Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 634: MALIGNANCY OF HEPATOBILIARY SYSTEM AND PANCREAS

Facility

$72.23

Service Code	EAPG 00634
Min. Negotiated Rate	$72.23
Max. Negotiated Rate	$72.23
Rate for Payer: Aetna CHP/Medicaid	$72.23
Rate for Payer: Humana OH Medicaid	$72.23

EAPG 635: PANCREAS DIAGNOSES EXCEPT MALIGNANCY

Facility

$141.43

Service Code	EAPG 00635
Min. Negotiated Rate	$141.43
Max. Negotiated Rate	$141.43
Rate for Payer: Aetna CHP/Medicaid	$141.43
Rate for Payer: Humana OH Medicaid	$141.43

EAPG 636: HEPATITIS WITHOUT COMA

Facility

$80.50

Service Code	EAPG 00636
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$80.50
Rate for Payer: Aetna CHP/Medicaid	$80.50
Rate for Payer: Humana OH Medicaid	$80.50

EAPG 637: GALLBLADDER AND BILIARY TRACT DIAGNOSES

Facility

$96.06

Service Code	EAPG 00637
Min. Negotiated Rate	$96.06
Max. Negotiated Rate	$96.06
Rate for Payer: Aetna CHP/Medicaid	$96.06
Rate for Payer: Humana OH Medicaid	$96.06

EAPG 638: CHOLECYSTITIS

Facility

$178.39

Service Code	EAPG 00638
Min. Negotiated Rate	$178.39
Max. Negotiated Rate	$178.39
Rate for Payer: Aetna CHP/Medicaid	$178.39
Rate for Payer: Humana OH Medicaid	$178.39

EAPG 639: OTHER HEPATOBILIARY SYSTEM DIAGNOSES

Facility

$68.95

Service Code	EAPG 00639
Min. Negotiated Rate	$68.95
Max. Negotiated Rate	$68.95
Rate for Payer: Aetna CHP/Medicaid	$68.95
Rate for Payer: Humana OH Medicaid	$68.95

EAPG 63: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$1,239.60

Service Code	EAPG 00063
Min. Negotiated Rate	$1,239.60
Max. Negotiated Rate	$1,239.60
Rate for Payer: Aetna CHP/Medicaid	$1,239.60
Rate for Payer: Humana OH Medicaid	$1,239.60

EAPG 641: HEPATIC COMA AND MAJOR ACUTE LIVER DIAGNOSES

Facility

$82.89

Service Code	EAPG 00641
Min. Negotiated Rate	$82.89
Max. Negotiated Rate	$82.89
Rate for Payer: Aetna CHP/Medicaid	$82.89
Rate for Payer: Humana OH Medicaid	$82.89

EAPG 642: GASTROINTESTINAL VASCULAR INSUFFICIENCY

Facility

$60.97

Service Code	EAPG 00642
Min. Negotiated Rate	$60.97
Max. Negotiated Rate	$60.97
Rate for Payer: Aetna CHP/Medicaid	$60.97
Rate for Payer: Humana OH Medicaid	$60.97

EAPG 647: FRACTURES, DISLOCATIONS, OTHER INJURIES - UPPER EXTREMITY INCLUDING SHOULDER

Facility

$150.73

Service Code	EAPG 00647
Min. Negotiated Rate	$150.73
Max. Negotiated Rate	$150.73
Rate for Payer: Aetna CHP/Medicaid	$150.73
Rate for Payer: Humana OH Medicaid	$150.73

EAPG 648: FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE

Facility

$113.78

Service Code	EAPG 00648
Min. Negotiated Rate	$113.78
Max. Negotiated Rate	$113.78
Rate for Payer: Aetna CHP/Medicaid	$113.78
Rate for Payer: Humana OH Medicaid	$113.78

EAPG 649: OTHER PATHOLOGICAL FRACTURES W/O MUSCULOSKELETAL MALIGNANCY

Facility

$97.89

Service Code	EAPG 00649
Min. Negotiated Rate	$97.89
Max. Negotiated Rate	$97.89
Rate for Payer: Aetna CHP/Medicaid	$97.89
Rate for Payer: Humana OH Medicaid	$97.89

