Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 465: CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$12,484.93

Service Code	EAPG 00465
Min. Negotiated Rate	$12,484.93
Max. Negotiated Rate	$12,484.93
Rate for Payer: Aetna CHP/Medicaid	$12,484.93
Rate for Payer: Humana OH Medicaid	$12,484.93

EAPG 466: CLASS XIV COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$15,826.96

Service Code	EAPG 00466
Min. Negotiated Rate	$15,826.96
Max. Negotiated Rate	$15,826.96
Rate for Payer: Aetna CHP/Medicaid	$15,826.96
Rate for Payer: Humana OH Medicaid	$15,826.96

EAPG 46: LEVEL I ARTHROPLASTY

Facility

$2,085.29

Service Code	EAPG 00046
Min. Negotiated Rate	$2,085.29
Max. Negotiated Rate	$2,085.29
Rate for Payer: Aetna CHP/Medicaid	$2,085.29
Rate for Payer: Humana OH Medicaid	$2,085.29

EAPG 470: OBSTETRICAL ULTRASOUND

Facility

$102.33

Service Code	EAPG 00470
Min. Negotiated Rate	$102.33
Max. Negotiated Rate	$102.33
Rate for Payer: Aetna CHP/Medicaid	$102.33
Rate for Payer: Humana OH Medicaid	$102.33

EAPG 471: LEVEL I CONVENTIONAL RADIOLOGY

Facility

$49.71

Service Code	EAPG 00471
Min. Negotiated Rate	$49.71
Max. Negotiated Rate	$49.71
Rate for Payer: Aetna CHP/Medicaid	$49.71
Rate for Payer: Humana OH Medicaid	$49.71

EAPG 472: ULTRASOUND GUIDANCE

Facility

$81.60

Service Code	EAPG 00472
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna CHP/Medicaid	$81.60
Rate for Payer: Humana OH Medicaid	$81.60

EAPG 473: CT GUIDANCE

Facility

$97.52

Service Code	EAPG 00473
Min. Negotiated Rate	$97.52
Max. Negotiated Rate	$97.52
Rate for Payer: Aetna CHP/Medicaid	$97.52
Rate for Payer: Humana OH Medicaid	$97.52

EAPG 474: RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES

Facility

$98.64

Service Code	EAPG 00474
Min. Negotiated Rate	$98.64
Max. Negotiated Rate	$98.64
Rate for Payer: Aetna CHP/Medicaid	$98.64
Rate for Payer: Humana OH Medicaid	$98.64

EAPG 475: MRI GUIDANCE

Facility

$45.62

Service Code	EAPG 00475
Min. Negotiated Rate	$45.62
Max. Negotiated Rate	$45.62
Rate for Payer: Aetna CHP/Medicaid	$45.62
Rate for Payer: Humana OH Medicaid	$45.62

EAPG 476: LEVEL I RADIATION TREATMENT PREPARATION AND PLANNING

Facility

$92.54

Service Code	EAPG 00476
Min. Negotiated Rate	$92.54
Max. Negotiated Rate	$92.54
Rate for Payer: Aetna CHP/Medicaid	$92.54
Rate for Payer: Humana OH Medicaid	$92.54

EAPG 477: LEVEL II RADIATION TREATMENT PREPARATION AND PLANNING

Facility

$428.03

Service Code	EAPG 00477
Min. Negotiated Rate	$428.03
Max. Negotiated Rate	$428.03
Rate for Payer: Aetna CHP/Medicaid	$428.03
Rate for Payer: Humana OH Medicaid	$428.03

EAPG 478: LEVEL III RADIATION TREATMENT PREPARATION AND PLANNING

Facility

$675.33

Service Code	EAPG 00478
Min. Negotiated Rate	$675.33
Max. Negotiated Rate	$675.33
Rate for Payer: Aetna CHP/Medicaid	$675.33
Rate for Payer: Humana OH Medicaid	$675.33

