Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL III PROSTHODONTICS, FIXED

Facility

$272.78

Service Code	EAPG 00355
Min. Negotiated Rate	$272.78
Max. Negotiated Rate	$272.78
Rate for Payer: Aetna CHP/Medicaid	$272.78
Rate for Payer: Humana OH Medicaid	$272.78

EAPG 3.18: LEVEL III PROSTHODONTICS, REMOVABLE

Facility

$175.82

Service Code	EAPG 00358
Min. Negotiated Rate	$175.82
Max. Negotiated Rate	$175.82
Rate for Payer: Aetna CHP/Medicaid	$175.82
Rate for Payer: Humana OH Medicaid	$175.82

EAPG 3.18: LEVEL III RADIATION THERAPY

Facility

$544.27

Service Code	EAPG 00348
Min. Negotiated Rate	$544.27
Max. Negotiated Rate	$544.27
Rate for Payer: Aetna CHP/Medicaid	$544.27
Rate for Payer: Humana OH Medicaid	$544.27

EAPG 3.18: LEVEL III RADIATION TREATMENT PREPARATION & PLANNING

Facility

$118.94

Service Code	EAPG 00478
Min. Negotiated Rate	$118.94
Max. Negotiated Rate	$118.94
Rate for Payer: Aetna CHP/Medicaid	$118.94
Rate for Payer: Humana OH Medicaid	$118.94

EAPG 3.18: LEVEL III SKIN EXCISIONS, BIOPSIES, AND REPAIRS

Facility

$1,462.16

Service Code	EAPG 00011
Min. Negotiated Rate	$1,462.16
Max. Negotiated Rate	$1,462.16
Rate for Payer: Aetna CHP/Medicaid	$1,462.16
Rate for Payer: Humana OH Medicaid	$1,462.16

EAPG 3.18: LEVEL III SPINE PROCEDURES

Facility

$2,761.42

Service Code	EAPG 00057
Min. Negotiated Rate	$2,761.42
Max. Negotiated Rate	$2,761.42
Rate for Payer: Aetna CHP/Medicaid	$2,761.42
Rate for Payer: Humana OH Medicaid	$2,761.42

EAPG 3.18: LEVEL III UPPER GI ENDOSCOPY

Facility

$689.06

Service Code	EAPG 00154
Min. Negotiated Rate	$689.06
Max. Negotiated Rate	$689.06
Rate for Payer: Aetna CHP/Medicaid	$689.06
Rate for Payer: Humana OH Medicaid	$689.06

EAPG 3.18: LEVEL III VASCULAR RADIOLOGICAL PROCEDURES

Facility

$652.86

Service Code	EAPG 00280
Min. Negotiated Rate	$652.86
Max. Negotiated Rate	$652.86
Rate for Payer: Aetna CHP/Medicaid	$652.86
Rate for Payer: Humana OH Medicaid	$652.86

EAPG 3.18: LEVEL II JOINT, TENDON, OR LIGAMENT INJECTION PROCEDURES

Facility

$374.91

Service Code	EAPG 00050
Min. Negotiated Rate	$374.91
Max. Negotiated Rate	$374.91
Rate for Payer: Aetna CHP/Medicaid	$374.91
Rate for Payer: Humana OH Medicaid	$374.91

EAPG 3.18: LEVEL II KIDNEY AND URETERAL PROCEDURES

Facility

$1,020.02

Service Code	EAPG 00171
Min. Negotiated Rate	$1,020.02
Max. Negotiated Rate	$1,020.02
Rate for Payer: Aetna CHP/Medicaid	$1,020.02
Rate for Payer: Humana OH Medicaid	$1,020.02

EAPG 3.18: LEVEL II KNEE AND LOWER LEG PROCEDURES

Facility

$1,411.74

Service Code	EAPG 00052
Min. Negotiated Rate	$1,411.74
Max. Negotiated Rate	$1,411.74
Rate for Payer: Aetna CHP/Medicaid	$1,411.74
Rate for Payer: Humana OH Medicaid	$1,411.74

