Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 37: LEVEL I ARTHROSCOPY

Facility

$1,603.20

Service Code	EAPG 00037
Min. Negotiated Rate	$1,603.20
Max. Negotiated Rate	$1,603.20
Rate for Payer: Aetna CHP/Medicaid	$1,603.20
Rate for Payer: Humana OH Medicaid	$1,603.20

EAPG 380: ANESTHESIA

Facility

$175.60

Service Code	EAPG 00380
Min. Negotiated Rate	$175.60
Max. Negotiated Rate	$175.60
Rate for Payer: Aetna CHP/Medicaid	$175.60
Rate for Payer: Humana OH Medicaid	$175.60

EAPG 384: LEVEL III CHEMISTRY TESTS

Facility

$32.29

Service Code	EAPG 00384
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Aetna CHP/Medicaid	$32.29
Rate for Payer: Humana OH Medicaid	$32.29

EAPG 385: LEVEL I COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$73.48

Service Code	EAPG 00385
Min. Negotiated Rate	$73.48
Max. Negotiated Rate	$73.48
Rate for Payer: Aetna CHP/Medicaid	$73.48
Rate for Payer: Humana OH Medicaid	$73.48

EAPG 386: LEVEL II COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$101.98

Service Code	EAPG 00386
Min. Negotiated Rate	$101.98
Max. Negotiated Rate	$101.98
Rate for Payer: Aetna CHP/Medicaid	$101.98
Rate for Payer: Humana OH Medicaid	$101.98

EAPG 387: LEVEL III COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS

Facility

$96.02

Service Code	EAPG 00387
Min. Negotiated Rate	$96.02
Max. Negotiated Rate	$96.02
Rate for Payer: Aetna CHP/Medicaid	$96.02
Rate for Payer: Humana OH Medicaid	$96.02

EAPG 388: LEVEL III MICROBIOLOGY TESTS

Facility

$43.02

Service Code	EAPG 00388
Min. Negotiated Rate	$43.02
Max. Negotiated Rate	$43.02
Rate for Payer: Aetna CHP/Medicaid	$43.02
Rate for Payer: Humana OH Medicaid	$43.02

EAPG 389: LEVEL II CONVENTIONAL RADIOLOGY

Facility

$124.85

Service Code	EAPG 00389
Min. Negotiated Rate	$124.85
Max. Negotiated Rate	$124.85
Rate for Payer: Aetna CHP/Medicaid	$124.85
Rate for Payer: Humana OH Medicaid	$124.85

EAPG 38: LEVEL II ARTHROSCOPY

Facility

$3,806.09

Service Code	EAPG 00038
Min. Negotiated Rate	$3,806.09
Max. Negotiated Rate	$3,806.09
Rate for Payer: Aetna CHP/Medicaid	$3,806.09
Rate for Payer: Humana OH Medicaid	$3,806.09

EAPG 390: LEVEL I PATHOLOGY TESTS

Facility

$7.85

Service Code	EAPG 00390
Min. Negotiated Rate	$7.85
Max. Negotiated Rate	$7.85
Rate for Payer: Aetna CHP/Medicaid	$7.85
Rate for Payer: Humana OH Medicaid	$7.85

EAPG 391: LEVEL II PATHOLOGY TESTS

Facility

$39.81

Service Code	EAPG 00391
Min. Negotiated Rate	$39.81
Max. Negotiated Rate	$39.81
Rate for Payer: Aetna CHP/Medicaid	$39.81
Rate for Payer: Humana OH Medicaid	$39.81

EAPG 392: PAP SMEARS

Facility

$13.38

Service Code	EAPG 00392
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$13.38
Rate for Payer: Aetna CHP/Medicaid	$13.38
Rate for Payer: Humana OH Medicaid	$13.38

EAPG 393: LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility

$59.15

Service Code	EAPG 00393
Min. Negotiated Rate	$59.15
Max. Negotiated Rate	$59.15
Rate for Payer: Aetna CHP/Medicaid	$59.15
Rate for Payer: Humana OH Medicaid	$59.15

EAPG 394: LEVEL I IMMUNOLOGY TESTS

Facility

$20.21

Service Code	EAPG 00394
Min. Negotiated Rate	$20.21
Max. Negotiated Rate	$20.21
Rate for Payer: Aetna CHP/Medicaid	$20.21
Rate for Payer: Humana OH Medicaid	$20.21

EAPG 395: LEVEL II IMMUNOLOGY TESTS

Facility

$25.09

Service Code	EAPG 00395
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$25.09
Rate for Payer: Aetna CHP/Medicaid	$25.09
Rate for Payer: Humana OH Medicaid	$25.09

EAPG 396: LEVEL I MICROBIOLOGY TESTS

Facility

$14.57

Service Code	EAPG 00396
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna CHP/Medicaid	$14.57
Rate for Payer: Humana OH Medicaid	$14.57

EAPG 397: LEVEL II MICROBIOLOGY TESTS

Facility

$29.44

Service Code	EAPG 00397
Min. Negotiated Rate	$29.44
Max. Negotiated Rate	$29.44
Rate for Payer: Aetna CHP/Medicaid	$29.44
Rate for Payer: Humana OH Medicaid	$29.44

EAPG 398: LEVEL I ENDOCRINOLOGY TESTS

Facility

$19.26

Service Code	EAPG 00398
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$19.26
Rate for Payer: Aetna CHP/Medicaid	$19.26
Rate for Payer: Humana OH Medicaid	$19.26

EAPG 399: LEVEL II ENDOCRINOLOGY TESTS

Facility

$24.24

Service Code	EAPG 00399
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$24.24
Rate for Payer: Aetna CHP/Medicaid	$24.24
Rate for Payer: Humana OH Medicaid	$24.24

EAPG 39: CAST APPLICATION OR REPLACEMENT

Facility

$92.18

Service Code	EAPG 00039
Min. Negotiated Rate	$92.18
Max. Negotiated Rate	$92.18
Rate for Payer: Aetna CHP/Medicaid	$92.18
Rate for Payer: Humana OH Medicaid	$92.18

EAPG 3: LEVEL I SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$147.75

Service Code	EAPG 00003
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$147.75
Rate for Payer: Aetna CHP/Medicaid	$147.75
Rate for Payer: Humana OH Medicaid	$147.75

EAPG 4001: EMERGING TECHNOLOGY PROCEDURES

Facility

$584.37

Service Code	EAPG 04001
Min. Negotiated Rate	$584.37
Max. Negotiated Rate	$584.37
Rate for Payer: Aetna CHP/Medicaid	$584.37
Rate for Payer: Humana OH Medicaid	$584.37

EAPG 400: LEVEL I CHEMISTRY TESTS

Facility

$15.89

Service Code	EAPG 00400
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$15.89
Rate for Payer: Aetna CHP/Medicaid	$15.89
Rate for Payer: Humana OH Medicaid	$15.89

EAPG 4010: LEVEL I OPIOID TREATMENT PROGRAM SERVICES

Facility

$29.28

Service Code	EAPG 04010
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$29.28
Rate for Payer: Aetna CHP/Medicaid	$29.28
Rate for Payer: Humana OH Medicaid	$29.28

EAPG 4011: LEVEL II OPIOID TREATMENT PROGRAM SERVICES

Facility

$81.36

Service Code	EAPG 04011
Min. Negotiated Rate	$81.36
Max. Negotiated Rate	$81.36
Rate for Payer: Aetna CHP/Medicaid	$81.36
Rate for Payer: Humana OH Medicaid	$81.36

Know your out-of-pocket cost for care.

All Charges