EAPG 47: LEVEL II ARTHROPLASTY

Facility

$6,899.80

Service Code	EAPG 00047
Min. Negotiated Rate	$6,899.80
Max. Negotiated Rate	$6,899.80
Rate for Payer: Aetna CHP/Medicaid	$6,899.80
Rate for Payer: Humana OH Medicaid	$6,899.80

EAPG 483: RADIATION THERAPY MANAGEMENT

Facility

$148.74

Service Code	EAPG 00483
Min. Negotiated Rate	$148.74
Max. Negotiated Rate	$148.74
Rate for Payer: Aetna CHP/Medicaid	$148.74
Rate for Payer: Humana OH Medicaid	$148.74

EAPG 485: CORNEAL TISSUE PROCESSING

Facility

$1,612.77

Service Code	EAPG 00485
Min. Negotiated Rate	$1,612.77
Max. Negotiated Rate	$1,612.77
Rate for Payer: Aetna CHP/Medicaid	$1,612.77
Rate for Payer: Humana OH Medicaid	$1,612.77

EAPG 486: LEVEL I BLOOD AND TISSUE TYPING TESTS

Facility

$24.38

Service Code	EAPG 00486
Min. Negotiated Rate	$24.38
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna CHP/Medicaid	$24.38
Rate for Payer: Humana OH Medicaid	$24.38

EAPG 488: MINOR DEVICE EVALUATION AND INTERROGATION

Facility

$20.00

Service Code	EAPG 00488
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna CHP/Medicaid	$20.00
Rate for Payer: Humana OH Medicaid	$20.00

EAPG 490: INCIDENTAL SERVICES FOR QUALITY OR PERFORMANCE MEASUREMENT

Facility

$9.36

Service Code	EAPG 00490
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$9.36
Rate for Payer: Aetna CHP/Medicaid	$9.36
Rate for Payer: Humana OH Medicaid	$9.36

EAPG 491: MEDICAL VISIT INDICATOR

Facility

$60.17

Service Code	EAPG 00491
Min. Negotiated Rate	$60.17
Max. Negotiated Rate	$60.17
Rate for Payer: Aetna CHP/Medicaid	$60.17
Rate for Payer: Humana OH Medicaid	$60.17

EAPG 493: LEVEL I ANCILLARY THERAPEUTIC SERVICES

Facility

$27.23

Service Code	EAPG 00493
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$27.23
Rate for Payer: Aetna CHP/Medicaid	$27.23
Rate for Payer: Humana OH Medicaid	$27.23

EAPG 494: COMPLEX BLOOD COLLECTION SERVICES

Facility

$31.27

Service Code	EAPG 00494
Min. Negotiated Rate	$31.27
Max. Negotiated Rate	$31.27
Rate for Payer: Aetna CHP/Medicaid	$31.27
Rate for Payer: Humana OH Medicaid	$31.27

EAPG 495: MINOR CHEMOTHERAPY DRUGS

Facility

$14.47

Service Code	EAPG 00495
Min. Negotiated Rate	$14.47
Max. Negotiated Rate	$14.47
Rate for Payer: Aetna CHP/Medicaid	$14.47
Rate for Payer: Humana OH Medicaid	$14.47

EAPG 496: MINOR PHARMACOTHERAPY

Facility

$8.44

Service Code	EAPG 00496
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna CHP/Medicaid	$8.44
Rate for Payer: Humana OH Medicaid	$8.44

EAPG 497: TELEHEALTH FACILITATION

Facility

$16.21

Service Code	EAPG 00497
Min. Negotiated Rate	$16.21
Max. Negotiated Rate	$16.21
Rate for Payer: Aetna CHP/Medicaid	$16.21
Rate for Payer: Humana OH Medicaid	$16.21

EAPG 499: BLOOD PROCESSING, STORAGE AND RELATED SERVICES

Facility

$56.16

Service Code	EAPG 00499
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$56.16
Rate for Payer: Aetna CHP/Medicaid	$56.16
Rate for Payer: Humana OH Medicaid	$56.16

Know your out-of-pocket cost for care.

All Charges