Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 223: LEVEL I NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION

Facility

$3,699.40

Service Code	EAPG 00223
Min. Negotiated Rate	$3,699.40
Max. Negotiated Rate	$3,699.40
Rate for Payer: Aetna CHP/Medicaid	$3,699.40
Rate for Payer: Humana OH Medicaid	$3,699.40

EAPG 224: LEVEL II NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION

Facility

$16,785.08

Service Code	EAPG 00224
Min. Negotiated Rate	$16,785.08
Max. Negotiated Rate	$16,785.08
Rate for Payer: Aetna CHP/Medicaid	$16,785.08
Rate for Payer: Humana OH Medicaid	$16,785.08

EAPG 225: OTHER INTRACRANIAL NEUROSURGERY PROCEDURES

Facility

$1,491.32

Service Code	EAPG 00225
Min. Negotiated Rate	$1,491.32
Max. Negotiated Rate	$1,491.32
Rate for Payer: Aetna CHP/Medicaid	$1,491.32
Rate for Payer: Humana OH Medicaid	$1,491.32

EAPG 226: SLEEP STUDIES UNATTENDED

Facility

$75.56

Service Code	EAPG 00226
Min. Negotiated Rate	$75.56
Max. Negotiated Rate	$75.56
Rate for Payer: Aetna CHP/Medicaid	$75.56
Rate for Payer: Humana OH Medicaid	$75.56

EAPG 227: LEVEL I CRANIOFACIAL BONE PROCEDURES

Facility

$1,802.69

Service Code	EAPG 00227
Min. Negotiated Rate	$1,802.69
Max. Negotiated Rate	$1,802.69
Rate for Payer: Aetna CHP/Medicaid	$1,802.69
Rate for Payer: Humana OH Medicaid	$1,802.69

EAPG 228: LEVEL II CRANIOFACIAL BONE PROCEDURES

Facility

$3,963.58

Service Code	EAPG 00228
Min. Negotiated Rate	$3,963.58
Max. Negotiated Rate	$3,963.58
Rate for Payer: Aetna CHP/Medicaid	$3,963.58
Rate for Payer: Humana OH Medicaid	$3,963.58

EAPG 229: MINOR AUDIOMETRY TESTS AND AUDIOLOGY SCREENING SERVICES

Facility

$35.02

Service Code	EAPG 00229
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$35.02
Rate for Payer: Aetna CHP/Medicaid	$35.02
Rate for Payer: Humana OH Medicaid	$35.02

EAPG 22: LEVEL II MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES

Facility

$4,274.32

Service Code	EAPG 00022
Min. Negotiated Rate	$4,274.32
Max. Negotiated Rate	$4,274.32
Rate for Payer: Aetna CHP/Medicaid	$4,274.32
Rate for Payer: Humana OH Medicaid	$4,274.32

EAPG 230: MINOR OPHTHALMOLOGICAL PROCEDURES AND DIAGNOSTIC SERVICES

Facility

$173.51

Service Code	EAPG 00230
Min. Negotiated Rate	$173.51
Max. Negotiated Rate	$173.51
Rate for Payer: Aetna CHP/Medicaid	$173.51
Rate for Payer: Humana OH Medicaid	$173.51

EAPG 233: CATARACT AND OTHER INTRAOCULAR LENS PROCEDURES

Facility

$1,155.56

Service Code	EAPG 00233
Min. Negotiated Rate	$1,155.56
Max. Negotiated Rate	$1,155.56
Rate for Payer: Aetna CHP/Medicaid	$1,155.56
Rate for Payer: Humana OH Medicaid	$1,155.56

EAPG 234: LEVEL I ANTERIOR CHAMBER EYE PROCEDURES

Facility

$333.65

Service Code	EAPG 00234
Min. Negotiated Rate	$333.65
Max. Negotiated Rate	$333.65
Rate for Payer: Aetna CHP/Medicaid	$333.65
Rate for Payer: Humana OH Medicaid	$333.65

EAPG 235: LEVEL II ANTERIOR CHAMBER EYE PROCEDURES

Facility

$2,119.12

Service Code	EAPG 00235
Min. Negotiated Rate	$2,119.12
Max. Negotiated Rate	$2,119.12
Rate for Payer: Aetna CHP/Medicaid	$2,119.12
Rate for Payer: Humana OH Medicaid	$2,119.12

