Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 277: LEVEL I VASCULAR RADIOLOGICAL PROCEDURES

Facility

$573.07

Service Code	EAPG 00277
Min. Negotiated Rate	$573.07
Max. Negotiated Rate	$573.07
Rate for Payer: Aetna CHP/Medicaid	$573.07
Rate for Payer: Humana OH Medicaid	$573.07

EAPG 278: INJECTION(S) FOR RADIOLOGICAL IMAGING

Facility

$71.78

Service Code	EAPG 00278
Min. Negotiated Rate	$71.78
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna CHP/Medicaid	$71.78
Rate for Payer: Humana OH Medicaid	$71.78

EAPG 279: LEVEL II VASCULAR RADIOLOGICAL PROCEDURES

Facility

$868.43

Service Code	EAPG 00279
Min. Negotiated Rate	$868.43
Max. Negotiated Rate	$868.43
Rate for Payer: Aetna CHP/Medicaid	$868.43
Rate for Payer: Humana OH Medicaid	$868.43

EAPG 27: LEVEL I HIP AND FEMUR PROCEDURES

Facility

$2,685.39

Service Code	EAPG 00027
Min. Negotiated Rate	$2,685.39
Max. Negotiated Rate	$2,685.39
Rate for Payer: Aetna CHP/Medicaid	$2,685.39
Rate for Payer: Humana OH Medicaid	$2,685.39

EAPG 280: LEVEL III VASCULAR RADIOLOGICAL PROCEDURES

Facility

$2,504.22

Service Code	EAPG 00280
Min. Negotiated Rate	$2,504.22
Max. Negotiated Rate	$2,504.22
Rate for Payer: Aetna CHP/Medicaid	$2,504.22
Rate for Payer: Humana OH Medicaid	$2,504.22

EAPG 282: MAGNETIC RESONANCE ANGIOGRAPHY

Facility

$272.04

Service Code	EAPG 00282
Min. Negotiated Rate	$272.04
Max. Negotiated Rate	$272.04
Rate for Payer: Aetna CHP/Medicaid	$272.04
Rate for Payer: Humana OH Medicaid	$272.04

EAPG 284: MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES

Facility

$333.17

Service Code	EAPG 00284
Min. Negotiated Rate	$333.17
Max. Negotiated Rate	$333.17
Rate for Payer: Aetna CHP/Medicaid	$333.17
Rate for Payer: Humana OH Medicaid	$333.17

EAPG 286: MAMMOGRAPHY AND OTHER RELATED PROCEDURES

Facility

$45.38

Service Code	EAPG 00286
Min. Negotiated Rate	$45.38
Max. Negotiated Rate	$45.38
Rate for Payer: Aetna CHP/Medicaid	$45.38
Rate for Payer: Humana OH Medicaid	$45.38

EAPG 288: LEVEL I DIAGNOSTIC ULTRASOUND

Facility

$85.53

Service Code	EAPG 00288
Min. Negotiated Rate	$85.53
Max. Negotiated Rate	$85.53
Rate for Payer: Aetna CHP/Medicaid	$85.53
Rate for Payer: Humana OH Medicaid	$85.53

EAPG 289: LEVEL II DIAGNOSTIC ULTRASOUND

Facility

$131.54

Service Code	EAPG 00289
Min. Negotiated Rate	$131.54
Max. Negotiated Rate	$131.54
Rate for Payer: Aetna CHP/Medicaid	$131.54
Rate for Payer: Humana OH Medicaid	$131.54

EAPG 28: LEVEL I SPINE PROCEDURES

Facility

$3,337.04

Service Code	EAPG 00028
Min. Negotiated Rate	$3,337.04
Max. Negotiated Rate	$3,337.04
Rate for Payer: Aetna CHP/Medicaid	$3,337.04
Rate for Payer: Humana OH Medicaid	$3,337.04

EAPG 290: PET SCANS

Facility

$1,024.71

Service Code	EAPG 00290
Min. Negotiated Rate	$1,024.71
Max. Negotiated Rate	$1,024.71
Rate for Payer: Aetna CHP/Medicaid	$1,024.71
Rate for Payer: Humana OH Medicaid	$1,024.71

EAPG 291: BONE DENSITY AND RELATED PROCEDURES

Facility

$63.85

Service Code	EAPG 00291
Min. Negotiated Rate	$63.85
Max. Negotiated Rate	$63.85
Rate for Payer: Aetna CHP/Medicaid	$63.85
Rate for Payer: Humana OH Medicaid	$63.85

