Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LASER EYE PROCEDURES

Facility

$381.38

Service Code	EAPG 00232
Min. Negotiated Rate	$381.38
Max. Negotiated Rate	$381.38
Rate for Payer: Aetna CHP/Medicaid	$381.38
Rate for Payer: Humana OH Medicaid	$381.38

EAPG 3.18: LEVEL I ADJUNCTIVE GENERAL DENTAL SERVICES

Facility

$59.47

Service Code	EAPG 00350
Min. Negotiated Rate	$59.47
Max. Negotiated Rate	$59.47
Rate for Payer: Aetna CHP/Medicaid	$59.47
Rate for Payer: Humana OH Medicaid	$59.47

EAPG 3.18: LEVEL I ANAL AND RECTAL PROCEDURES

Facility

$769.22

Service Code	EAPG 00141
Min. Negotiated Rate	$769.22
Max. Negotiated Rate	$769.22
Rate for Payer: Aetna CHP/Medicaid	$769.22
Rate for Payer: Humana OH Medicaid	$769.22

EAPG 3.18: LEVEL I ANCILLARY THERAPEUTIC SERVICES

Facility

$18.10

Service Code	EAPG 00493
Min. Negotiated Rate	$18.10
Max. Negotiated Rate	$18.10
Rate for Payer: Aetna CHP/Medicaid	$18.10
Rate for Payer: Humana OH Medicaid	$18.10

EAPG 3.18: LEVEL I ANTERIOR SEGMENT EYE PROCEDURES

Facility

$1,154.47

Service Code	EAPG 00234
Min. Negotiated Rate	$1,154.47
Max. Negotiated Rate	$1,154.47
Rate for Payer: Aetna CHP/Medicaid	$1,154.47
Rate for Payer: Humana OH Medicaid	$1,154.47

EAPG 3.18: LEVEL I ARTHROPLASTY

Facility

$2,144.76

Service Code	EAPG 00046
Min. Negotiated Rate	$2,144.76
Max. Negotiated Rate	$2,144.76
Rate for Payer: Aetna CHP/Medicaid	$2,144.76
Rate for Payer: Humana OH Medicaid	$2,144.76

EAPG 3.18: LEVEL I ARTHROSCOPY

Facility

$1,286.34

Service Code	EAPG 00037
Min. Negotiated Rate	$1,286.34
Max. Negotiated Rate	$1,286.34
Rate for Payer: Aetna CHP/Medicaid	$1,286.34
Rate for Payer: Humana OH Medicaid	$1,286.34

EAPG 3.18: LEVEL I BLADDER AND URETERAL PROCEDURES

Facility

$1,144.13

Service Code	EAPG 00173
Min. Negotiated Rate	$1,144.13
Max. Negotiated Rate	$1,144.13
Rate for Payer: Aetna CHP/Medicaid	$1,144.13
Rate for Payer: Humana OH Medicaid	$1,144.13

EAPG 3.18: LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$382.67

Service Code	EAPG 00113
Min. Negotiated Rate	$382.67
Max. Negotiated Rate	$382.67
Rate for Payer: Aetna CHP/Medicaid	$382.67
Rate for Payer: Humana OH Medicaid	$382.67

EAPG 3.18: LEVEL I BLOOD AND TISSUE TYPING TESTS

Facility

$33.61

Service Code	EAPG 00486
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$33.61
Rate for Payer: Aetna CHP/Medicaid	$33.61
Rate for Payer: Humana OH Medicaid	$33.61

EAPG 3.18: LEVEL I BLOOD PRODUCTS

Facility

$382.67

Service Code	EAPG 02061
Min. Negotiated Rate	$382.67
Max. Negotiated Rate	$382.67
Rate for Payer: Aetna CHP/Medicaid	$382.67
Rate for Payer: Humana OH Medicaid	$382.67

