Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: CONNECTIVE TISSUE DIAGNOSES

Facility

$89.20

Service Code	EAPG 00655
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: CONSTIPATION

Facility

$109.89

Service Code	EAPG 00630
Min. Negotiated Rate	$109.89
Max. Negotiated Rate	$109.89
Rate for Payer: Aetna CHP/Medicaid	$109.89
Rate for Payer: Humana OH Medicaid	$109.89

EAPG 3.18: CONTRACEPTIVE MANAGEMENT

Facility

$210.73

Service Code	EAPG 00875
Min. Negotiated Rate	$210.73
Max. Negotiated Rate	$210.73
Rate for Payer: Aetna CHP/Medicaid	$210.73
Rate for Payer: Humana OH Medicaid	$210.73

EAPG 3.18: CONTUSIONS TO EXTERNAL ORGANS OTHER THAN HEAD TRAUMA

Facility

$124.11

Service Code	EAPG 00610
Min. Negotiated Rate	$124.11
Max. Negotiated Rate	$124.11
Rate for Payer: Aetna CHP/Medicaid	$124.11
Rate for Payer: Humana OH Medicaid	$124.11

EAPG 3.18: CORNEAL TISSUE PROCESSING

Facility

$545.56

Service Code	EAPG 00485
Min. Negotiated Rate	$545.56
Max. Negotiated Rate	$545.56
Rate for Payer: Aetna CHP/Medicaid	$545.56
Rate for Payer: Humana OH Medicaid	$545.56

EAPG 3.18: COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY

Facility

$80.15

Service Code	EAPG 00315
Min. Negotiated Rate	$80.15
Max. Negotiated Rate	$80.15
Rate for Payer: Aetna CHP/Medicaid	$80.15
Rate for Payer: Humana OH Medicaid	$80.15

EAPG 3.18: CRANIAL AND SPINAL SHUNT PROCEDURES

Facility

$2,500.28

Service Code	EAPG 00268
Min. Negotiated Rate	$2,500.28
Max. Negotiated Rate	$2,500.28
Rate for Payer: Aetna CHP/Medicaid	$2,500.28
Rate for Payer: Humana OH Medicaid	$2,500.28

EAPG 3.18: CRISIS INTERVENTION

Facility

$107.30

Service Code	EAPG 00321
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: CT GUIDANCE

Facility

$137.04

Service Code	EAPG 00473
Min. Negotiated Rate	$137.04
Max. Negotiated Rate	$137.04
Rate for Payer: Aetna CHP/Medicaid	$137.04
Rate for Payer: Humana OH Medicaid	$137.04

EAPG 3.18: CVA AND PRECEREBRAL OCCLUSION W INFARCT

Facility

$87.91

Service Code	EAPG 00535
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: CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

$125.40

Service Code	EAPG 00570
Min. Negotiated Rate	$125.40
Max. Negotiated Rate	$125.40
Rate for Payer: Aetna CHP/Medicaid	$125.40
Rate for Payer: Humana OH Medicaid	$125.40

EAPG 3.18: DAY REHABILITATION, FULL DAY

Facility

$107.30

Service Code	EAPG 00329
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: DAY REHABILITATION, HALF DAY

Facility

$80.15

Service Code	EAPG 00328
Min. Negotiated Rate	$80.15
Max. Negotiated Rate	$80.15
Rate for Payer: Aetna CHP/Medicaid	$80.15
Rate for Payer: Humana OH Medicaid	$80.15

EAPG 3.18: DEEP LYMPH STRUCTURE PROCEDURES

Facility

$1,013.56

Service Code	EAPG 00115
Min. Negotiated Rate	$1,013.56
Max. Negotiated Rate	$1,013.56
Rate for Payer: Aetna CHP/Medicaid	$1,013.56
Rate for Payer: Humana OH Medicaid	$1,013.56

EAPG 3.18: DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS

Facility

$93.08

Service Code	EAPG 00522
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$93.08
Rate for Payer: Aetna CHP/Medicaid	$93.08
Rate for Payer: Humana OH Medicaid	$93.08

EAPG 3.18: DENTAL AND ORAL DIAGNOSES AND INJURIES

Facility

$80.15

Service Code	EAPG 00563
Min. Negotiated Rate	$80.15
Max. Negotiated Rate	$80.15
Rate for Payer: Aetna CHP/Medicaid	$80.15
Rate for Payer: Humana OH Medicaid	$80.15

EAPG 3.18: DENTAL ANESTHESIA

Facility

$730.43

Service Code	EAPG 00375
Min. Negotiated Rate	$730.43
Max. Negotiated Rate	$730.43
Rate for Payer: Aetna CHP/Medicaid	$730.43
Rate for Payer: Humana OH Medicaid	$730.43

EAPG 3.18: DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES

Facility

$85.32

Service Code	EAPG 00824
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: DEVELOPMENTAL & NEUROPSYCHOLOGICAL TESTING

Facility

$107.30

Service Code	EAPG 00310
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: DIABETES WITH NEUROLOGIC MANIFESTATIONS

Facility

$95.67

Service Code	EAPG 00712
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: DIABETES WITH OPHTHALMIC MANIFESTATIONS

Facility

$96.96

Service Code	EAPG 00710
Min. Negotiated Rate	$96.96
Max. Negotiated Rate	$96.96
Rate for Payer: Aetna CHP/Medicaid	$96.96
Rate for Payer: Humana OH Medicaid	$96.96

EAPG 3.18: DIABETES WITH OTHER MANIFESTATIONS & COMPLICATIONS

Facility

$87.91

Service Code	EAPG 00711
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: DIABETES WITHOUT COMPLICATIONS

Facility

$82.74

Service Code	EAPG 00713
Min. Negotiated Rate	$82.74
Max. Negotiated Rate	$82.74
Rate for Payer: Aetna CHP/Medicaid	$82.74
Rate for Payer: Humana OH Medicaid	$82.74

EAPG 3.18: DIABETES WITH RENAL MANIFESTATIONS

Facility

$77.57

Service Code	EAPG 00714
Min. Negotiated Rate	$77.57
Max. Negotiated Rate	$77.57
Rate for Payer: Aetna CHP/Medicaid	$77.57
Rate for Payer: Humana OH Medicaid	$77.57

EAPG 3.18: DIABETES WITH VASCULAR COMPLICATIONS INCLUDING FOOT AND OTHER SKIN ULCERS

Facility

$87.91

Service Code	EAPG 00715
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

Know your out-of-pocket cost for care.

All Charges