EAPG 293: MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST

Facility

$223.64

Service Code	EAPG 00293
Min. Negotiated Rate	$223.64
Max. Negotiated Rate	$223.64
Rate for Payer: Aetna CHP/Medicaid	$223.64
Rate for Payer: Humana OH Medicaid	$223.64

EAPG 295: MAGNETIC RESONANCE IMAGING WITH CONTRAST

Facility

$337.96

Service Code	EAPG 00295
Min. Negotiated Rate	$337.96
Max. Negotiated Rate	$337.96
Rate for Payer: Aetna CHP/Medicaid	$337.96
Rate for Payer: Humana OH Medicaid	$337.96

EAPG 297: MAGNETOCEPHALOGRAPHY

Facility

$1,029.92

Service Code	EAPG 00297
Min. Negotiated Rate	$1,029.92
Max. Negotiated Rate	$1,029.92
Rate for Payer: Aetna CHP/Medicaid	$1,029.92
Rate for Payer: Humana OH Medicaid	$1,029.92

EAPG 299: LEVEL I COMPUTED TOMOGRAPHY

Facility

$160.79

Service Code	EAPG 00299
Min. Negotiated Rate	$160.79
Max. Negotiated Rate	$160.79
Rate for Payer: Aetna CHP/Medicaid	$160.79
Rate for Payer: Humana OH Medicaid	$160.79

EAPG 29: LEVEL II SPINE PROCEDURES

Facility

$8,164.34

Service Code	EAPG 00029
Min. Negotiated Rate	$8,164.34
Max. Negotiated Rate	$8,164.34
Rate for Payer: Aetna CHP/Medicaid	$8,164.34
Rate for Payer: Humana OH Medicaid	$8,164.34

EAPG 2: SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION

Facility

$336.75

Service Code	EAPG 00002
Min. Negotiated Rate	$336.75
Max. Negotiated Rate	$336.75
Rate for Payer: Aetna CHP/Medicaid	$336.75
Rate for Payer: Humana OH Medicaid	$336.75

EAPG 300: LEVEL II COMPUTED TOMOGRAPHY

Facility

$344.67

Service Code	EAPG 00300
Min. Negotiated Rate	$344.67
Max. Negotiated Rate	$344.67
Rate for Payer: Aetna CHP/Medicaid	$344.67
Rate for Payer: Humana OH Medicaid	$344.67

EAPG 3011: BONE CONDUCTION HEARING DEVICE IMPLANTATION

Facility

$3,975.33

Service Code	EAPG 03011
Min. Negotiated Rate	$3,975.33
Max. Negotiated Rate	$3,975.33
Rate for Payer: Aetna CHP/Medicaid	$3,975.33
Rate for Payer: Humana OH Medicaid	$3,975.33

EAPG 301: COMPUTED TOMOGRAPHY- OTHER

Facility

$62.55

Service Code	EAPG 00301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Aetna CHP/Medicaid	$62.55
Rate for Payer: Humana OH Medicaid	$62.55

EAPG 302: COMPUTED TOMOGRAPHIC ANGIOGRAPHY

Facility

$396.94

Service Code	EAPG 00302
Min. Negotiated Rate	$396.94
Max. Negotiated Rate	$396.94
Rate for Payer: Aetna CHP/Medicaid	$396.94
Rate for Payer: Humana OH Medicaid	$396.94

EAPG 3030: SPINAL IMPLANTATION OF DRUG INFUSION DEVICE

Facility

$11,172.02

Service Code	EAPG 03030
Min. Negotiated Rate	$11,172.02
Max. Negotiated Rate	$11,172.02
Rate for Payer: Aetna CHP/Medicaid	$11,172.02
Rate for Payer: Humana OH Medicaid	$11,172.02

EAPG 3033: INGUINAL, FEMORAL AND UMBILICAL HERNIA REPAIR

Facility

$2,132.86

Service Code	EAPG 03033
Min. Negotiated Rate	$2,132.86
Max. Negotiated Rate	$2,132.86
Rate for Payer: Aetna CHP/Medicaid	$2,132.86
Rate for Payer: Humana OH Medicaid	$2,132.86

Know your out-of-pocket cost for care.

All Charges