Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 431: CLASS II CHEMOTHERAPY DRUGS

Facility

$311.50

Service Code	EAPG 00431
Min. Negotiated Rate	$311.50
Max. Negotiated Rate	$311.50
Rate for Payer: Aetna CHP/Medicaid	$311.50
Rate for Payer: Humana OH Medicaid	$311.50

EAPG 432: CLASS III CHEMOTHERAPY DRUGS

Facility

$476.24

Service Code	EAPG 00432
Min. Negotiated Rate	$476.24
Max. Negotiated Rate	$476.24
Rate for Payer: Aetna CHP/Medicaid	$476.24
Rate for Payer: Humana OH Medicaid	$476.24

EAPG 433: CLASS IV CHEMOTHERAPY DRUGS

Facility

$896.13

Service Code	EAPG 00433
Min. Negotiated Rate	$896.13
Max. Negotiated Rate	$896.13
Rate for Payer: Aetna CHP/Medicaid	$896.13
Rate for Payer: Humana OH Medicaid	$896.13

EAPG 434: CLASS V CHEMOTHERAPY DRUGS

Facility

$1,596.40

Service Code	EAPG 00434
Min. Negotiated Rate	$1,596.40
Max. Negotiated Rate	$1,596.40
Rate for Payer: Aetna CHP/Medicaid	$1,596.40
Rate for Payer: Humana OH Medicaid	$1,596.40

EAPG 435: CLASS I PHARMACOTHERAPY

Facility

$45.69

Service Code	EAPG 00435
Min. Negotiated Rate	$45.69
Max. Negotiated Rate	$45.69
Rate for Payer: Aetna CHP/Medicaid	$45.69
Rate for Payer: Humana OH Medicaid	$45.69

EAPG 436: CLASS II PHARMACOTHERAPY

Facility

$124.16

Service Code	EAPG 00436
Min. Negotiated Rate	$124.16
Max. Negotiated Rate	$124.16
Rate for Payer: Aetna CHP/Medicaid	$124.16
Rate for Payer: Humana OH Medicaid	$124.16

EAPG 437: CLASS III PHARMACOTHERAPY

Facility

$175.65

Service Code	EAPG 00437
Min. Negotiated Rate	$175.65
Max. Negotiated Rate	$175.65
Rate for Payer: Aetna CHP/Medicaid	$175.65
Rate for Payer: Humana OH Medicaid	$175.65

EAPG 438: CLASS IV PHARMACOTHERAPY

Facility

$351.77

Service Code	EAPG 00438
Min. Negotiated Rate	$351.77
Max. Negotiated Rate	$351.77
Rate for Payer: Aetna CHP/Medicaid	$351.77
Rate for Payer: Humana OH Medicaid	$351.77

EAPG 439: CLASS V PHARMACOTHERAPY

Facility

$635.29

Service Code	EAPG 00439
Min. Negotiated Rate	$635.29
Max. Negotiated Rate	$635.29
Rate for Payer: Aetna CHP/Medicaid	$635.29
Rate for Payer: Humana OH Medicaid	$635.29

EAPG 43: OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES

Facility

$3,154.12

Service Code	EAPG 00043
Min. Negotiated Rate	$3,154.12
Max. Negotiated Rate	$3,154.12
Rate for Payer: Aetna CHP/Medicaid	$3,154.12
Rate for Payer: Humana OH Medicaid	$3,154.12

EAPG 440: CLASS VI PHARMACOTHERAPY

Facility

$686.66

Service Code	EAPG 00440
Min. Negotiated Rate	$686.66
Max. Negotiated Rate	$686.66
Rate for Payer: Aetna CHP/Medicaid	$686.66
Rate for Payer: Humana OH Medicaid	$686.66

EAPG 441: CLASS VI CHEMOTHERAPY DRUGS

Facility

$1,043.69

Service Code	EAPG 00441
Min. Negotiated Rate	$1,043.69
Max. Negotiated Rate	$1,043.69
Rate for Payer: Aetna CHP/Medicaid	$1,043.69
Rate for Payer: Humana OH Medicaid	$1,043.69

