Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAGLE EYE PLATINUM

Facility

$4,625.00

Service Code	HCPCS C1753
Hospital Charge Code	27000042
Hospital Revenue Code	272
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$4,440.00
Rate for Payer: Aetna Commercial	$3,561.25
Rate for Payer: Anthem POS/PPO/Traditional	$3,607.50
Rate for Payer: Cash Price	$2,312.50
Rate for Payer: Cigna Commercial	$3,838.75
Rate for Payer: First Health Commercial	$4,393.75
Rate for Payer: Humana Commercial	$3,931.25
Rate for Payer: Medical Mutual Of Ohio HMO	$3,792.50
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$3,413.25
Rate for Payer: Molina Healthcare Benefit Exchange	$1,387.50
Rate for Payer: Ohio Health Choice Commercial	$4,070.00
Rate for Payer: Ohio Health Group HMO	$3,468.75
Rate for Payer: Ohio Health Group PPO Differential	$3,700.00
Rate for Payer: Ohio Health Group PPO No Differential	$4,023.75
Rate for Payer: Ohio Health Group PPO SOMC Employees	$3,191.25
Rate for Payer: PHCS Commercial	$4,440.00
Rate for Payer: United Healthcare All Payer	$4,070.00

EAPG 3.18: ABDOMINAL HERNIA REPAIR

Facility

$1,534.55

Service Code	EAPG 03035
Min. Negotiated Rate	$1,534.55
Max. Negotiated Rate	$1,534.55
Rate for Payer: Aetna CHP/Medicaid	$1,534.55
Rate for Payer: Humana OH Medicaid	$1,534.55

EAPG 3.18: ABDOMINAL PAIN

Facility

$99.55

Service Code	EAPG 00628
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$99.55
Rate for Payer: Aetna CHP/Medicaid	$99.55
Rate for Payer: Humana OH Medicaid	$99.55

EAPG 3.18: ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES

Facility

$425.33

Service Code	EAPG 00150
Min. Negotiated Rate	$425.33
Max. Negotiated Rate	$425.33
Rate for Payer: Aetna CHP/Medicaid	$425.33
Rate for Payer: Humana OH Medicaid	$425.33

EAPG 3.18: ABORTION AND MISCARRIAGE TREATMENT AND PROCEDURES

Facility

$536.51

Service Code	EAPG 00194
Min. Negotiated Rate	$536.51
Max. Negotiated Rate	$536.51
Rate for Payer: Aetna CHP/Medicaid	$536.51
Rate for Payer: Humana OH Medicaid	$536.51

EAPG 3.18: ABORTION RELATED DIAGNOSES

Facility

$95.67

Service Code	EAPG 00763
Min. Negotiated Rate	$95.67
Max. Negotiated Rate	$95.67
Rate for Payer: Aetna CHP/Medicaid	$95.67
Rate for Payer: Humana OH Medicaid	$95.67

EAPG 3.18: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$91.79

Service Code	EAPG 00608
Min. Negotiated Rate	$91.79
Max. Negotiated Rate	$91.79
Rate for Payer: Aetna CHP/Medicaid	$91.79
Rate for Payer: Humana OH Medicaid	$91.79

EAPG 3.18: ACUTE ANXIETY AND DELIRIUM STATES

Facility

$85.32

Service Code	EAPG 00826
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$85.32
Rate for Payer: Aetna CHP/Medicaid	$85.32
Rate for Payer: Humana OH Medicaid	$85.32

EAPG 3.18: ACUTE BRONCHITIS

Facility

$107.30

Service Code	EAPG 00584
Min. Negotiated Rate	$107.30
Max. Negotiated Rate	$107.30
Rate for Payer: Aetna CHP/Medicaid	$107.30
Rate for Payer: Humana OH Medicaid	$107.30

EAPG 3.18: ACUTE KIDNEY INJURY

Facility

$86.62

Service Code	EAPG 00729
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$86.62
Rate for Payer: Aetna CHP/Medicaid	$86.62
Rate for Payer: Humana OH Medicaid	$86.62

EAPG 3.18: ACUTE LEUKEMIA

Facility

$131.87

Service Code	EAPG 00800
Min. Negotiated Rate	$131.87
Max. Negotiated Rate	$131.87
Rate for Payer: Aetna CHP/Medicaid	$131.87
Rate for Payer: Humana OH Medicaid	$131.87

