Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II GASTROINTESTINAL PROCEDURES

Facility

$1,705.20

Service Code	EAPG 00144
Min. Negotiated Rate	$1,705.20
Max. Negotiated Rate	$1,705.20
Rate for Payer: Aetna CHP/Medicaid	$1,705.20
Rate for Payer: Humana OH Medicaid	$1,705.20

EAPG 3.18: LEVEL II HAND PROCEDURES

Facility

$1,476.38

Service Code	EAPG 00034
Min. Negotiated Rate	$1,476.38
Max. Negotiated Rate	$1,476.38
Rate for Payer: Aetna CHP/Medicaid	$1,476.38
Rate for Payer: Humana OH Medicaid	$1,476.38

EAPG 3.18: LEVEL II HEMATOLOGY TESTS

Facility

$21.98

Service Code	EAPG 00409
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: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$1,619.88

Service Code	EAPG 00152
Min. Negotiated Rate	$1,619.88
Max. Negotiated Rate	$1,619.88
Rate for Payer: Aetna CHP/Medicaid	$1,619.88
Rate for Payer: Humana OH Medicaid	$1,619.88

EAPG 3.18: LEVEL II HIP AND FEMUR PROCEDURES

Facility

$1,546.19

Service Code	EAPG 00055
Min. Negotiated Rate	$1,546.19
Max. Negotiated Rate	$1,546.19
Rate for Payer: Aetna CHP/Medicaid	$1,546.19
Rate for Payer: Humana OH Medicaid	$1,546.19

EAPG 3.18: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$1,449.23

Service Code	EAPG 00206
Min. Negotiated Rate	$1,449.23
Max. Negotiated Rate	$1,449.23
Rate for Payer: Aetna CHP/Medicaid	$1,449.23
Rate for Payer: Humana OH Medicaid	$1,449.23

EAPG 3.18: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES

Facility

$2,230.08

Service Code	EAPG 00236
Min. Negotiated Rate	$2,230.08
Max. Negotiated Rate	$2,230.08
Rate for Payer: Aetna CHP/Medicaid	$2,230.08
Rate for Payer: Humana OH Medicaid	$2,230.08

EAPG 3.18: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility

$33.61

Service Code	EAPG 02043
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 III BLOOD PRODUCT EXCHANGE SERVICES

Facility

$1,441.47

Service Code	EAPG 00155
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 III BRACHYTHERAPY SOURCES

Facility

$10,148.48

Service Code	EAPG 00337
Min. Negotiated Rate	$10,148.48
Max. Negotiated Rate	$10,148.48
Rate for Payer: Aetna CHP/Medicaid	$10,148.48
Rate for Payer: Humana OH Medicaid	$10,148.48

EAPG 3.18: LEVEL III BREAST PROCEDURES

Facility

$2,241.72

Service Code	EAPG 00022
Min. Negotiated Rate	$2,241.72
Max. Negotiated Rate	$2,241.72
Rate for Payer: Aetna CHP/Medicaid	$2,241.72
Rate for Payer: Humana OH Medicaid	$2,241.72

EAPG 3.18: LEVEL III CHEMISTRY TESTS

Facility

$37.49

Service Code	EAPG 00384
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$37.49
Rate for Payer: Aetna CHP/Medicaid	$37.49
Rate for Payer: Humana OH Medicaid	$37.49

EAPG 3.18: LEVEL III DENTAL RESTORATIONS

Facility

$303.81

Service Code	EAPG 00363
Min. Negotiated Rate	$303.81
Max. Negotiated Rate	$303.81
Rate for Payer: Aetna CHP/Medicaid	$303.81
Rate for Payer: Humana OH Medicaid	$303.81

EAPG 3.18: LEVEL III DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$1,283.75

Service Code	EAPG 00339
Min. Negotiated Rate	$1,283.75
Max. Negotiated Rate	$1,283.75
Rate for Payer: Aetna CHP/Medicaid	$1,283.75
Rate for Payer: Humana OH Medicaid	$1,283.75

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

Facility

$1,675.47

Service Code	EAPG 00254
Min. Negotiated Rate	$1,675.47
Max. Negotiated Rate	$1,675.47
Rate for Payer: Aetna CHP/Medicaid	$1,675.47
Rate for Payer: Humana OH Medicaid	$1,675.47

EAPG 3.18: LEVEL III ENDODONTICS

Facility

$146.09

Service Code	EAPG 00366
Min. Negotiated Rate	$146.09
Max. Negotiated Rate	$146.09
Rate for Payer: Aetna CHP/Medicaid	$146.09
Rate for Payer: Humana OH Medicaid	$146.09

EAPG 3.18: LEVEL III KIDNEY AND URETERAL PROCEDURES

Facility

$1,383.30

Service Code	EAPG 00172
Min. Negotiated Rate	$1,383.30
Max. Negotiated Rate	$1,383.30
Rate for Payer: Aetna CHP/Medicaid	$1,383.30
Rate for Payer: Humana OH Medicaid	$1,383.30

EAPG 3.18: LEVEL III LAPAROSCOPY

Facility

$2,275.33

Service Code	EAPG 00148
Min. Negotiated Rate	$2,275.33
Max. Negotiated Rate	$2,275.33
Rate for Payer: Aetna CHP/Medicaid	$2,275.33
Rate for Payer: Humana OH Medicaid	$2,275.33

EAPG 3.18: LEVEL III MICROBIOLOGY TESTS

Facility

$42.66

Service Code	EAPG 00388
Min. Negotiated Rate	$42.66
Max. Negotiated Rate	$42.66
Rate for Payer: Aetna CHP/Medicaid	$42.66
Rate for Payer: Humana OH Medicaid	$42.66

EAPG 3.18: LEVEL II IMMUNIZATION

Facility

$47.83

Service Code	EAPG 00415
Min. Negotiated Rate	$47.83
Max. Negotiated Rate	$47.83
Rate for Payer: Aetna CHP/Medicaid	$47.83
Rate for Payer: Humana OH Medicaid	$47.83

EAPG 3.18: LEVEL II IMMUNOLOGY TESTS

Facility

$29.73

Service Code	EAPG 00395
Min. Negotiated Rate	$29.73
Max. Negotiated Rate	$29.73
Rate for Payer: Aetna CHP/Medicaid	$29.73
Rate for Payer: Humana OH Medicaid	$29.73

EAPG 3.18: LEVEL III NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$10,008.86

Service Code	EAPG 00223
Min. Negotiated Rate	$10,008.86
Max. Negotiated Rate	$10,008.86
Rate for Payer: Aetna CHP/Medicaid	$10,008.86
Rate for Payer: Humana OH Medicaid	$10,008.86

EAPG 3.18: LEVEL III ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$268.90

Service Code	EAPG 00369
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 III PATHOLOGY TESTS

Facility

$60.76

Service Code	EAPG 00308
Min. Negotiated Rate	$60.76
Max. Negotiated Rate	$60.76
Rate for Payer: Aetna CHP/Medicaid	$60.76
Rate for Payer: Humana OH Medicaid	$60.76

EAPG 3.18: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,883.61

Service Code	EAPG 00085
Min. Negotiated Rate	$1,883.61
Max. Negotiated Rate	$1,883.61
Rate for Payer: Aetna CHP/Medicaid	$1,883.61
Rate for Payer: Humana OH Medicaid	$1,883.61

Know your out-of-pocket cost for care.

All Charges