Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II BLOOD PRODUCTS

Facility

$470.58

Service Code	EAPG 02062
Min. Negotiated Rate	$470.58
Max. Negotiated Rate	$470.58
Rate for Payer: Aetna CHP/Medicaid	$470.58
Rate for Payer: Humana OH Medicaid	$470.58

EAPG 3.18: LEVEL II BRACHYTHERAPY SOURCES

Facility

$973.48

Service Code	EAPG 00336
Min. Negotiated Rate	$973.48
Max. Negotiated Rate	$973.48
Rate for Payer: Aetna CHP/Medicaid	$973.48
Rate for Payer: Humana OH Medicaid	$973.48

EAPG 3.18: LEVEL II BREAST PROCEDURES

Facility

$1,564.29

Service Code	EAPG 00021
Min. Negotiated Rate	$1,564.29
Max. Negotiated Rate	$1,564.29
Rate for Payer: Aetna CHP/Medicaid	$1,564.29
Rate for Payer: Humana OH Medicaid	$1,564.29

EAPG 3.18: LEVEL II CENTRAL VENOUS ACCESS PROCEDURES

Facility

$978.65

Service Code	EAPG 00083
Min. Negotiated Rate	$978.65
Max. Negotiated Rate	$978.65
Rate for Payer: Aetna CHP/Medicaid	$978.65
Rate for Payer: Humana OH Medicaid	$978.65

EAPG 3.18: LEVEL II CHEMISTRY TESTS

Facility

$27.15

Service Code	EAPG 00401
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$27.15
Rate for Payer: Aetna CHP/Medicaid	$27.15
Rate for Payer: Humana OH Medicaid	$27.15

EAPG 3.18: LEVEL II CLOTTING TESTS

Facility

$32.32

Service Code	EAPG 00407
Min. Negotiated Rate	$32.32
Max. Negotiated Rate	$32.32
Rate for Payer: Aetna CHP/Medicaid	$32.32
Rate for Payer: Humana OH Medicaid	$32.32

EAPG 3.18: LEVEL II COMPUTED TOMOGRAPHY

Facility

$250.80

Service Code	EAPG 00300
Min. Negotiated Rate	$250.80
Max. Negotiated Rate	$250.80
Rate for Payer: Aetna CHP/Medicaid	$250.80
Rate for Payer: Humana OH Medicaid	$250.80

EAPG 3.18: LEVEL II CONVENTIONAL RADIOLOGY

Facility

$179.70

Service Code	EAPG 00389
Min. Negotiated Rate	$179.70
Max. Negotiated Rate	$179.70
Rate for Payer: Aetna CHP/Medicaid	$179.70
Rate for Payer: Humana OH Medicaid	$179.70

EAPG 3.18: LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$2,077.53

Service Code	EAPG 00248
Min. Negotiated Rate	$2,077.53
Max. Negotiated Rate	$2,077.53
Rate for Payer: Aetna CHP/Medicaid	$2,077.53
Rate for Payer: Humana OH Medicaid	$2,077.53

EAPG 3.18: LEVEL II CRANIOFACIAL BONE PROCEDURES

Facility

$2,258.52

Service Code	EAPG 00228
Min. Negotiated Rate	$2,258.52
Max. Negotiated Rate	$2,258.52
Rate for Payer: Aetna CHP/Medicaid	$2,258.52
Rate for Payer: Humana OH Medicaid	$2,258.52

EAPG 3.18: LEVEL II DENTAL FILM

Facility

$59.47

Service Code	EAPG 00374
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 II DENTAL RESTORATIONS

Facility

$126.69

Service Code	EAPG 00362
Min. Negotiated Rate	$126.69
Max. Negotiated Rate	$126.69
Rate for Payer: Aetna CHP/Medicaid	$126.69
Rate for Payer: Humana OH Medicaid	$126.69

EAPG 3.18: LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$899.79

Service Code	EAPG 00338
Min. Negotiated Rate	$899.79
Max. Negotiated Rate	$899.79
Rate for Payer: Aetna CHP/Medicaid	$899.79
Rate for Payer: Humana OH Medicaid	$899.79

