaid	$26.37
Rate for Payer: Humana OH Medicaid	$26.37

EAPG 2041: LEVEL II DRUG SCREENING AND DEFINITIVE TESTS

Facility

$30.48

Service Code	EAPG 02041
Min. Negotiated Rate	$30.48
Max. Negotiated Rate	$30.48
Rate for Payer: Aetna CHP/Medicaid	$30.48
Rate for Payer: Humana OH Medicaid	$30.48

EAPG 2042: LEVEL III DRUG SCREENING AND DEFINITIVE TESTS

Facility

$66.04

Service Code	EAPG 02042
Min. Negotiated Rate	$66.04
Max. Negotiated Rate	$66.04
Rate for Payer: Aetna CHP/Medicaid	$66.04
Rate for Payer: Humana OH Medicaid	$66.04

EAPG 2043: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility

$45.74

Service Code	EAPG 02043
Min. Negotiated Rate	$45.74
Max. Negotiated Rate	$45.74
Rate for Payer: Aetna CHP/Medicaid	$45.74
Rate for Payer: Humana OH Medicaid	$45.74

EAPG 2044: LEVEL IV COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$151.54

Service Code	EAPG 02044
Min. Negotiated Rate	$151.54
Max. Negotiated Rate	$151.54
Rate for Payer: Aetna CHP/Medicaid	$151.54
Rate for Payer: Humana OH Medicaid	$151.54

EAPG 2045: ADVANCED MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$588.29

Service Code	EAPG 02045
Min. Negotiated Rate	$588.29
Max. Negotiated Rate	$588.29
Rate for Payer: Aetna CHP/Medicaid	$588.29
Rate for Payer: Humana OH Medicaid	$588.29

EAPG 204: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$2,784.55

Service Code	EAPG 00204
Min. Negotiated Rate	$2,784.55
Max. Negotiated Rate	$2,784.55
Rate for Payer: Aetna CHP/Medicaid	$2,784.55
Rate for Payer: Humana OH Medicaid	$2,784.55

EAPG 205: OBSTETRICAL PROCEDURES

Facility

$1,082.10

Service Code	EAPG 00205
Min. Negotiated Rate	$1,082.10
Max. Negotiated Rate	$1,082.10
Rate for Payer: Aetna CHP/Medicaid	$1,082.10
Rate for Payer: Humana OH Medicaid	$1,082.10

EAPG 2061: CLASS I BLOOD PRODUCTS

Facility

$183.02

Service Code	EAPG 02061
Min. Negotiated Rate	$183.02
Max. Negotiated Rate	$183.02
Rate for Payer: Aetna CHP/Medicaid	$183.02
Rate for Payer: Humana OH Medicaid	$183.02

EAPG 2062: CLASS II BLOOD PRODUCTS

Facility

$300.24

Service Code	EAPG 02062
Min. Negotiated Rate	$300.24
Max. Negotiated Rate	$300.24
Rate for Payer: Aetna CHP/Medicaid	$300.24
Rate for Payer: Humana OH Medicaid	$300.24

EAPG 206: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$4,814.74

Service Code	EAPG 00206
Min. Negotiated Rate	$4,814.74
Max. Negotiated Rate	$4,814.74
Rate for Payer: Aetna CHP/Medicaid	$4,814.74
Rate for Payer: Humana OH Medicaid	$4,814.74

EAPG 207: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$1,491.53

Service Code	EAPG 00207
Min. Negotiated Rate	$1,491.53
Max. Negotiated Rate	$1,491.53
Rate for Payer: Aetna CHP/Medicaid	$1,491.53
Rate for Payer: Humana OH Medicaid	$1,491.53

EAPG 208: LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$2,438.47

Service Code	EAPG 00208
Min. Negotiated Rate	$2,438.47
Max. Negotiated Rate	$2,438.47
Rate for Payer: Aetna CHP/Medicaid	$2,438.47
Rate for Payer: Humana OH Medicaid	$2,438.47

