Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 401: LEVEL II CHEMISTRY TESTS

Facility

$18.27

Service Code	EAPG 00401
Min. Negotiated Rate	$18.27
Max. Negotiated Rate	$18.27
Rate for Payer: Aetna CHP/Medicaid	$18.27
Rate for Payer: Humana OH Medicaid	$18.27

EAPG 402: BASIC CHEMISTRY TESTS

Facility

$10.29

Service Code	EAPG 00402
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$10.29
Rate for Payer: Aetna CHP/Medicaid	$10.29
Rate for Payer: Humana OH Medicaid	$10.29

EAPG 403: ORGAN OR DISEASE ORIENTED PANELS

Facility

$17.22

Service Code	EAPG 00403
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$17.22
Rate for Payer: Aetna CHP/Medicaid	$17.22
Rate for Payer: Humana OH Medicaid	$17.22

EAPG 404: TOXICOLOGY TESTS

Facility

$14.19

Service Code	EAPG 00404
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$14.19
Rate for Payer: Aetna CHP/Medicaid	$14.19
Rate for Payer: Humana OH Medicaid	$14.19

EAPG 405: THERAPEUTIC DRUG MONITORING

Facility

$16.03

Service Code	EAPG 00405
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$16.03
Rate for Payer: Aetna CHP/Medicaid	$16.03
Rate for Payer: Humana OH Medicaid	$16.03

EAPG 406: LEVEL I CLOTTING TESTS

Facility

$8.51

Service Code	EAPG 00406
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$8.51
Rate for Payer: Aetna CHP/Medicaid	$8.51
Rate for Payer: Humana OH Medicaid	$8.51

EAPG 407: LEVEL II CLOTTING TESTS

Facility

$41.16

Service Code	EAPG 00407
Min. Negotiated Rate	$41.16
Max. Negotiated Rate	$41.16
Rate for Payer: Aetna CHP/Medicaid	$41.16
Rate for Payer: Humana OH Medicaid	$41.16

EAPG 408: LEVEL I HEMATOLOGY TESTS

Facility

$7.43

Service Code	EAPG 00408
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna CHP/Medicaid	$7.43
Rate for Payer: Humana OH Medicaid	$7.43

EAPG 409: LEVEL II HEMATOLOGY TESTS

Facility

$2.62

Service Code	EAPG 00409
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna CHP/Medicaid	$2.62
Rate for Payer: Humana OH Medicaid	$2.62

EAPG 40: MINOR SPLINT AND STRAPPING APPLICATION

Facility

$49.44

Service Code	EAPG 00040
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$49.44
Rate for Payer: Aetna CHP/Medicaid	$49.44
Rate for Payer: Humana OH Medicaid	$49.44

EAPG 410: URINALYSIS

Facility

$5.58

Service Code	EAPG 00410
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$5.58
Rate for Payer: Aetna CHP/Medicaid	$5.58
Rate for Payer: Humana OH Medicaid	$5.58

EAPG 412: ANCILLARY RESPIRATORY THERAPY AND OTHER PULMONARY TESTS AND SERVICES

Facility

$56.88

Service Code	EAPG 00412
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$56.88
Rate for Payer: Aetna CHP/Medicaid	$56.88
Rate for Payer: Humana OH Medicaid	$56.88

EAPG 413: CARDIOGRAM

Facility

$20.58

Service Code	EAPG 00413
Min. Negotiated Rate	$20.58
Max. Negotiated Rate	$20.58
Rate for Payer: Aetna CHP/Medicaid	$20.58
Rate for Payer: Humana OH Medicaid	$20.58

EAPG 414: LEVEL I IMMUNIZATION

Facility

$8.75

Service Code	EAPG 00414
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$8.75
Rate for Payer: Aetna CHP/Medicaid	$8.75
Rate for Payer: Humana OH Medicaid	$8.75

EAPG 415: LEVEL II IMMUNIZATION

Facility

$14.75

Service Code	EAPG 00415
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$14.75
Rate for Payer: Aetna CHP/Medicaid	$14.75
Rate for Payer: Humana OH Medicaid	$14.75

EAPG 417: MINOR FEMALE REPRODUCTIVE PROCEDURES

Facility

$60.05

Service Code	EAPG 00417
Min. Negotiated Rate	$60.05
Max. Negotiated Rate	$60.05
Rate for Payer: Aetna CHP/Medicaid	$60.05
Rate for Payer: Humana OH Medicaid	$60.05

EAPG 418: AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS

Facility

$75.85

Service Code	EAPG 00418
Min. Negotiated Rate	$75.85
Max. Negotiated Rate	$75.85
Rate for Payer: Aetna CHP/Medicaid	$75.85
Rate for Payer: Humana OH Medicaid	$75.85

EAPG 419: ANCILLARY OPHTHALMOLOGY OR OPTOMETRY SERVICES

Facility

$42.58

Service Code	EAPG 00419
Min. Negotiated Rate	$42.58
Max. Negotiated Rate	$42.58
Rate for Payer: Aetna CHP/Medicaid	$42.58
Rate for Payer: Humana OH Medicaid	$42.58

EAPG 41: CLOSED TREATMENT FX AND DISLOCATION

Facility

$258.33

Service Code	EAPG 00041
Min. Negotiated Rate	$258.33
Max. Negotiated Rate	$258.33
Rate for Payer: Aetna CHP/Medicaid	$258.33
Rate for Payer: Humana OH Medicaid	$258.33

EAPG 420: ELECTRONIC ANALYSIS FOR CARDIAC, NEUROLOGICAL AND OTHER DEVICES

Facility

$81.10

Service Code	EAPG 00420
Min. Negotiated Rate	$81.10
Max. Negotiated Rate	$81.10
Rate for Payer: Aetna CHP/Medicaid	$81.10
Rate for Payer: Humana OH Medicaid	$81.10

EAPG 423: VASCULAR ACCESS BY NEEDLE OR CATHETER

Facility

$313.13

Service Code	EAPG 00423
Min. Negotiated Rate	$313.13
Max. Negotiated Rate	$313.13
Rate for Payer: Aetna CHP/Medicaid	$313.13
Rate for Payer: Humana OH Medicaid	$313.13

EAPG 427: BIOFEEDBACK AND OTHER TRAINING

Facility

$106.86

Service Code	EAPG 00427
Min. Negotiated Rate	$106.86
Max. Negotiated Rate	$106.86
Rate for Payer: Aetna CHP/Medicaid	$106.86
Rate for Payer: Humana OH Medicaid	$106.86

EAPG 428: PATIENT EDUCATION, INDIVIDUAL

Facility

$34.23

Service Code	EAPG 00428
Min. Negotiated Rate	$34.23
Max. Negotiated Rate	$34.23
Rate for Payer: Aetna CHP/Medicaid	$34.23
Rate for Payer: Humana OH Medicaid	$34.23

EAPG 429: PATIENT EDUCATION, GROUP

Facility

$39.11

Service Code	EAPG 00429
Min. Negotiated Rate	$39.11
Max. Negotiated Rate	$39.11
Rate for Payer: Aetna CHP/Medicaid	$39.11
Rate for Payer: Humana OH Medicaid	$39.11

EAPG 430: CLASS I CHEMOTHERAPY DRUGS

Facility

$107.96

Service Code	EAPG 00430
Min. Negotiated Rate	$107.96
Max. Negotiated Rate	$107.96
Rate for Payer: Aetna CHP/Medicaid	$107.96
Rate for Payer: Humana OH Medicaid	$107.96

Know your out-of-pocket cost for care.

All Charges