Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$1,030.36

Service Code	EAPG 00189
Min. Negotiated Rate	$1,030.36
Max. Negotiated Rate	$1,030.36
Rate for Payer: Aetna CHP/Medicaid	$1,030.36
Rate for Payer: Humana OH Medicaid	$1,030.36

EAPG 3.18: LEVEL II PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,883.61

Service Code	EAPG 00079
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

EAPG 3.18: LEVEL II PERIPHERAL VASCULAR REPAIR, LIGATION OR RECONSTRUCTION

Facility

$1,803.46

Service Code	EAPG 00091
Min. Negotiated Rate	$1,803.46
Max. Negotiated Rate	$1,803.46
Rate for Payer: Aetna CHP/Medicaid	$1,803.46
Rate for Payer: Humana OH Medicaid	$1,803.46

EAPG 3.18: LEVEL II POSTERIOR SEGMENT EYE PROCEDURES

Facility

$1,959.88

Service Code	EAPG 00238
Min. Negotiated Rate	$1,959.88
Max. Negotiated Rate	$1,959.88
Rate for Payer: Aetna CHP/Medicaid	$1,959.88
Rate for Payer: Humana OH Medicaid	$1,959.88

EAPG 3.18: LEVEL II PROSTATE PROCEDURES

Facility

$1,900.42

Service Code	EAPG 00184
Min. Negotiated Rate	$1,900.42
Max. Negotiated Rate	$1,900.42
Rate for Payer: Aetna CHP/Medicaid	$1,900.42
Rate for Payer: Humana OH Medicaid	$1,900.42

EAPG 3.18: LEVEL II PROSTHODONTICS, FIXED

Facility

$219.78

Service Code	EAPG 00354
Min. Negotiated Rate	$219.78
Max. Negotiated Rate	$219.78
Rate for Payer: Aetna CHP/Medicaid	$219.78
Rate for Payer: Humana OH Medicaid	$219.78

EAPG 3.18: LEVEL II PROSTHODONTICS, REMOVABLE

Facility

$227.53

Service Code	EAPG 00357
Min. Negotiated Rate	$227.53
Max. Negotiated Rate	$227.53
Rate for Payer: Aetna CHP/Medicaid	$227.53
Rate for Payer: Humana OH Medicaid	$227.53

EAPG 3.18: LEVEL II RADIATION THERAPY

Facility

$113.77

Service Code	EAPG 00347
Min. Negotiated Rate	$113.77
Max. Negotiated Rate	$113.77
Rate for Payer: Aetna CHP/Medicaid	$113.77
Rate for Payer: Humana OH Medicaid	$113.77

EAPG 3.18: LEVEL II RADIATION TREATMENT PREPARATION & PLANNING

Facility

$311.56

Service Code	EAPG 00477
Min. Negotiated Rate	$311.56
Max. Negotiated Rate	$311.56
Rate for Payer: Aetna CHP/Medicaid	$311.56
Rate for Payer: Humana OH Medicaid	$311.56

EAPG 3.18: LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$1,345.80

Service Code	EAPG 00241
Min. Negotiated Rate	$1,345.80
Max. Negotiated Rate	$1,345.80
Rate for Payer: Aetna CHP/Medicaid	$1,345.80
Rate for Payer: Humana OH Medicaid	$1,345.80

EAPG 3.18: LEVEL II SHOULDER AND UPPER ARM PROCEDURES

Facility

$1,606.95

Service Code	EAPG 00058
Min. Negotiated Rate	$1,606.95
Max. Negotiated Rate	$1,606.95
Rate for Payer: Aetna CHP/Medicaid	$1,606.95
Rate for Payer: Humana OH Medicaid	$1,606.95

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

Facility

$872.64

Service Code	EAPG 00010
Min. Negotiated Rate	$872.64
Max. Negotiated Rate	$872.64
Rate for Payer: Aetna CHP/Medicaid	$872.64
Rate for Payer: Humana OH Medicaid	$872.64

EAPG 3.18: LEVEL II SKIN INCISION AND DRAINAGE, DEBRIDEMENT, DESTRUCTION, OTHER RELATED PX

Facility

$429.21

Service Code	EAPG 00004
Min. Negotiated Rate	$429.21
Max. Negotiated Rate	$429.21
Rate for Payer: Aetna CHP/Medicaid	$429.21
Rate for Payer: Humana OH Medicaid	$429.21

