Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: CLASS II PHARMACOTHERAPY

Facility

$72.40

Service Code	EAPG 00436
Min. Negotiated Rate	$72.40
Max. Negotiated Rate	$72.40
Rate for Payer: Aetna CHP/Medicaid	$72.40
Rate for Payer: Humana OH Medicaid	$72.40

EAPG 3.18: CLASS II THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$281.83

Service Code	EAPG 00244
Min. Negotiated Rate	$281.83
Max. Negotiated Rate	$281.83
Rate for Payer: Aetna CHP/Medicaid	$281.83
Rate for Payer: Humana OH Medicaid	$281.83

EAPG 3.18: CLASS I PHARMACOTHERAPY

Facility

$24.56

Service Code	EAPG 00435
Min. Negotiated Rate	$24.56
Max. Negotiated Rate	$24.56
Rate for Payer: Aetna CHP/Medicaid	$24.56
Rate for Payer: Humana OH Medicaid	$24.56

EAPG 3.18: CLASS I THERAPEUTIC RADIOPHARMACEUTICALS

Facility

$11.64

Service Code	EAPG 00243
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$11.64
Rate for Payer: Aetna CHP/Medicaid	$11.64
Rate for Payer: Humana OH Medicaid	$11.64

EAPG 3.18: CLASS IV PHARMACOTHERAPY

Facility

$219.78

Service Code	EAPG 00438
Min. Negotiated Rate	$219.78
Max. Negotiated Rate	$219.78
Rate for Payer: Aetna CHP/Medicaid	$219.78
Rate for Payer: Humana OH Medicaid	$219.78

EAPG 3.18: CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$1,644.44

Service Code	EAPG 00461
Min. Negotiated Rate	$1,644.44
Max. Negotiated Rate	$1,644.44
Rate for Payer: Aetna CHP/Medicaid	$1,644.44
Rate for Payer: Humana OH Medicaid	$1,644.44

EAPG 3.18: CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$1,191.96

Service Code	EAPG 00460
Min. Negotiated Rate	$1,191.96
Max. Negotiated Rate	$1,191.96
Rate for Payer: Aetna CHP/Medicaid	$1,191.96
Rate for Payer: Humana OH Medicaid	$1,191.96

EAPG 3.18: CLASS VII PHARMACOTHERAPY

Facility

$828.68

Service Code	EAPG 00444
Min. Negotiated Rate	$828.68
Max. Negotiated Rate	$828.68
Rate for Payer: Aetna CHP/Medicaid	$828.68
Rate for Payer: Humana OH Medicaid	$828.68

EAPG 3.18: CLASS VI PHARMACOTHERAPY

Facility

$553.32

Service Code	EAPG 00440
Min. Negotiated Rate	$553.32
Max. Negotiated Rate	$553.32
Rate for Payer: Aetna CHP/Medicaid	$553.32
Rate for Payer: Humana OH Medicaid	$553.32

EAPG 3.18: CLASS V PHARMACOTHERAPY

Facility

$355.52

Service Code	EAPG 00439
Min. Negotiated Rate	$355.52
Max. Negotiated Rate	$355.52
Rate for Payer: Aetna CHP/Medicaid	$355.52
Rate for Payer: Humana OH Medicaid	$355.52

EAPG 3.18: CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$2,611.46

Service Code	EAPG 00462
Min. Negotiated Rate	$2,611.46
Max. Negotiated Rate	$2,611.46
Rate for Payer: Aetna CHP/Medicaid	$2,611.46
Rate for Payer: Humana OH Medicaid	$2,611.46

EAPG 3.18: CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$4,211.94

Service Code	EAPG 00463
Min. Negotiated Rate	$4,211.94
Max. Negotiated Rate	$4,211.94
Rate for Payer: Aetna CHP/Medicaid	$4,211.94
Rate for Payer: Humana OH Medicaid	$4,211.94

