Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 251: OTORHINOLARYNGOLOGIC FUNCTION TESTS

Facility

$214.77

Service Code	EAPG 00251
Min. Negotiated Rate	$214.77
Max. Negotiated Rate	$214.77
Rate for Payer: Aetna CHP/Medicaid	$214.77
Rate for Payer: Humana OH Medicaid	$214.77

EAPG 252: LEVEL I EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$822.52

Service Code	EAPG 00252
Min. Negotiated Rate	$822.52
Max. Negotiated Rate	$822.52
Rate for Payer: Aetna CHP/Medicaid	$822.52
Rate for Payer: Humana OH Medicaid	$822.52

EAPG 253: LEVEL II EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$1,364.18

Service Code	EAPG 00253
Min. Negotiated Rate	$1,364.18
Max. Negotiated Rate	$1,364.18
Rate for Payer: Aetna CHP/Medicaid	$1,364.18
Rate for Payer: Humana OH Medicaid	$1,364.18

EAPG 254: LEVEL III EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$2,372.91

Service Code	EAPG 00254
Min. Negotiated Rate	$2,372.91
Max. Negotiated Rate	$2,372.91
Rate for Payer: Aetna CHP/Medicaid	$2,372.91
Rate for Payer: Humana OH Medicaid	$2,372.91

EAPG 255: LEVEL IV EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$2,973.01

Service Code	EAPG 00255
Min. Negotiated Rate	$2,973.01
Max. Negotiated Rate	$2,973.01
Rate for Payer: Aetna CHP/Medicaid	$2,973.01
Rate for Payer: Humana OH Medicaid	$2,973.01

EAPG 256: TONSIL AND ADENOID PROCEDURES

Facility

$1,255.75

Service Code	EAPG 00256
Min. Negotiated Rate	$1,255.75
Max. Negotiated Rate	$1,255.75
Rate for Payer: Aetna CHP/Medicaid	$1,255.75
Rate for Payer: Humana OH Medicaid	$1,255.75

EAPG 257: AUDIOMETRY

Facility

$117.85

Service Code	EAPG 00257
Min. Negotiated Rate	$117.85
Max. Negotiated Rate	$117.85
Rate for Payer: Aetna CHP/Medicaid	$117.85
Rate for Payer: Humana OH Medicaid	$117.85

EAPG 258: LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$1,010.01

Service Code	EAPG 00258
Min. Negotiated Rate	$1,010.01
Max. Negotiated Rate	$1,010.01
Rate for Payer: Aetna CHP/Medicaid	$1,010.01
Rate for Payer: Humana OH Medicaid	$1,010.01

EAPG 259: LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$1,339.87

Service Code	EAPG 00259
Min. Negotiated Rate	$1,339.87
Max. Negotiated Rate	$1,339.87
Rate for Payer: Aetna CHP/Medicaid	$1,339.87
Rate for Payer: Humana OH Medicaid	$1,339.87

EAPG 25: LEVEL I SHOULDER AND UPPER ARM PROCEDURES

Facility

$2,867.07

Service Code	EAPG 00025
Min. Negotiated Rate	$2,867.07
Max. Negotiated Rate	$2,867.07
Rate for Payer: Aetna CHP/Medicaid	$2,867.07
Rate for Payer: Humana OH Medicaid	$2,867.07

EAPG 260: CASE MANAGEMENT AND CARE PLANNING SERVICES

Facility

$19.13

Service Code	EAPG 00260
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$19.13
Rate for Payer: Aetna CHP/Medicaid	$19.13
Rate for Payer: Humana OH Medicaid	$19.13

EAPG 261: ESRD MONTHLY CASE MANAGEMENT

Facility

$312.81

Service Code	EAPG 00261
Min. Negotiated Rate	$312.81
Max. Negotiated Rate	$312.81
Rate for Payer: Aetna CHP/Medicaid	$312.81
Rate for Payer: Humana OH Medicaid	$312.81

EAPG 262: CLEFT LIP AND PALATE REPAIR

Facility

$2,901.20

Service Code	EAPG 00262
Min. Negotiated Rate	$2,901.20
Max. Negotiated Rate	$2,901.20
Rate for Payer: Aetna CHP/Medicaid	$2,901.20
Rate for Payer: Humana OH Medicaid	$2,901.20