EAPG 3.18: LEVEL I BRACHYTHERAPY SOURCES

Facility

$695.53

Service Code	EAPG 00335
Min. Negotiated Rate	$695.53
Max. Negotiated Rate	$695.53
Rate for Payer: Aetna CHP/Medicaid	$695.53
Rate for Payer: Humana OH Medicaid	$695.53

EAPG 3.18: LEVEL I BREAST PROCEDURES

Facility

$1,107.93

Service Code	EAPG 00020
Min. Negotiated Rate	$1,107.93
Max. Negotiated Rate	$1,107.93
Rate for Payer: Aetna CHP/Medicaid	$1,107.93
Rate for Payer: Humana OH Medicaid	$1,107.93

EAPG 3.18: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES

Facility

$164.19

Service Code	EAPG 00075
Min. Negotiated Rate	$164.19
Max. Negotiated Rate	$164.19
Rate for Payer: Aetna CHP/Medicaid	$164.19
Rate for Payer: Humana OH Medicaid	$164.19

EAPG 3.18: LEVEL I CHEMISTRY TESTS

Facility

$9.05

Service Code	EAPG 00400
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$9.05
Rate for Payer: Aetna CHP/Medicaid	$9.05
Rate for Payer: Humana OH Medicaid	$9.05

EAPG 3.18: LEVEL I CLOTTING TESTS

Facility

$10.34

Service Code	EAPG 00406
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$10.34
Rate for Payer: Aetna CHP/Medicaid	$10.34
Rate for Payer: Humana OH Medicaid	$10.34

EAPG 3.18: LEVEL I COMPUTED TOMOGRAPHY

Facility

$210.73

Service Code	EAPG 00299
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: LEVEL I CONVENTIONAL RADIOLOGY

Facility

$24.56

Service Code	EAPG 00471
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: LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$1,136.37

Service Code	EAPG 00247
Min. Negotiated Rate	$1,136.37
Max. Negotiated Rate	$1,136.37
Rate for Payer: Aetna CHP/Medicaid	$1,136.37
Rate for Payer: Humana OH Medicaid	$1,136.37

EAPG 3.18: LEVEL I CRANIOFACIAL BONE PROCEDURES

Facility

$1,794.41

Service Code	EAPG 00227
Min. Negotiated Rate	$1,794.41
Max. Negotiated Rate	$1,794.41
Rate for Payer: Aetna CHP/Medicaid	$1,794.41
Rate for Payer: Humana OH Medicaid	$1,794.41

EAPG 3.18: LEVEL I DENTAL FILM

Facility

$16.81

Service Code	EAPG 00373
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$16.81
Rate for Payer: Aetna CHP/Medicaid	$16.81
Rate for Payer: Humana OH Medicaid	$16.81

EAPG 3.18: LEVEL I DENTAL RESTORATIONS

Facility

$85.32

Service Code	EAPG 00361
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: LEVEL I DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$585.64

Service Code	EAPG 00334
Min. Negotiated Rate	$585.64
Max. Negotiated Rate	$585.64
Rate for Payer: Aetna CHP/Medicaid	$585.64
Rate for Payer: Humana OH Medicaid	$585.64

EAPG 3.18: LEVEL I DIAGNOSTIC NUCLEAR MEDICINE

Facility

$240.46

Service Code	EAPG 00331
Min. Negotiated Rate	$240.46
Max. Negotiated Rate	$240.46
Rate for Payer: Aetna CHP/Medicaid	$240.46
Rate for Payer: Humana OH Medicaid	$240.46

EAPG 3.18: LEVEL I DIAGNOSTIC ULTRASOUND

Facility

$104.72

Service Code	EAPG 00288
Min. Negotiated Rate	$104.72
Max. Negotiated Rate	$104.72
Rate for Payer: Aetna CHP/Medicaid	$104.72
Rate for Payer: Humana OH Medicaid	$104.72

Know your out-of-pocket cost for care.

All Charges