EAPG 237: LEVEL I INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES

Facility

$351.94

Service Code	EAPG 00237
Min. Negotiated Rate	$351.94
Max. Negotiated Rate	$351.94
Rate for Payer: Aetna CHP/Medicaid	$351.94
Rate for Payer: Humana OH Medicaid	$351.94

EAPG 238: LEVEL II INTRAVITREAL, RETINAL AND OTHER POSTERIOR CHAMBER EYE PROCEDURES

Facility

$2,525.55

Service Code	EAPG 00238
Min. Negotiated Rate	$2,525.55
Max. Negotiated Rate	$2,525.55
Rate for Payer: Aetna CHP/Medicaid	$2,525.55
Rate for Payer: Humana OH Medicaid	$2,525.55

EAPG 239: EXTRAOCULAR MUSCLE PROCEDURES

Facility

$1,694.90

Service Code	EAPG 00239
Min. Negotiated Rate	$1,694.90
Max. Negotiated Rate	$1,694.90
Rate for Payer: Aetna CHP/Medicaid	$1,694.90
Rate for Payer: Humana OH Medicaid	$1,694.90

EAPG 23: LEVEL I FOREARM AND WRIST PROCEDURES

Facility

$1,081.88

Service Code	EAPG 00023
Min. Negotiated Rate	$1,081.88
Max. Negotiated Rate	$1,081.88
Rate for Payer: Aetna CHP/Medicaid	$1,081.88
Rate for Payer: Humana OH Medicaid	$1,081.88

EAPG 241: OCULAR RECONSTRUCTIVE PROCEDURES W OR W/O OCULAR DEVICE

Facility

$1,858.19

Service Code	EAPG 00241
Min. Negotiated Rate	$1,858.19
Max. Negotiated Rate	$1,858.19
Rate for Payer: Aetna CHP/Medicaid	$1,858.19
Rate for Payer: Humana OH Medicaid	$1,858.19

EAPG 244: CLASS II THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$295.74

Service Code	EAPG 00244
Min. Negotiated Rate	$295.74
Max. Negotiated Rate	$295.74
Rate for Payer: Aetna CHP/Medicaid	$295.74
Rate for Payer: Humana OH Medicaid	$295.74

EAPG 245: CLASS III THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$5,678.22

Service Code	EAPG 00245
Min. Negotiated Rate	$5,678.22
Max. Negotiated Rate	$5,678.22
Rate for Payer: Aetna CHP/Medicaid	$5,678.22
Rate for Payer: Humana OH Medicaid	$5,678.22

EAPG 246: CLASS IV THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$16,348.50

Service Code	EAPG 00246
Min. Negotiated Rate	$16,348.50
Max. Negotiated Rate	$16,348.50
Rate for Payer: Aetna CHP/Medicaid	$16,348.50
Rate for Payer: Humana OH Medicaid	$16,348.50

EAPG 247: LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$278.69

Service Code	EAPG 00247
Min. Negotiated Rate	$278.69
Max. Negotiated Rate	$278.69
Rate for Payer: Aetna CHP/Medicaid	$278.69
Rate for Payer: Humana OH Medicaid	$278.69

EAPG 248: LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$2,428.93

Service Code	EAPG 00248
Min. Negotiated Rate	$2,428.93
Max. Negotiated Rate	$2,428.93
Rate for Payer: Aetna CHP/Medicaid	$2,428.93
Rate for Payer: Humana OH Medicaid	$2,428.93

EAPG 249: MINOR EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$94.23

Service Code	EAPG 00249
Min. Negotiated Rate	$94.23
Max. Negotiated Rate	$94.23
Rate for Payer: Aetna CHP/Medicaid	$94.23
Rate for Payer: Humana OH Medicaid	$94.23

EAPG 24: LEVEL II FOREARM AND WRIST PROCEDURES

Facility

$3,643.86

Service Code	EAPG 00024
Min. Negotiated Rate	$3,643.86
Max. Negotiated Rate	$3,643.86
Rate for Payer: Aetna CHP/Medicaid	$3,643.86
Rate for Payer: Humana OH Medicaid	$3,643.86

EAPG 250: COCHLEAR DEVICE IMPLANTATION

Facility

$8,563.24

Service Code	EAPG 00250
Min. Negotiated Rate	$8,563.24
Max. Negotiated Rate	$8,563.24
Rate for Payer: Aetna CHP/Medicaid	$8,563.24
Rate for Payer: Humana OH Medicaid	$8,563.24

Know your out-of-pocket cost for care.

All Charges