EAPG 3.18: ACUTE LOWER URINARY TRACT INFECTIONS

Facility

$100.84

Service Code	EAPG 00727
Min. Negotiated Rate	$100.84
Max. Negotiated Rate	$100.84
Rate for Payer: Aetna CHP/Medicaid	$100.84
Rate for Payer: Humana OH Medicaid	$100.84

EAPG 3.18: ACUTE MAJOR EYE INFECTIONS

Facility

$84.03

Service Code	EAPG 00550
Min. Negotiated Rate	$84.03
Max. Negotiated Rate	$84.03
Rate for Payer: Aetna CHP/Medicaid	$84.03
Rate for Payer: Humana OH Medicaid	$84.03

EAPG 3.18: ACUTE MYOCARDIAL INFARCTION

Facility

$190.04

Service Code	EAPG 00591
Min. Negotiated Rate	$190.04
Max. Negotiated Rate	$190.04
Rate for Payer: Aetna CHP/Medicaid	$190.04
Rate for Payer: Humana OH Medicaid	$190.04

EAPG 3.18: ADJUSTMENT DISORDERS AND NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$85.32

Service Code	EAPG 00825
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$85.32
Rate for Payer: Aetna CHP/Medicaid	$85.32
Rate for Payer: Humana OH Medicaid	$85.32

EAPG 3.18: ADULT PREVENTIVE MEDICINE

Facility

$90.50

Service Code	EAPG 00876
Min. Negotiated Rate	$90.50
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna CHP/Medicaid	$90.50
Rate for Payer: Humana OH Medicaid	$90.50

EAPG 3.18: AFTERCARE, BURNS, CORROSIONS, OTHER INJURIES RELATED TO THE SKIN AND SUB TIS

Facility

$112.47

Service Code	EAPG 00787
Min. Negotiated Rate	$112.47
Max. Negotiated Rate	$112.47
Rate for Payer: Aetna CHP/Medicaid	$112.47
Rate for Payer: Humana OH Medicaid	$112.47

EAPG 3.18: AFTERCARE FOR JOINT REPLACEMENT

Facility

$84.03

Service Code	EAPG 00874
Min. Negotiated Rate	$84.03
Max. Negotiated Rate	$84.03
Rate for Payer: Aetna CHP/Medicaid	$84.03
Rate for Payer: Humana OH Medicaid	$84.03

EAPG 3.18: AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE INJURIES

Facility

$95.67

Service Code	EAPG 00869
Min. Negotiated Rate	$95.67
Max. Negotiated Rate	$95.67
Rate for Payer: Aetna CHP/Medicaid	$95.67
Rate for Payer: Humana OH Medicaid	$95.67

EAPG 3.18: AFTERCARE, OPEN WOUNDS AND OTHER TRAUMATIC INJURIES

Facility

$111.18

Service Code	EAPG 00585
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$111.18
Rate for Payer: Aetna CHP/Medicaid	$111.18
Rate for Payer: Humana OH Medicaid	$111.18

EAPG 3.18: AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT

Facility

$89.20

Service Code	EAPG 00533
Min. Negotiated Rate	$89.20
Max. Negotiated Rate	$89.20
Rate for Payer: Aetna CHP/Medicaid	$89.20
Rate for Payer: Humana OH Medicaid	$89.20

EAPG 3.18: AICD AND RELATED CARDIAC DEVICE INSERTION OR REPLACEMENT

Facility

$10,648.79

Service Code	EAPG 00097
Min. Negotiated Rate	$10,648.79
Max. Negotiated Rate	$10,648.79
Rate for Payer: Aetna CHP/Medicaid	$10,648.79
Rate for Payer: Humana OH Medicaid	$10,648.79

EAPG 3.18: AIDS

Facility

$117.64

Service Code	EAPG 00881
Min. Negotiated Rate	$117.64
Max. Negotiated Rate	$117.64
Rate for Payer: Aetna CHP/Medicaid	$117.64
Rate for Payer: Humana OH Medicaid	$117.64

EAPG 3.18: ALCOHOL ABUSE AND DEPENDENCE

Facility

$103.42

Service Code	EAPG 00842
Min. Negotiated Rate	$103.42
Max. Negotiated Rate	$103.42
Rate for Payer: Aetna CHP/Medicaid	$103.42
Rate for Payer: Humana OH Medicaid	$103.42

EAPG 3.18: ALCOHOLIC LIVER DISEASE

Facility

$90.50

Service Code	EAPG 00633
Min. Negotiated Rate	$90.50
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna CHP/Medicaid	$90.50
Rate for Payer: Humana OH Medicaid	$90.50

Know your out-of-pocket cost for care.

All Charges