EAPG 209: OTHER GYNECOLOGICAL PROCEDURES

Facility

$179.36

Service Code	EAPG 00209
Min. Negotiated Rate	$179.36
Max. Negotiated Rate	$179.36
Rate for Payer: Aetna CHP/Medicaid	$179.36
Rate for Payer: Humana OH Medicaid	$179.36

EAPG 20: BREAST BIOPSIES, EXCISIONS, AND OTHER RELATED PROCEDURES

Facility

$903.20

Service Code	EAPG 00020
Min. Negotiated Rate	$903.20
Max. Negotiated Rate	$903.20
Rate for Payer: Aetna CHP/Medicaid	$903.20
Rate for Payer: Humana OH Medicaid	$903.20

EAPG 210: EXTENDED EEG STUDIES

Facility

$609.08

Service Code	EAPG 00210
Min. Negotiated Rate	$609.08
Max. Negotiated Rate	$609.08
Rate for Payer: Aetna CHP/Medicaid	$609.08
Rate for Payer: Humana OH Medicaid	$609.08

EAPG 211: ELECTROENCEPHALOGRAM

Facility

$184.69

Service Code	EAPG 00211
Min. Negotiated Rate	$184.69
Max. Negotiated Rate	$184.69
Rate for Payer: Aetna CHP/Medicaid	$184.69
Rate for Payer: Humana OH Medicaid	$184.69

EAPG 212: ELECTROCONVULSIVE THERAPY

Facility

$471.51

Service Code	EAPG 00212
Min. Negotiated Rate	$471.51
Max. Negotiated Rate	$471.51
Rate for Payer: Aetna CHP/Medicaid	$471.51
Rate for Payer: Humana OH Medicaid	$471.51

EAPG 213: NERVE AND MUSCLE TESTS

Facility

$342.93

Service Code	EAPG 00213
Min. Negotiated Rate	$342.93
Max. Negotiated Rate	$342.93
Rate for Payer: Aetna CHP/Medicaid	$342.93
Rate for Payer: Humana OH Medicaid	$342.93

EAPG 214: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$253.27

Service Code	EAPG 00214
Min. Negotiated Rate	$253.27
Max. Negotiated Rate	$253.27
Rate for Payer: Aetna CHP/Medicaid	$253.27
Rate for Payer: Humana OH Medicaid	$253.27

EAPG 217: LEVEL I PERIPHERAL NERVE PROCEDURES

Facility

$954.32

Service Code	EAPG 00217
Min. Negotiated Rate	$954.32
Max. Negotiated Rate	$954.32
Rate for Payer: Aetna CHP/Medicaid	$954.32
Rate for Payer: Humana OH Medicaid	$954.32

EAPG 218: LEVEL II PERIPHERAL NERVE PROCEDURES

Facility

$3,112.62

Service Code	EAPG 00218
Min. Negotiated Rate	$3,112.62
Max. Negotiated Rate	$3,112.62
Rate for Payer: Aetna CHP/Medicaid	$3,112.62
Rate for Payer: Humana OH Medicaid	$3,112.62

EAPG 21: LEVEL I MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES

Facility

$2,695.35

Service Code	EAPG 00021
Min. Negotiated Rate	$2,695.35
Max. Negotiated Rate	$2,695.35
Rate for Payer: Aetna CHP/Medicaid	$2,695.35
Rate for Payer: Humana OH Medicaid	$2,695.35

EAPG 220: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$616.06

Service Code	EAPG 00220
Min. Negotiated Rate	$616.06
Max. Negotiated Rate	$616.06
Rate for Payer: Aetna CHP/Medicaid	$616.06
Rate for Payer: Humana OH Medicaid	$616.06

EAPG 222: SLEEP STUDIES ATTENDED

Facility

$616.79

Service Code	EAPG 00222
Min. Negotiated Rate	$616.79
Max. Negotiated Rate	$616.79
Rate for Payer: Aetna CHP/Medicaid	$616.79
Rate for Payer: Humana OH Medicaid	$616.79

Know your out-of-pocket cost for care.

All Charges