EAPG 443: CLASS VII CHEMOTHERAPY DRUGS

Facility

$1,179.21

Service Code	EAPG 00443
Min. Negotiated Rate	$1,179.21
Max. Negotiated Rate	$1,179.21
Rate for Payer: Aetna CHP/Medicaid	$1,179.21
Rate for Payer: Humana OH Medicaid	$1,179.21

EAPG 444: CLASS VII PHARMACOTHERAPY

Facility

$1,226.51

Service Code	EAPG 00444
Min. Negotiated Rate	$1,226.51
Max. Negotiated Rate	$1,226.51
Rate for Payer: Aetna CHP/Medicaid	$1,226.51
Rate for Payer: Humana OH Medicaid	$1,226.51

EAPG 448: EXPANDED HOURS ACCESS

Facility

$9.40

Service Code	EAPG 00448
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$9.40
Rate for Payer: Aetna CHP/Medicaid	$9.40
Rate for Payer: Humana OH Medicaid	$9.40

EAPG 449: ADDITIONAL UNDIFFERENTIATED MEDICAL VISITS/SERVICES

Facility

$464.62

Service Code	EAPG 00449
Min. Negotiated Rate	$464.62
Max. Negotiated Rate	$464.62
Rate for Payer: Aetna CHP/Medicaid	$464.62
Rate for Payer: Humana OH Medicaid	$464.62

EAPG 44: BONE OR JOINT MANIPULATION UNDER ANESTHESIA

Facility

$721.89

Service Code	EAPG 00044
Min. Negotiated Rate	$721.89
Max. Negotiated Rate	$721.89
Rate for Payer: Aetna CHP/Medicaid	$721.89
Rate for Payer: Humana OH Medicaid	$721.89

EAPG 455: INCIDENTAL BIOLOGICAL AND SYNTHETIC APPLICATION PRODUCTS

Facility

$964.21

Service Code	EAPG 00455
Min. Negotiated Rate	$964.21
Max. Negotiated Rate	$964.21
Rate for Payer: Aetna CHP/Medicaid	$964.21
Rate for Payer: Humana OH Medicaid	$964.21

EAPG 458: ALLERGY THERAPY

Facility

$17.38

Service Code	EAPG 00458
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$17.38
Rate for Payer: Aetna CHP/Medicaid	$17.38
Rate for Payer: Humana OH Medicaid	$17.38

EAPG 459: VACCINE ADMINISTRATION

Facility

$14.96

Service Code	EAPG 00459
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$14.96
Rate for Payer: Aetna CHP/Medicaid	$14.96
Rate for Payer: Humana OH Medicaid	$14.96

EAPG 460: CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$2,516.95

Service Code	EAPG 00460
Min. Negotiated Rate	$2,516.95
Max. Negotiated Rate	$2,516.95
Rate for Payer: Aetna CHP/Medicaid	$2,516.95
Rate for Payer: Humana OH Medicaid	$2,516.95

EAPG 461: CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$3,102.22

Service Code	EAPG 00461
Min. Negotiated Rate	$3,102.22
Max. Negotiated Rate	$3,102.22
Rate for Payer: Aetna CHP/Medicaid	$3,102.22
Rate for Payer: Humana OH Medicaid	$3,102.22

EAPG 462: CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$4,274.11

Service Code	EAPG 00462
Min. Negotiated Rate	$4,274.11
Max. Negotiated Rate	$4,274.11
Rate for Payer: Aetna CHP/Medicaid	$4,274.11
Rate for Payer: Humana OH Medicaid	$4,274.11

EAPG 463: CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$4,207.47

Service Code	EAPG 00463
Min. Negotiated Rate	$4,207.47
Max. Negotiated Rate	$4,207.47
Rate for Payer: Aetna CHP/Medicaid	$4,207.47
Rate for Payer: Humana OH Medicaid	$4,207.47

EAPG 464: CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$6,677.58

Service Code	EAPG 00464
Min. Negotiated Rate	$6,677.58
Max. Negotiated Rate	$6,677.58
Rate for Payer: Aetna CHP/Medicaid	$6,677.58
Rate for Payer: Humana OH Medicaid	$6,677.58

Know your out-of-pocket cost for care.

All Charges