Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 327: INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT

Facility

$56.92

Service Code	EAPG 00327
Min. Negotiated Rate	$56.92
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna CHP/Medicaid	$56.92
Rate for Payer: Humana OH Medicaid	$56.92

EAPG 328: DAY REHABILITATION, HALF DAY

Facility

$68.43

Service Code	EAPG 00328
Min. Negotiated Rate	$68.43
Max. Negotiated Rate	$68.43
Rate for Payer: Aetna CHP/Medicaid	$68.43
Rate for Payer: Humana OH Medicaid	$68.43

EAPG 329: DAY REHABILITATION, FULL DAY

Facility

$50.28

Service Code	EAPG 00329
Min. Negotiated Rate	$50.28
Max. Negotiated Rate	$50.28
Rate for Payer: Aetna CHP/Medicaid	$50.28
Rate for Payer: Humana OH Medicaid	$50.28

EAPG 331: LEVEL I DIAGNOSTIC NUCLEAR MEDICINE

Facility

$272.55

Service Code	EAPG 00331
Min. Negotiated Rate	$272.55
Max. Negotiated Rate	$272.55
Rate for Payer: Aetna CHP/Medicaid	$272.55
Rate for Payer: Humana OH Medicaid	$272.55

EAPG 332: LEVEL II DIAGNOSTIC NUCLEAR MEDICINE

Facility

$777.94

Service Code	EAPG 00332
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$777.94
Rate for Payer: Aetna CHP/Medicaid	$777.94
Rate for Payer: Humana OH Medicaid	$777.94

EAPG 333: BEHAVIORAL HEALTH RESIDENTIAL TREATMENT

Facility

$113.28

Service Code	EAPG 00333
Min. Negotiated Rate	$113.28
Max. Negotiated Rate	$113.28
Rate for Payer: Aetna CHP/Medicaid	$113.28
Rate for Payer: Humana OH Medicaid	$113.28

EAPG 335: CLASS I BRACHYTHERAPY SOURCES

Facility

$271.19

Service Code	EAPG 00335
Min. Negotiated Rate	$271.19
Max. Negotiated Rate	$271.19
Rate for Payer: Aetna CHP/Medicaid	$271.19
Rate for Payer: Humana OH Medicaid	$271.19

EAPG 336: CLASS II BRACHYTHERAPY SOURCES

Facility

$2,400.12

Service Code	EAPG 00336
Min. Negotiated Rate	$2,400.12
Max. Negotiated Rate	$2,400.12
Rate for Payer: Aetna CHP/Medicaid	$2,400.12
Rate for Payer: Humana OH Medicaid	$2,400.12

EAPG 337: CLASS III BRACHYTHERAPY SOURCES

Facility

$11,480.08

Service Code	EAPG 00337
Min. Negotiated Rate	$11,480.08
Max. Negotiated Rate	$11,480.08
Rate for Payer: Aetna CHP/Medicaid	$11,480.08
Rate for Payer: Humana OH Medicaid	$11,480.08

EAPG 33: LEVEL I HAND PROCEDURES

Facility

$1,022.67

Service Code	EAPG 00033
Min. Negotiated Rate	$1,022.67
Max. Negotiated Rate	$1,022.67
Rate for Payer: Aetna CHP/Medicaid	$1,022.67
Rate for Payer: Humana OH Medicaid	$1,022.67

EAPG 340: THERAPEUTIC NUCLEAR MEDICINE

Facility

$238.03

Service Code	EAPG 00340
Min. Negotiated Rate	$238.03
Max. Negotiated Rate	$238.03
Rate for Payer: Aetna CHP/Medicaid	$238.03
Rate for Payer: Humana OH Medicaid	$238.03

EAPG 343: LEVEL I RADIATION THERAPY

Facility

$119.51

Service Code	EAPG 00343
Min. Negotiated Rate	$119.51
Max. Negotiated Rate	$119.51
Rate for Payer: Aetna CHP/Medicaid	$119.51
Rate for Payer: Humana OH Medicaid	$119.51

EAPG 346: RADIOSURGERY

Facility

$3,512.09

Service Code	EAPG 00346
Min. Negotiated Rate	$3,512.09
Max. Negotiated Rate	$3,512.09
Rate for Payer: Aetna CHP/Medicaid	$3,512.09
Rate for Payer: Humana OH Medicaid	$3,512.09

