Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I LOWER AIRWAY ENDOSCOPY

Facility

$826.10

Service Code	EAPG 00064
Min. Negotiated Rate	$826.10
Max. Negotiated Rate	$826.10
Rate for Payer: Aetna CHP/Medicaid	$826.10
Rate for Payer: Humana OH Medicaid	$826.10

EAPG 3.18: LEVEL I LOWER GI ENDOSCOPY

Facility

$545.56

Service Code	EAPG 00136
Min. Negotiated Rate	$545.56
Max. Negotiated Rate	$545.56
Rate for Payer: Aetna CHP/Medicaid	$545.56
Rate for Payer: Humana OH Medicaid	$545.56

EAPG 3.18: LEVEL I MAXILLOFACIAL PROSTHETICS

Facility

$33.61

Service Code	EAPG 00359
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 I MICROBIOLOGY TESTS

Facility

$7.76

Service Code	EAPG 00396
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$7.76
Rate for Payer: Aetna CHP/Medicaid	$7.76
Rate for Payer: Humana OH Medicaid	$7.76

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

Facility

$935.99

Service Code	EAPG 00217
Min. Negotiated Rate	$935.99
Max. Negotiated Rate	$935.99
Rate for Payer: Aetna CHP/Medicaid	$935.99
Rate for Payer: Humana OH Medicaid	$935.99

EAPG 3.18: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP

Facility

$327.08

Service Code	EAPG 00214
Min. Negotiated Rate	$327.08
Max. Negotiated Rate	$327.08
Rate for Payer: Aetna CHP/Medicaid	$327.08
Rate for Payer: Humana OH Medicaid	$327.08

EAPG 3.18: LEVEL I ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$96.96

Service Code	EAPG 00367
Min. Negotiated Rate	$96.96
Max. Negotiated Rate	$96.96
Rate for Payer: Aetna CHP/Medicaid	$96.96
Rate for Payer: Humana OH Medicaid	$96.96

EAPG 3.18: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES

Facility

$985.11

Service Code	EAPG 00207
Min. Negotiated Rate	$985.11
Max. Negotiated Rate	$985.11
Rate for Payer: Aetna CHP/Medicaid	$985.11
Rate for Payer: Humana OH Medicaid	$985.11

EAPG 3.18: LEVEL I PATHOLOGY TESTS

Facility

$29.73

Service Code	EAPG 00390
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 I PENILE PROCEDURES

Facility

$667.08

Service Code	EAPG 00183
Min. Negotiated Rate	$667.08
Max. Negotiated Rate	$667.08
Rate for Payer: Aetna CHP/Medicaid	$667.08
Rate for Payer: Humana OH Medicaid	$667.08

EAPG 3.18: LEVEL I PERCUTANEOUS CORONARY AND INTRACARDIAC INTERVENTIONAL PROCEDURES

Facility

$1,883.61

Service Code	EAPG 00099
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 I PERINEAL AND VAGINAL GYNECOLOGICAL PROCEDURES

Facility

$914.01

Service Code	EAPG 00188
Min. Negotiated Rate	$914.01
Max. Negotiated Rate	$914.01
Rate for Payer: Aetna CHP/Medicaid	$914.01
Rate for Payer: Humana OH Medicaid	$914.01

EAPG 3.18: LEVEL I PERIODONTICS

Facility

$104.72

Service Code	EAPG 00352
Min. Negotiated Rate	$104.72
Max. Negotiated Rate	$104.72
Rate for Payer: Aetna CHP/Medicaid	$104.72
Rate for Payer: Humana OH Medicaid	$104.72

EAPG 3.18: LEVEL I PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,561.70

Service Code	EAPG 00077
Min. Negotiated Rate	$1,561.70
Max. Negotiated Rate	$1,561.70
Rate for Payer: Aetna CHP/Medicaid	$1,561.70
Rate for Payer: Humana OH Medicaid	$1,561.70

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

Facility

$1,803.46

Service Code	EAPG 00078
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 I POSTERIOR SEGMENT EYE PROCEDURES

Facility

$409.82

Service Code	EAPG 00237
Min. Negotiated Rate	$409.82
Max. Negotiated Rate	$409.82
Rate for Payer: Aetna CHP/Medicaid	$409.82
Rate for Payer: Humana OH Medicaid	$409.82

EAPG 3.18: LEVEL I PROSTATE PROCEDURES

Facility

$1,405.27

Service Code	EAPG 00176
Min. Negotiated Rate	$1,405.27
Max. Negotiated Rate	$1,405.27
Rate for Payer: Aetna CHP/Medicaid	$1,405.27
Rate for Payer: Humana OH Medicaid	$1,405.27

EAPG 3.18: LEVEL I PROSTHODONTICS, FIXED

Facility

$59.47

Service Code	EAPG 00353
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 I PROSTHODONTICS, REMOVABLE

Facility

$118.94

Service Code	EAPG 00356
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 I RADIATION THERAPY

Facility

$245.63

Service Code	EAPG 00343
Min. Negotiated Rate	$245.63
Max. Negotiated Rate	$245.63
Rate for Payer: Aetna CHP/Medicaid	$245.63
Rate for Payer: Humana OH Medicaid	$245.63

EAPG 3.18: LEVEL I RADIATION TREATMENT PREPARATION & PLANNING

Facility

$329.66

Service Code	EAPG 00476
Min. Negotiated Rate	$329.66
Max. Negotiated Rate	$329.66
Rate for Payer: Aetna CHP/Medicaid	$329.66
Rate for Payer: Humana OH Medicaid	$329.66

EAPG 3.18: LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE

Facility

$540.39

Service Code	EAPG 00240
Min. Negotiated Rate	$540.39
Max. Negotiated Rate	$540.39
Rate for Payer: Aetna CHP/Medicaid	$540.39
Rate for Payer: Humana OH Medicaid	$540.39

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

Facility

$444.72

Service Code	EAPG 00009
Min. Negotiated Rate	$444.72
Max. Negotiated Rate	$444.72
Rate for Payer: Aetna CHP/Medicaid	$444.72
Rate for Payer: Humana OH Medicaid	$444.72

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

Facility

$227.53

Service Code	EAPG 00003
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 I SMALL AND LARGE INTESTINE SURGICAL PROCEDURES

Facility

$1,622.46

Service Code	EAPG 00127
Min. Negotiated Rate	$1,622.46
Max. Negotiated Rate	$1,622.46
Rate for Payer: Aetna CHP/Medicaid	$1,622.46
Rate for Payer: Humana OH Medicaid	$1,622.46

Know your out-of-pocket cost for care.

All Charges