Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I EAR, NOSE, MOUTH AND THROAT PROCEDURES

Facility

$879.10

Service Code	EAPG 00252
Min. Negotiated Rate	$879.10
Max. Negotiated Rate	$879.10
Rate for Payer: Aetna CHP/Medicaid	$879.10
Rate for Payer: Humana OH Medicaid	$879.10

EAPG 3.18: LEVEL I ENDOCRINOLOGY TESTS

Facility

$20.68

Service Code	EAPG 00398
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$20.68
Rate for Payer: Aetna CHP/Medicaid	$20.68
Rate for Payer: Humana OH Medicaid	$20.68

EAPG 3.18: LEVEL I ENDODONTICS

Facility

$81.45

Service Code	EAPG 00364
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

EAPG 3.18: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility

$268.90

Service Code	EAPG 00062
Min. Negotiated Rate	$268.90
Max. Negotiated Rate	$268.90
Rate for Payer: Aetna CHP/Medicaid	$268.90
Rate for Payer: Humana OH Medicaid	$268.90

EAPG 3.18: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$917.89

Service Code	EAPG 00138
Min. Negotiated Rate	$917.89
Max. Negotiated Rate	$917.89
Rate for Payer: Aetna CHP/Medicaid	$917.89
Rate for Payer: Humana OH Medicaid	$917.89

EAPG 3.18: LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,264.36

Service Code	EAPG 00125
Min. Negotiated Rate	$1,264.36
Max. Negotiated Rate	$1,264.36
Rate for Payer: Aetna CHP/Medicaid	$1,264.36
Rate for Payer: Humana OH Medicaid	$1,264.36

EAPG 3.18: LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$840.32

Service Code	EAPG 00258
Min. Negotiated Rate	$840.32
Max. Negotiated Rate	$840.32
Rate for Payer: Aetna CHP/Medicaid	$840.32
Rate for Payer: Humana OH Medicaid	$840.32

EAPG 3.18: LEVEL I FETAL PROCEDURES

Facility

$168.06

Service Code	EAPG 00191
Min. Negotiated Rate	$168.06
Max. Negotiated Rate	$168.06
Rate for Payer: Aetna CHP/Medicaid	$168.06
Rate for Payer: Humana OH Medicaid	$168.06

EAPG 3.18: LEVEL I FOOT PROCEDURES

Facility

$1,150.59

Service Code	EAPG 00035
Min. Negotiated Rate	$1,150.59
Max. Negotiated Rate	$1,150.59
Rate for Payer: Aetna CHP/Medicaid	$1,150.59
Rate for Payer: Humana OH Medicaid	$1,150.59

EAPG 3.18: LEVEL I FOREARM AND WRIST PROCEDURES

Facility

$1,401.40

Service Code	EAPG 00023
Min. Negotiated Rate	$1,401.40
Max. Negotiated Rate	$1,401.40
Rate for Payer: Aetna CHP/Medicaid	$1,401.40
Rate for Payer: Humana OH Medicaid	$1,401.40

EAPG 3.18: LEVEL I GASTROINTESTINAL PROCEDURES

Facility

$849.37

Service Code	EAPG 00143
Min. Negotiated Rate	$849.37
Max. Negotiated Rate	$849.37
Rate for Payer: Aetna CHP/Medicaid	$849.37
Rate for Payer: Humana OH Medicaid	$849.37

EAPG 3.18: LEVEL I HAND PROCEDURES

Facility

$893.32

Service Code	EAPG 00033
Min. Negotiated Rate	$893.32
Max. Negotiated Rate	$893.32
Rate for Payer: Aetna CHP/Medicaid	$893.32
Rate for Payer: Humana OH Medicaid	$893.32

EAPG 3.18: LEVEL I HEMATOLOGY TESTS

Facility

$9.05

Service Code	EAPG 00408
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 HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$1,021.31

Service Code	EAPG 00151
Min. Negotiated Rate	$1,021.31
Max. Negotiated Rate	$1,021.31
Rate for Payer: Aetna CHP/Medicaid	$1,021.31
Rate for Payer: Humana OH Medicaid	$1,021.31

EAPG 3.18: LEVEL I HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$846.78

Service Code	EAPG 00204
Min. Negotiated Rate	$846.78
Max. Negotiated Rate	$846.78
Rate for Payer: Aetna CHP/Medicaid	$846.78
Rate for Payer: Humana OH Medicaid	$846.78

EAPG 3.18: LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES

Facility

$169.36

Service Code	EAPG 00351
Min. Negotiated Rate	$169.36
Max. Negotiated Rate	$169.36
Rate for Payer: Aetna CHP/Medicaid	$169.36
Rate for Payer: Humana OH Medicaid	$169.36

EAPG 3.18: LEVEL II ALLERGY TESTS

Facility

$178.41

Service Code	EAPG 02016
Min. Negotiated Rate	$178.41
Max. Negotiated Rate	$178.41
Rate for Payer: Aetna CHP/Medicaid	$178.41
Rate for Payer: Humana OH Medicaid	$178.41

EAPG 3.18: LEVEL II ANAL AND RECTAL PROCEDURES

Facility

$1,082.07

Service Code	EAPG 00142
Min. Negotiated Rate	$1,082.07
Max. Negotiated Rate	$1,082.07
Rate for Payer: Aetna CHP/Medicaid	$1,082.07
Rate for Payer: Humana OH Medicaid	$1,082.07

EAPG 3.18: LEVEL II ANCLLARY THERAPEUTIC SERVICES

Facility

$50.42

Service Code	EAPG 00269
Min. Negotiated Rate	$50.42
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna CHP/Medicaid	$50.42
Rate for Payer: Humana OH Medicaid	$50.42

EAPG 3.18: LEVEL II ANTERIOR SEGMENT EYE PROCEDURES

Facility

$1,547.48

Service Code	EAPG 00235
Min. Negotiated Rate	$1,547.48
Max. Negotiated Rate	$1,547.48
Rate for Payer: Aetna CHP/Medicaid	$1,547.48
Rate for Payer: Humana OH Medicaid	$1,547.48

EAPG 3.18: LEVEL II ARTHROPLASTY

Facility

$2,465.37

Service Code	EAPG 00047
Min. Negotiated Rate	$2,465.37
Max. Negotiated Rate	$2,465.37
Rate for Payer: Aetna CHP/Medicaid	$2,465.37
Rate for Payer: Humana OH Medicaid	$2,465.37

EAPG 3.18: LEVEL II ARTHROSCOPY

Facility

$2,444.68

Service Code	EAPG 00038
Min. Negotiated Rate	$2,444.68
Max. Negotiated Rate	$2,444.68
Rate for Payer: Aetna CHP/Medicaid	$2,444.68
Rate for Payer: Humana OH Medicaid	$2,444.68

EAPG 3.18: LEVEL II BLADDER AND URETERAL PROCEDURES

Facility

$1,372.95

Service Code	EAPG 00174
Min. Negotiated Rate	$1,372.95
Max. Negotiated Rate	$1,372.95
Rate for Payer: Aetna CHP/Medicaid	$1,372.95
Rate for Payer: Humana OH Medicaid	$1,372.95

EAPG 3.18: LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$1,441.47

Service Code	EAPG 00114
Min. Negotiated Rate	$1,441.47
Max. Negotiated Rate	$1,441.47
Rate for Payer: Aetna CHP/Medicaid	$1,441.47
Rate for Payer: Humana OH Medicaid	$1,441.47

EAPG 3.18: LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility

$33.61

Service Code	EAPG 00393
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

Know your out-of-pocket cost for care.

All Charges