Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I SPINE PROCEDURES

Facility

$2,276.62

Service Code	EAPG 00028
Min. Negotiated Rate	$2,276.62
Max. Negotiated Rate	$2,276.62
Rate for Payer: Aetna CHP/Medicaid	$2,276.62
Rate for Payer: Humana OH Medicaid	$2,276.62

EAPG 3.18: LEVEL I SURGICAL PATHOLOGY TESTS

Facility

$40.08

Service Code	EAPG 00305
Min. Negotiated Rate	$40.08
Max. Negotiated Rate	$40.08
Rate for Payer: Aetna CHP/Medicaid	$40.08
Rate for Payer: Humana OH Medicaid	$40.08

EAPG 3.18: LEVEL I THORACIC AND CHEST PROCEDURES

Facility

$1,266.94

Service Code	EAPG 00069
Min. Negotiated Rate	$1,266.94
Max. Negotiated Rate	$1,266.94
Rate for Payer: Aetna CHP/Medicaid	$1,266.94
Rate for Payer: Humana OH Medicaid	$1,266.94

EAPG 3.18: LEVEL I UPPER GI ENDOSCOPY

Facility

$568.83

Service Code	EAPG 00134
Min. Negotiated Rate	$568.83
Max. Negotiated Rate	$568.83
Rate for Payer: Aetna CHP/Medicaid	$568.83
Rate for Payer: Humana OH Medicaid	$568.83

EAPG 3.18: LEVEL I URETHRAL PROCEDURES

Facility

$708.45

Service Code	EAPG 00166
Min. Negotiated Rate	$708.45
Max. Negotiated Rate	$708.45
Rate for Payer: Aetna CHP/Medicaid	$708.45
Rate for Payer: Humana OH Medicaid	$708.45

EAPG 3.18: LEVEL I VARICOSE VEIN AND RELATED PROCEDURES

Facility

$739.48

Service Code	EAPG 00090
Min. Negotiated Rate	$739.48
Max. Negotiated Rate	$739.48
Rate for Payer: Aetna CHP/Medicaid	$739.48
Rate for Payer: Humana OH Medicaid	$739.48

EAPG 3.18: LEVEL I VASCULAR RADIOLOGICAL PROCEDURES

Facility

$224.95

Service Code	EAPG 00277
Min. Negotiated Rate	$224.95
Max. Negotiated Rate	$224.95
Rate for Payer: Aetna CHP/Medicaid	$224.95
Rate for Payer: Humana OH Medicaid	$224.95

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

Facility

$2,412.36

Service Code	EAPG 00255
Min. Negotiated Rate	$2,412.36
Max. Negotiated Rate	$2,412.36
Rate for Payer: Aetna CHP/Medicaid	$2,412.36
Rate for Payer: Humana OH Medicaid	$2,412.36

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

Facility

$13,332.65

Service Code	EAPG 00224
Min. Negotiated Rate	$13,332.65
Max. Negotiated Rate	$13,332.65
Rate for Payer: Aetna CHP/Medicaid	$13,332.65
Rate for Payer: Humana OH Medicaid	$13,332.65

EAPG 3.18: LEVEL IV ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$268.90

Service Code	EAPG 00370
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: LYMPHATIC AND OTHER MALIGNANCIES AND NEOPLASMS OF UNCERTAIN BEHAVIOR

Facility

$99.55

Service Code	EAPG 00804
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$99.55
Rate for Payer: Aetna CHP/Medicaid	$99.55
Rate for Payer: Humana OH Medicaid	$99.55

EAPG 3.18: LYMPHOMA, MYELOMA AND NON-ACUTE LEUKEMIA

Facility

$99.55

Service Code	EAPG 00801
Min. Negotiated Rate	$99.55
Max. Negotiated Rate	$99.55
Rate for Payer: Aetna CHP/Medicaid	$99.55
Rate for Payer: Humana OH Medicaid	$99.55

EAPG 3.18: MAGNETIC RESONANCE ANGIOGRAPHY

Facility

$394.30

Service Code	EAPG 00282
Min. Negotiated Rate	$394.30
Max. Negotiated Rate	$394.30
Rate for Payer: Aetna CHP/Medicaid	$394.30
Rate for Payer: Humana OH Medicaid	$394.30

EAPG 3.18: MAGNETIC RESONANCE IMAGING WITH CONTRAST

Facility

$464.12

Service Code	EAPG 00295
Min. Negotiated Rate	$464.12
Max. Negotiated Rate	$464.12
Rate for Payer: Aetna CHP/Medicaid	$464.12
Rate for Payer: Humana OH Medicaid	$464.12

EAPG 3.18: MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST

Facility

$307.69

Service Code	EAPG 00293
Min. Negotiated Rate	$307.69
Max. Negotiated Rate	$307.69
Rate for Payer: Aetna CHP/Medicaid	$307.69
Rate for Payer: Humana OH Medicaid	$307.69

EAPG 3.18: MAGNETOCEPHALOGRAPHY

Facility

$417.57

Service Code	EAPG 00297
Min. Negotiated Rate	$417.57
Max. Negotiated Rate	$417.57
Rate for Payer: Aetna CHP/Medicaid	$417.57
Rate for Payer: Humana OH Medicaid	$417.57

EAPG 3.18: MAJOR CHEST AND RESPIRATORY TRAUMA

Facility

$109.89

Service Code	EAPG 00580
Min. Negotiated Rate	$109.89
Max. Negotiated Rate	$109.89
Rate for Payer: Aetna CHP/Medicaid	$109.89
Rate for Payer: Humana OH Medicaid	$109.89

EAPG 3.18: MAJOR DEPRESSIVE DIAGNOSES AND OTHER OR UNSPECIFIED PSYCHOSES

Facility

$85.32

Service Code	EAPG 00821
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$85.32
Rate for Payer: Aetna CHP/Medicaid	$85.32
Rate for Payer: Humana OH Medicaid	$85.32

EAPG 3.18: MAJOR OPEN ABDOMINAL AND THORACIC VASCULAR PROCEDURES

Facility

$1,803.46

Service Code	EAPG 00106
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: MAJOR SIGNS, SYMPTOMS AND FINDINGS

Facility

$104.72

Service Code	EAPG 00510
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: MAJOR SKIN DIAGNOSES

Facility

$85.32

Service Code	EAPG 00671
Min. Negotiated Rate	$85.32
Max. Negotiated Rate	$85.32
Rate for Payer: Aetna CHP/Medicaid	$85.32
Rate for Payer: Humana OH Medicaid	$85.32

EAPG 3.18: MALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$98.25

Service Code	EAPG 00744
Min. Negotiated Rate	$98.25
Max. Negotiated Rate	$98.25
Rate for Payer: Aetna CHP/Medicaid	$98.25
Rate for Payer: Humana OH Medicaid	$98.25

EAPG 3.18: MALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$89.20

Service Code	EAPG 00740
Min. Negotiated Rate	$89.20
Max. Negotiated Rate	$89.20
Rate for Payer: Aetna CHP/Medicaid	$89.20
Rate for Payer: Humana OH Medicaid	$89.20

EAPG 3.18: MALFUNCTION, REACTION AND COMPLICATION OF GI DEVICE OR PROCEDURE

Facility

$113.77

Service Code	EAPG 00629
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: MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC

Facility

$90.50

Service Code	EAPG 00537
Min. Negotiated Rate	$90.50
Max. Negotiated Rate	$90.50
Rate for Payer: Aetna CHP/Medicaid	$90.50
Rate for Payer: Humana OH Medicaid	$90.50

Know your out-of-pocket cost for care.

All Charges