EAPG 3.18: CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY

Facility

$6,465.29

Service Code	EAPG 00464
Min. Negotiated Rate	$6,465.29
Max. Negotiated Rate	$6,465.29
Rate for Payer: Aetna CHP/Medicaid	$6,465.29
Rate for Payer: Humana OH Medicaid	$6,465.29

EAPG 3.18: CLEFT LIP AND PALATE REPAIR

Facility

$2,165.44

Service Code	EAPG 00262
Min. Negotiated Rate	$2,165.44
Max. Negotiated Rate	$2,165.44
Rate for Payer: Aetna CHP/Medicaid	$2,165.44
Rate for Payer: Humana OH Medicaid	$2,165.44

EAPG 3.18: CLOSED TREATMENT FX AND DISLOCATION

Facility

$354.23

Service Code	EAPG 00041
Min. Negotiated Rate	$354.23
Max. Negotiated Rate	$354.23
Rate for Payer: Aetna CHP/Medicaid	$354.23
Rate for Payer: Humana OH Medicaid	$354.23

EAPG 3.18: COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES

Facility

$87.91

Service Code	EAPG 00781
Min. Negotiated Rate	$87.91
Max. Negotiated Rate	$87.91
Rate for Payer: Aetna CHP/Medicaid	$87.91
Rate for Payer: Humana OH Medicaid	$87.91

EAPG 3.18: COCAINE ABUSE AND DEPENDENCE

Facility

$103.42

Service Code	EAPG 00841
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: COCHLEAR DEVICE IMPLANTATION

Facility

$21,775.92

Service Code	EAPG 00250
Min. Negotiated Rate	$21,775.92
Max. Negotiated Rate	$21,775.92
Rate for Payer: Aetna CHP/Medicaid	$21,775.92
Rate for Payer: Humana OH Medicaid	$21,775.92

EAPG 3.18: COMPLEX BLOOD COLLECTION SERVICES

Facility

$21.98

Service Code	EAPG 00494
Min. Negotiated Rate	$21.98
Max. Negotiated Rate	$21.98
Rate for Payer: Aetna CHP/Medicaid	$21.98
Rate for Payer: Humana OH Medicaid	$21.98

EAPG 3.18: COMPLEX KIDNEY AND URINARY TRACT INFECTIONS

Facility

$103.42

Service Code	EAPG 00723
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: COMPLEX WOUND REPAIR AND TREATMENT

Facility

$979.94

Service Code	EAPG 00018
Min. Negotiated Rate	$979.94
Max. Negotiated Rate	$979.94
Rate for Payer: Aetna CHP/Medicaid	$979.94
Rate for Payer: Humana OH Medicaid	$979.94

EAPG 3.18: COMPLICATIONS OF TREATMENT AFFECTING PREGNANCY

Facility

$98.25

Service Code	EAPG 00767
Min. Negotiated Rate	$98.25
Max. Negotiated Rate	$98.25
Rate for Payer: Aetna CHP/Medicaid	$98.25
Rate for Payer: Humana OH Medicaid	$98.25

EAPG 3.18: COMPUTED TOMOGRAPHIC ANGIOGRAPHY

Facility

$266.32

Service Code	EAPG 00302
Min. Negotiated Rate	$266.32
Max. Negotiated Rate	$266.32
Rate for Payer: Aetna CHP/Medicaid	$266.32
Rate for Payer: Humana OH Medicaid	$266.32

EAPG 3.18: COMPUTED TOMOGRAPHY- OTHER

Facility

$188.75

Service Code	EAPG 00301
Min. Negotiated Rate	$188.75
Max. Negotiated Rate	$188.75
Rate for Payer: Aetna CHP/Medicaid	$188.75
Rate for Payer: Humana OH Medicaid	$188.75

EAPG 3.18: CONJUNCTIVITIS

Facility

$81.45

Service Code	EAPG 00555
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Aetna CHP/Medicaid	$81.45
Rate for Payer: Humana OH Medicaid	$81.45

Know your out-of-pocket cost for care.

All Charges