EAPG 3.18: LEVEL II SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$1,778.89

Service Code	EAPG 00128
Min. Negotiated Rate	$1,778.89
Max. Negotiated Rate	$1,778.89
Rate for Payer: Aetna CHP/Medicaid	$1,778.89
Rate for Payer: Humana OH Medicaid	$1,778.89

EAPG 3.18: LEVEL II SPINE PROCEDURES

Facility

$2,761.42

Service Code	EAPG 00029
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 II SURGICAL PATHOLOGY TESTS

Facility

$56.88

Service Code	EAPG 00306
Min. Negotiated Rate	$56.88
Max. Negotiated Rate	$56.88
Rate for Payer: Aetna CHP/Medicaid	$56.88
Rate for Payer: Humana OH Medicaid	$56.88

EAPG 3.18: LEVEL II THORACIC AND CHEST PROCEDURES

Facility

$1,644.44

Service Code	EAPG 00070
Min. Negotiated Rate	$1,644.44
Max. Negotiated Rate	$1,644.44
Rate for Payer: Aetna CHP/Medicaid	$1,644.44
Rate for Payer: Humana OH Medicaid	$1,644.44

EAPG 3.18: LEVEL II UPPER GI ENDOSCOPY

Facility

$650.28

Service Code	EAPG 00135
Min. Negotiated Rate	$650.28
Max. Negotiated Rate	$650.28
Rate for Payer: Aetna CHP/Medicaid	$650.28
Rate for Payer: Humana OH Medicaid	$650.28

EAPG 3.18: LEVEL II URETHRAL PROCEDURES

Facility

$1,785.36

Service Code	EAPG 00167
Min. Negotiated Rate	$1,785.36
Max. Negotiated Rate	$1,785.36
Rate for Payer: Aetna CHP/Medicaid	$1,785.36
Rate for Payer: Humana OH Medicaid	$1,785.36

EAPG 3.18: LEVEL II VARICOSE VEIN AND RELATED PROCEDURES

Facility

$1,690.98

Service Code	EAPG 00103
Min. Negotiated Rate	$1,690.98
Max. Negotiated Rate	$1,690.98
Rate for Payer: Aetna CHP/Medicaid	$1,690.98
Rate for Payer: Humana OH Medicaid	$1,690.98

EAPG 3.18: LEVEL II VASCULAR RADIOLOGICAL PROCEDURES

Facility

$249.51

Service Code	EAPG 00279
Min. Negotiated Rate	$249.51
Max. Negotiated Rate	$249.51
Rate for Payer: Aetna CHP/Medicaid	$249.51
Rate for Payer: Humana OH Medicaid	$249.51

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

Facility

$206.85

Service Code	EAPG 00049
Min. Negotiated Rate	$206.85
Max. Negotiated Rate	$206.85
Rate for Payer: Aetna CHP/Medicaid	$206.85
Rate for Payer: Humana OH Medicaid	$206.85

EAPG 3.18: LEVEL I KIDNEY AND URETERAL PROCEDURES

Facility

$773.09

Service Code	EAPG 00170
Min. Negotiated Rate	$773.09
Max. Negotiated Rate	$773.09
Rate for Payer: Aetna CHP/Medicaid	$773.09
Rate for Payer: Humana OH Medicaid	$773.09

EAPG 3.18: LEVEL I KNEE AND LOWER LEG PROCEDURES

Facility

$1,238.50

Service Code	EAPG 00026
Min. Negotiated Rate	$1,238.50
Max. Negotiated Rate	$1,238.50
Rate for Payer: Aetna CHP/Medicaid	$1,238.50
Rate for Payer: Humana OH Medicaid	$1,238.50

EAPG 3.18: LEVEL I LAPAROSCOPY

Facility

$1,310.90

Service Code	EAPG 00145
Min. Negotiated Rate	$1,310.90
Max. Negotiated Rate	$1,310.90
Rate for Payer: Aetna CHP/Medicaid	$1,310.90
Rate for Payer: Humana OH Medicaid	$1,310.90

Know your out-of-pocket cost for care.

All Charges