EAPG 347: LEVEL II RADIATION THERAPY

Facility

$313.84

Service Code	EAPG 00347
Min. Negotiated Rate	$313.84
Max. Negotiated Rate	$313.84
Rate for Payer: Aetna CHP/Medicaid	$313.84
Rate for Payer: Humana OH Medicaid	$313.84

EAPG 348: LEVEL III RADIATION THERAPY

Facility

$866.41

Service Code	EAPG 00348
Min. Negotiated Rate	$866.41
Max. Negotiated Rate	$866.41
Rate for Payer: Aetna CHP/Medicaid	$866.41
Rate for Payer: Humana OH Medicaid	$866.41

EAPG 34: LEVEL II HAND PROCEDURES

Facility

$1,674.49

Service Code	EAPG 00034
Min. Negotiated Rate	$1,674.49
Max. Negotiated Rate	$1,674.49
Rate for Payer: Aetna CHP/Medicaid	$1,674.49
Rate for Payer: Humana OH Medicaid	$1,674.49

EAPG 350: ADJUNCTIVE DENTAL SERVICES

Facility

$50.51

Service Code	EAPG 00350
Min. Negotiated Rate	$50.51
Max. Negotiated Rate	$50.51
Rate for Payer: Aetna CHP/Medicaid	$50.51
Rate for Payer: Humana OH Medicaid	$50.51

EAPG 35: LEVEL I FOOT PROCEDURES

Facility

$1,536.17

Service Code	EAPG 00035
Min. Negotiated Rate	$1,536.17
Max. Negotiated Rate	$1,536.17
Rate for Payer: Aetna CHP/Medicaid	$1,536.17
Rate for Payer: Humana OH Medicaid	$1,536.17

EAPG 36: LEVEL II FOOT PROCEDURES

Facility

$3,580.58

Service Code	EAPG 00036
Min. Negotiated Rate	$3,580.58
Max. Negotiated Rate	$3,580.58
Rate for Payer: Aetna CHP/Medicaid	$3,580.58
Rate for Payer: Humana OH Medicaid	$3,580.58

EAPG 372: SEALANT

Facility

$920.37

Service Code	EAPG 00372
Min. Negotiated Rate	$920.37
Max. Negotiated Rate	$920.37
Rate for Payer: Aetna CHP/Medicaid	$920.37
Rate for Payer: Humana OH Medicaid	$920.37

EAPG 373: LEVEL I DENTAL IMAGING

Facility

$583.62

Service Code	EAPG 00373
Min. Negotiated Rate	$583.62
Max. Negotiated Rate	$583.62
Rate for Payer: Aetna CHP/Medicaid	$583.62
Rate for Payer: Humana OH Medicaid	$583.62

EAPG 374: LEVEL II DENTAL IMAGING

Facility

$25.60

Service Code	EAPG 00374
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$25.60
Rate for Payer: Aetna CHP/Medicaid	$25.60
Rate for Payer: Humana OH Medicaid	$25.60

EAPG 375: DENTAL ANESTHESIA

Facility

$174.73

Service Code	EAPG 00375
Min. Negotiated Rate	$174.73
Max. Negotiated Rate	$174.73
Rate for Payer: Aetna CHP/Medicaid	$174.73
Rate for Payer: Humana OH Medicaid	$174.73

EAPG 376: DIAGNOSTIC DENTAL PROCEDURES

Facility

$732.93

Service Code	EAPG 00376
Min. Negotiated Rate	$732.93
Max. Negotiated Rate	$732.93
Rate for Payer: Aetna CHP/Medicaid	$732.93
Rate for Payer: Humana OH Medicaid	$732.93

EAPG 377: PREVENTIVE DENTAL PROCEDURES

Facility

$885.46

Service Code	EAPG 00377
Min. Negotiated Rate	$885.46
Max. Negotiated Rate	$885.46
Rate for Payer: Aetna CHP/Medicaid	$885.46
Rate for Payer: Humana OH Medicaid	$885.46

Know your out-of-pocket cost for care.

All Charges