Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3035: ABDOMINAL HERNIA REPAIR

Facility

$2,969.47

Service Code	EAPG 03035
Min. Negotiated Rate	$2,969.47
Max. Negotiated Rate	$2,969.47
Rate for Payer: Aetna CHP/Medicaid	$2,969.47
Rate for Payer: Humana OH Medicaid	$2,969.47

EAPG 304: MINOR SPECIMEN COLLECTION SERVICES

Facility

$2.31

Service Code	EAPG 00304
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna CHP/Medicaid	$2.31
Rate for Payer: Humana OH Medicaid	$2.31

EAPG 3050: OTHER TRANSPLANT PROCEDURES

Facility

$1,076.27

Service Code	EAPG 03050
Min. Negotiated Rate	$1,076.27
Max. Negotiated Rate	$1,076.27
Rate for Payer: Aetna CHP/Medicaid	$1,076.27
Rate for Payer: Humana OH Medicaid	$1,076.27

EAPG 3051: HEART AND/OR LUNG TRANSPLANT

Facility

$2,745.04

Service Code	EAPG 03051
Min. Negotiated Rate	$2,745.04
Max. Negotiated Rate	$2,745.04
Rate for Payer: Aetna CHP/Medicaid	$2,745.04
Rate for Payer: Humana OH Medicaid	$2,745.04

EAPG 3052: KIDNEY TRANSPLANT

Facility

$1,568.59

Service Code	EAPG 03052
Min. Negotiated Rate	$1,568.59
Max. Negotiated Rate	$1,568.59
Rate for Payer: Aetna CHP/Medicaid	$1,568.59
Rate for Payer: Humana OH Medicaid	$1,568.59

EAPG 305: LEVEL I SURGICAL PATHOLOGY TESTS

Facility

$32.73

Service Code	EAPG 00305
Min. Negotiated Rate	$32.73
Max. Negotiated Rate	$32.73
Rate for Payer: Aetna CHP/Medicaid	$32.73
Rate for Payer: Humana OH Medicaid	$32.73

EAPG 3060: VENTRICULAR ASSIST DEVICE PROCEDURES

Facility

$59,698.67

Service Code	EAPG 03060
Min. Negotiated Rate	$59,698.67
Max. Negotiated Rate	$59,698.67
Rate for Payer: Aetna CHP/Medicaid	$59,698.67
Rate for Payer: Humana OH Medicaid	$59,698.67

EAPG 306: LEVEL II SURGICAL PATHOLOGY TESTS

Facility

$59.96

Service Code	EAPG 00306
Min. Negotiated Rate	$59.96
Max. Negotiated Rate	$59.96
Rate for Payer: Aetna CHP/Medicaid	$59.96
Rate for Payer: Humana OH Medicaid	$59.96

EAPG 3070: EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) PROCEDURES

Facility

$1,513.77

Service Code	EAPG 03070
Min. Negotiated Rate	$1,513.77
Max. Negotiated Rate	$1,513.77
Rate for Payer: Aetna CHP/Medicaid	$1,513.77
Rate for Payer: Humana OH Medicaid	$1,513.77

EAPG 307: INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE

Facility

$69.81

Service Code	EAPG 00307
Min. Negotiated Rate	$69.81
Max. Negotiated Rate	$69.81
Rate for Payer: Aetna CHP/Medicaid	$69.81
Rate for Payer: Humana OH Medicaid	$69.81

EAPG 308: LEVEL III PATHOLOGY TESTS

Facility

$53.17

Service Code	EAPG 00308
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$53.17
Rate for Payer: Aetna CHP/Medicaid	$53.17
Rate for Payer: Humana OH Medicaid	$53.17

EAPG 309: ADAPTIVE BEHAVIORAL HEALTH TREATMENT SERVICES

Facility

$139.69

Service Code	EAPG 00309
Min. Negotiated Rate	$139.69
Max. Negotiated Rate	$139.69
Rate for Payer: Aetna CHP/Medicaid	$139.69
Rate for Payer: Humana OH Medicaid	$139.69