EAPG 263: THYROID AND PARATHYROID PROCEDURES

Facility

$3,776.07

Service Code	EAPG 00263
Min. Negotiated Rate	$3,776.07
Max. Negotiated Rate	$3,776.07
Rate for Payer: Aetna CHP/Medicaid	$3,776.07
Rate for Payer: Humana OH Medicaid	$3,776.07

EAPG 264: MAJOR CRANIOTOMY AND CRANIECTOMY SURGICAL PROCEDURES

Facility

$2,362.45

Service Code	EAPG 00264
Min. Negotiated Rate	$2,362.45
Max. Negotiated Rate	$2,362.45
Rate for Payer: Aetna CHP/Medicaid	$2,362.45
Rate for Payer: Humana OH Medicaid	$2,362.45

EAPG 265: PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$6,732.80

Service Code	EAPG 00265
Min. Negotiated Rate	$6,732.80
Max. Negotiated Rate	$6,732.80
Rate for Payer: Aetna CHP/Medicaid	$6,732.80
Rate for Payer: Humana OH Medicaid	$6,732.80

EAPG 266: OPEN INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$961.93

Service Code	EAPG 00266
Min. Negotiated Rate	$961.93
Max. Negotiated Rate	$961.93
Rate for Payer: Aetna CHP/Medicaid	$961.93
Rate for Payer: Humana OH Medicaid	$961.93

EAPG 267: OTHER CRANIOTOMY PROCEDURES INCLUDING CRANIOPLASTY

Facility

$4,408.72

Service Code	EAPG 00267
Min. Negotiated Rate	$4,408.72
Max. Negotiated Rate	$4,408.72
Rate for Payer: Aetna CHP/Medicaid	$4,408.72
Rate for Payer: Humana OH Medicaid	$4,408.72

EAPG 268: CRANIAL AND SPINAL SHUNT PROCEDURES

Facility

$4,689.53

Service Code	EAPG 00268
Min. Negotiated Rate	$4,689.53
Max. Negotiated Rate	$4,689.53
Rate for Payer: Aetna CHP/Medicaid	$4,689.53
Rate for Payer: Humana OH Medicaid	$4,689.53

EAPG 269: LEVEL II ANCILLARY THERAPEUTIC SERVICES

Facility

$74.48

Service Code	EAPG 00269
Min. Negotiated Rate	$74.48
Max. Negotiated Rate	$74.48
Rate for Payer: Aetna CHP/Medicaid	$74.48
Rate for Payer: Humana OH Medicaid	$74.48

EAPG 26: LEVEL I KNEE AND LOWER LEG PROCEDURES

Facility

$2,173.61

Service Code	EAPG 00026
Min. Negotiated Rate	$2,173.61
Max. Negotiated Rate	$2,173.61
Rate for Payer: Aetna CHP/Medicaid	$2,173.61
Rate for Payer: Humana OH Medicaid	$2,173.61

EAPG 270: OCCUPATIONAL THERAPY

Facility

$113.24

Service Code	EAPG 00270
Min. Negotiated Rate	$113.24
Max. Negotiated Rate	$113.24
Rate for Payer: Aetna CHP/Medicaid	$113.24
Rate for Payer: Humana OH Medicaid	$113.24

EAPG 271: PHYSICAL THERAPY

Facility

$81.58

Service Code	EAPG 00271
Min. Negotiated Rate	$81.58
Max. Negotiated Rate	$81.58
Rate for Payer: Aetna CHP/Medicaid	$81.58
Rate for Payer: Humana OH Medicaid	$81.58

EAPG 272: SPEECH THERAPY AND EVALUATION

Facility

$61.93

Service Code	EAPG 00272
Min. Negotiated Rate	$61.93
Max. Negotiated Rate	$61.93
Rate for Payer: Aetna CHP/Medicaid	$61.93
Rate for Payer: Humana OH Medicaid	$61.93

EAPG 276: PROCEDURES FOR REVISION OR REMOVAL OF NEUROSTIMULATOR DEVICES

Facility

$1,897.57

Service Code	EAPG 00276
Min. Negotiated Rate	$1,897.57
Max. Negotiated Rate	$1,897.57
Rate for Payer: Aetna CHP/Medicaid	$1,897.57
Rate for Payer: Humana OH Medicaid	$1,897.57

Know your out-of-pocket cost for care.

All Charges