EAPG 3.18: LEVEL II DIAGNOSTIC NUCLEAR MEDICINE

Facility

$526.17

Service Code	EAPG 00332
Min. Negotiated Rate	$526.17
Max. Negotiated Rate	$526.17
Rate for Payer: Aetna CHP/Medicaid	$526.17
Rate for Payer: Humana OH Medicaid	$526.17

EAPG 3.18: LEVEL II DIAGNOSTIC ULTRASOUND

Facility

$451.19

Service Code	EAPG 00289
Min. Negotiated Rate	$451.19
Max. Negotiated Rate	$451.19
Rate for Payer: Aetna CHP/Medicaid	$451.19
Rate for Payer: Humana OH Medicaid	$451.19

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

Facility

$1,181.62

Service Code	EAPG 00253
Min. Negotiated Rate	$1,181.62
Max. Negotiated Rate	$1,181.62
Rate for Payer: Aetna CHP/Medicaid	$1,181.62
Rate for Payer: Humana OH Medicaid	$1,181.62

EAPG 3.18: LEVEL II ENDOCRINOLOGY TESTS

Facility

$28.44

Service Code	EAPG 00399
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$28.44
Rate for Payer: Aetna CHP/Medicaid	$28.44
Rate for Payer: Humana OH Medicaid	$28.44

EAPG 3.18: LEVEL II ENDODONTICS

Facility

$144.79

Service Code	EAPG 00365
Min. Negotiated Rate	$144.79
Max. Negotiated Rate	$144.79
Rate for Payer: Aetna CHP/Medicaid	$144.79
Rate for Payer: Humana OH Medicaid	$144.79

EAPG 3.18: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$1,189.38

Service Code	EAPG 00063
Min. Negotiated Rate	$1,189.38
Max. Negotiated Rate	$1,189.38
Rate for Payer: Aetna CHP/Medicaid	$1,189.38
Rate for Payer: Humana OH Medicaid	$1,189.38

EAPG 3.18: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$1,009.68

Service Code	EAPG 00153
Min. Negotiated Rate	$1,009.68
Max. Negotiated Rate	$1,009.68
Rate for Payer: Aetna CHP/Medicaid	$1,009.68
Rate for Payer: Humana OH Medicaid	$1,009.68

EAPG 3.18: LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,693.57

Service Code	EAPG 00126
Min. Negotiated Rate	$1,693.57
Max. Negotiated Rate	$1,693.57
Rate for Payer: Aetna CHP/Medicaid	$1,693.57
Rate for Payer: Humana OH Medicaid	$1,693.57

EAPG 3.18: LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$1,269.53

Service Code	EAPG 00259
Min. Negotiated Rate	$1,269.53
Max. Negotiated Rate	$1,269.53
Rate for Payer: Aetna CHP/Medicaid	$1,269.53
Rate for Payer: Humana OH Medicaid	$1,269.53

EAPG 3.18: LEVEL II FETAL PROCEDURES

Facility

$502.90

Service Code	EAPG 00192
Min. Negotiated Rate	$502.90
Max. Negotiated Rate	$502.90
Rate for Payer: Aetna CHP/Medicaid	$502.90
Rate for Payer: Humana OH Medicaid	$502.90

EAPG 3.18: LEVEL II FOOT PROCEDURES

Facility

$1,471.21

Service Code	EAPG 00036
Min. Negotiated Rate	$1,471.21
Max. Negotiated Rate	$1,471.21
Rate for Payer: Aetna CHP/Medicaid	$1,471.21
Rate for Payer: Humana OH Medicaid	$1,471.21

EAPG 3.18: LEVEL II FOREARM AND WRIST PROCEDURES

Facility

$1,597.90

Service Code	EAPG 00024
Min. Negotiated Rate	$1,597.90
Max. Negotiated Rate	$1,597.90
Rate for Payer: Aetna CHP/Medicaid	$1,597.90
Rate for Payer: Humana OH Medicaid	$1,597.90

Know your out-of-pocket cost for care.

All Charges