EAPG 310: DEVELOPMENTAL AND NEUROPSYCHOLOGICAL TESTING

Facility

$158.41

Service Code	EAPG 00310
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$158.41
Rate for Payer: Aetna CHP/Medicaid	$158.41
Rate for Payer: Humana OH Medicaid	$158.41

EAPG 312: BEHAVIORAL AND SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM

Facility

$65.96

Service Code	EAPG 00312
Min. Negotiated Rate	$65.96
Max. Negotiated Rate	$65.96
Rate for Payer: Aetna CHP/Medicaid	$65.96
Rate for Payer: Humana OH Medicaid	$65.96

EAPG 315: COUNSELING OR INDIVIDUAL BRIEF PSYCHOTHERAPY

Facility

$73.00

Service Code	EAPG 00315
Min. Negotiated Rate	$73.00
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna CHP/Medicaid	$73.00
Rate for Payer: Humana OH Medicaid	$73.00

EAPG 316: INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY

Facility

$91.32

Service Code	EAPG 00316
Min. Negotiated Rate	$91.32
Max. Negotiated Rate	$91.32
Rate for Payer: Aetna CHP/Medicaid	$91.32
Rate for Payer: Humana OH Medicaid	$91.32

EAPG 317: FAMILY PSYCHOTHERAPY

Facility

$121.90

Service Code	EAPG 00317
Min. Negotiated Rate	$121.90
Max. Negotiated Rate	$121.90
Rate for Payer: Aetna CHP/Medicaid	$121.90
Rate for Payer: Humana OH Medicaid	$121.90

EAPG 318: GROUP PSYCHOTHERAPY

Facility

$101.14

Service Code	EAPG 00318
Min. Negotiated Rate	$101.14
Max. Negotiated Rate	$101.14
Rate for Payer: Aetna CHP/Medicaid	$101.14
Rate for Payer: Humana OH Medicaid	$101.14

EAPG 319: ACTIVITY THERAPY

Facility

$37.34

Service Code	EAPG 00319
Min. Negotiated Rate	$37.34
Max. Negotiated Rate	$37.34
Rate for Payer: Aetna CHP/Medicaid	$37.34
Rate for Payer: Humana OH Medicaid	$37.34

EAPG 320: BEHAVIORAL HEALTH - CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT

Facility

$31.82

Service Code	EAPG 00320
Min. Negotiated Rate	$31.82
Max. Negotiated Rate	$31.82
Rate for Payer: Aetna CHP/Medicaid	$31.82
Rate for Payer: Humana OH Medicaid	$31.82

EAPG 321: CRISIS INTERVENTION

Facility

$45.91

Service Code	EAPG 00321
Min. Negotiated Rate	$45.91
Max. Negotiated Rate	$45.91
Rate for Payer: Aetna CHP/Medicaid	$45.91
Rate for Payer: Humana OH Medicaid	$45.91

EAPG 322: MEDICATION ADMINISTRATION AND OBSERVATION

Facility

$8.13

Service Code	EAPG 00322
Min. Negotiated Rate	$8.13
Max. Negotiated Rate	$8.13
Rate for Payer: Aetna CHP/Medicaid	$8.13
Rate for Payer: Humana OH Medicaid	$8.13

EAPG 323: BEHAVIORAL HEALTH ASSESSMENT

Facility

$151.48

Service Code	EAPG 00323
Min. Negotiated Rate	$151.48
Max. Negotiated Rate	$151.48
Rate for Payer: Aetna CHP/Medicaid	$151.48
Rate for Payer: Humana OH Medicaid	$151.48

EAPG 324: SCREENING FOR BEHAVIORAL CHANGE OR RISK ASSESSMENT

Facility

$36.17

Service Code	EAPG 00324
Min. Negotiated Rate	$36.17
Max. Negotiated Rate	$36.17
Rate for Payer: Aetna CHP/Medicaid	$36.17
Rate for Payer: Humana OH Medicaid	$36.17

EAPG 325: PREVENTION COUNSELING

Facility

$75.78

Service Code	EAPG 00325
Min. Negotiated Rate	$75.78
Max. Negotiated Rate	$75.78
Rate for Payer: Aetna CHP/Medicaid	$75.78
Rate for Payer: Humana OH Medicaid	$75.78

Know your out-of-pocket cost for care.

All Charges