EAPG 3.18: LEVEL II LAPAROSCOPY

Facility

$1,777.60

Service Code	EAPG 00146
Min. Negotiated Rate	$1,777.60
Max. Negotiated Rate	$1,777.60
Rate for Payer: Aetna CHP/Medicaid	$1,777.60
Rate for Payer: Humana OH Medicaid	$1,777.60

EAPG 3.18: LEVEL II LOWER AIRWAY ENDOSCOPY

Facility

$908.84

Service Code	EAPG 00071
Min. Negotiated Rate	$908.84
Max. Negotiated Rate	$908.84
Rate for Payer: Aetna CHP/Medicaid	$908.84
Rate for Payer: Humana OH Medicaid	$908.84

EAPG 3.18: LEVEL II LOWER GI ENDOSCOPY

Facility

$617.96

Service Code	EAPG 00137
Min. Negotiated Rate	$617.96
Max. Negotiated Rate	$617.96
Rate for Payer: Aetna CHP/Medicaid	$617.96
Rate for Payer: Humana OH Medicaid	$617.96

EAPG 3.18: LEVEL II MAXILLOFACIAL PROSTHETICS

Facility

$173.24

Service Code	EAPG 00360
Min. Negotiated Rate	$173.24
Max. Negotiated Rate	$173.24
Rate for Payer: Aetna CHP/Medicaid	$173.24
Rate for Payer: Humana OH Medicaid	$173.24

EAPG 3.18: LEVEL II MICROBIOLOGY TESTS

Facility

$31.03

Service Code	EAPG 00397
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$31.03
Rate for Payer: Aetna CHP/Medicaid	$31.03
Rate for Payer: Humana OH Medicaid	$31.03

EAPG 3.18: LEVEL I IMMUNIZATION

Facility

$23.27

Service Code	EAPG 00414
Min. Negotiated Rate	$23.27
Max. Negotiated Rate	$23.27
Rate for Payer: Aetna CHP/Medicaid	$23.27
Rate for Payer: Humana OH Medicaid	$23.27

EAPG 3.18: LEVEL I IMMUNOLOGY TESTS

Facility

$9.05

Service Code	EAPG 00394
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 II NERVE PROCEDURE W OR W/O NEUROLOGICAL DEVICE

Facility

$2,500.28

Service Code	EAPG 00218
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: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$393.01

Service Code	EAPG 00220
Min. Negotiated Rate	$393.01
Max. Negotiated Rate	$393.01
Rate for Payer: Aetna CHP/Medicaid	$393.01
Rate for Payer: Humana OH Medicaid	$393.01

EAPG 3.18: LEVEL II ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$268.90

Service Code	EAPG 00368
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 II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$1,217.82

Service Code	EAPG 00208
Min. Negotiated Rate	$1,217.82
Max. Negotiated Rate	$1,217.82
Rate for Payer: Aetna CHP/Medicaid	$1,217.82
Rate for Payer: Humana OH Medicaid	$1,217.82

EAPG 3.18: LEVEL II PATHOLOGY TESTS

Facility

$55.59

Service Code	EAPG 00391
Min. Negotiated Rate	$55.59
Max. Negotiated Rate	$55.59
Rate for Payer: Aetna CHP/Medicaid	$55.59
Rate for Payer: Humana OH Medicaid	$55.59

EAPG 3.18: LEVEL II PENILE PROCEDURES

Facility

$699.40

Service Code	EAPG 00187
Min. Negotiated Rate	$699.40
Max. Negotiated Rate	$699.40
Rate for Payer: Aetna CHP/Medicaid	$699.40
Rate for Payer: Humana OH Medicaid	$699.40

EAPG 3.18: LEVEL II PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$1,935.32

Service Code	EAPG 00121
Min. Negotiated Rate	$1,935.32
Max. Negotiated Rate	$1,935.32
Rate for Payer: Aetna CHP/Medicaid	$1,935.32
Rate for Payer: Humana OH Medicaid	$1,935.32

Know your out-of-pocket cost for care.

All Charges