EAPG 64: LEVEL I LOWER AIRWAY ENDOSCOPY

Facility

$975.39

Service Code	EAPG 00064
Min. Negotiated Rate	$975.39
Max. Negotiated Rate	$975.39
Rate for Payer: Aetna CHP/Medicaid	$975.39
Rate for Payer: Humana OH Medicaid	$975.39

EAPG 650: FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR

Facility

$149.21

Service Code	EAPG 00650
Min. Negotiated Rate	$149.21
Max. Negotiated Rate	$149.21
Rate for Payer: Aetna CHP/Medicaid	$149.21
Rate for Payer: Humana OH Medicaid	$149.21

EAPG 651: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP

Facility

$117.93

Service Code	EAPG 00651
Min. Negotiated Rate	$117.93
Max. Negotiated Rate	$117.93
Rate for Payer: Aetna CHP/Medicaid	$117.93
Rate for Payer: Humana OH Medicaid	$117.93

EAPG 652: OTHER INJURIES AND DISORDERS OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE

Facility

$73.29

Service Code	EAPG 00652
Min. Negotiated Rate	$73.29
Max. Negotiated Rate	$73.29
Rate for Payer: Aetna CHP/Medicaid	$73.29
Rate for Payer: Humana OH Medicaid	$73.29

EAPG 653: MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FX DUE TO MALIGNANCY

Facility

$92.53

Service Code	EAPG 00653
Min. Negotiated Rate	$92.53
Max. Negotiated Rate	$92.53
Rate for Payer: Aetna CHP/Medicaid	$92.53
Rate for Payer: Humana OH Medicaid	$92.53

EAPG 654: OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$68.60

Service Code	EAPG 00654
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$68.60
Rate for Payer: Aetna CHP/Medicaid	$68.60
Rate for Payer: Humana OH Medicaid	$68.60

EAPG 655: CONNECTIVE TISSUE DIAGNOSES

Facility

$77.05

Service Code	EAPG 00655
Min. Negotiated Rate	$77.05
Max. Negotiated Rate	$77.05
Rate for Payer: Aetna CHP/Medicaid	$77.05
Rate for Payer: Humana OH Medicaid	$77.05

EAPG 656: FRACTURES, DISLOCATIONS, OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST

Facility

$137.45

Service Code	EAPG 00656
Min. Negotiated Rate	$137.45
Max. Negotiated Rate	$137.45
Rate for Payer: Aetna CHP/Medicaid	$137.45
Rate for Payer: Humana OH Medicaid	$137.45

EAPG 657: FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK

Facility

$53.99

Service Code	EAPG 00657
Min. Negotiated Rate	$53.99
Max. Negotiated Rate	$53.99
Rate for Payer: Aetna CHP/Medicaid	$53.99
Rate for Payer: Humana OH Medicaid	$53.99

EAPG 658: SCIATICA AND LOW BACK PAIN

Facility

$95.11

Service Code	EAPG 00658
Min. Negotiated Rate	$95.11
Max. Negotiated Rate	$95.11
Rate for Payer: Aetna CHP/Medicaid	$95.11
Rate for Payer: Humana OH Medicaid	$95.11

EAPG 659: MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE

Facility

$81.06

Service Code	EAPG 00659
Min. Negotiated Rate	$81.06
Max. Negotiated Rate	$81.06
Rate for Payer: Aetna CHP/Medicaid	$81.06
Rate for Payer: Humana OH Medicaid	$81.06

EAPG 660: OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES

Facility

$106.72

Service Code	EAPG 00660
Min. Negotiated Rate	$106.72
Max. Negotiated Rate	$106.72
Rate for Payer: Aetna CHP/Medicaid	$106.72
Rate for Payer: Humana OH Medicaid	$106.72

EAPG 662: OSTEOPOROSIS

Facility

$63.88

Service Code	EAPG 00662
Min. Negotiated Rate	$63.88
Max. Negotiated Rate	$63.88
Rate for Payer: Aetna CHP/Medicaid	$63.88
Rate for Payer: Humana OH Medicaid	$63.88

Know your out-of-pocket cost for care.

All Charges