|
EAPG 3.18: INCIDENTAL SKIN SUBSTITUTES
|
Facility
|
OP
|
$592.90
|
|
|
Service Code
|
EAPG 02010
|
| Min. Negotiated Rate |
$592.90 |
| Max. Negotiated Rate |
$592.90 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$592.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$592.90
|
|
|
EAPG 3.18: INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY
|
Facility
|
OP
|
$76.18
|
|
|
Service Code
|
EAPG 00316
|
| Min. Negotiated Rate |
$76.18 |
| Max. Negotiated Rate |
$76.18 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$76.18
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$76.18
|
|
|
EAPG 3.18: INFECTIONS OF UPPER RESPIRATORY TRACT & OTITIS MEDIA
|
Facility
|
OP
|
$58.74
|
|
|
Service Code
|
EAPG 00562
|
| Min. Negotiated Rate |
$58.74 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$58.74
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$58.74
|
|
|
EAPG 3.18: INFLAMMATORY BOWEL DISEASE
|
Facility
|
OP
|
$56.90
|
|
|
Service Code
|
EAPG 00626
|
| Min. Negotiated Rate |
$56.90 |
| Max. Negotiated Rate |
$56.90 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$56.90
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$56.90
|
|
|
EAPG 3.18: INGUINAL, FEMORAL AND UMBILICAL HERNIA REPAIR
|
Facility
|
OP
|
$1,043.54
|
|
|
Service Code
|
EAPG 03033
|
| Min. Negotiated Rate |
$1,043.54 |
| Max. Negotiated Rate |
$1,043.54 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,043.54
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$1,043.54
|
|
|
EAPG 3.18: INJECTION(S) FOR RADIOLOGICAL IMAGING
|
Facility
|
OP
|
$232.20
|
|
|
Service Code
|
EAPG 00278
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$232.20
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$232.20
|
|
|
EAPG 3.18: INSERTION OF PENILE PROSTHESIS
|
Facility
|
OP
|
$2,648.77
|
|
|
Service Code
|
EAPG 00182
|
| Min. Negotiated Rate |
$2,648.77 |
| Max. Negotiated Rate |
$2,648.77 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$2,648.77
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2,648.77
|
|
|
EAPG 3.18: INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$161.53
|
|
|
Service Code
|
EAPG 00307
|
| Min. Negotiated Rate |
$161.53 |
| Max. Negotiated Rate |
$161.53 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.53
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$161.53
|
|
|
EAPG 3.18: INTELLECTUAL DISABILITY
|
Facility
|
OP
|
$62.41
|
|
|
Service Code
|
EAPG 00828
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$62.41 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$62.41
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$62.41
|
|
|
EAPG 3.18: INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT
|
Facility
|
OP
|
$70.67
|
|
|
Service Code
|
EAPG 00327
|
| Min. Negotiated Rate |
$70.67 |
| Max. Negotiated Rate |
$70.67 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$70.67
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$70.67
|
|
|
EAPG 3.18: INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE
|
Facility
|
OP
|
$82.60
|
|
|
Service Code
|
EAPG 00832
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$82.60 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$82.60
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$82.60
|
|
|
EAPG 3.18: INTERMEDIATE WOUND REPAIR AND TREATMENT
|
Facility
|
OP
|
$349.68
|
|
|
Service Code
|
EAPG 00017
|
| Min. Negotiated Rate |
$349.68 |
| Max. Negotiated Rate |
$349.68 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$349.68
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$349.68
|
|
|
EAPG 3.18: INTERSTITIAL AND ALVEOLAR LUNG DIAGNOSES
|
Facility
|
OP
|
$85.36
|
|
|
Service Code
|
EAPG 00582
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$85.36
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$85.36
|
|
|
EAPG 3.18: INTESTINAL OBSTRUCTION DIAGNOSES
|
Facility
|
OP
|
$68.83
|
|
|
Service Code
|
EAPG 00618
|
| Min. Negotiated Rate |
$68.83 |
| Max. Negotiated Rate |
$68.83 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$68.83
|
|
|
EAPG 3.18: INTRACRANIAL HEMORRHAGE
|
Facility
|
OP
|
$69.75
|
|
|
Service Code
|
EAPG 00539
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$69.75 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$69.75
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$69.75
|
|
|
EAPG 3.18: IRRITABLE BOWEL SYNDROME
|
Facility
|
OP
|
$52.31
|
|
|
Service Code
|
EAPG 00632
|
| Min. Negotiated Rate |
$52.31 |
| Max. Negotiated Rate |
$52.31 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.31
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$52.31
|
|
|
EAPG 3.18: KIDNEY AND URINARY TRACT MALIGNANCY
|
Facility
|
OP
|
$68.83
|
|
|
Service Code
|
EAPG 00721
|
| Min. Negotiated Rate |
$68.83 |
| Max. Negotiated Rate |
$68.83 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.83
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$68.83
|
|
|
EAPG 3.18: LABOR AND DELIVERY RELATED DIAGNOSES
|
Facility
|
OP
|
$57.82
|
|
|
Service Code
|
EAPG 00760
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$57.82 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$57.82
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$57.82
|
|
|
EAPG 3.18: LASER EYE PROCEDURES
|
Facility
|
OP
|
$270.75
|
|
|
Service Code
|
EAPG 00232
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$270.75
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$270.75
|
|
|
EAPG 3.18: LEVEL I ADJUNCTIVE GENERAL DENTAL SERVICES
|
Facility
|
OP
|
$42.22
|
|
|
Service Code
|
EAPG 00350
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$42.22 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$42.22
|
|
|
EAPG 3.18: LEVEL I ANAL AND RECTAL PROCEDURES
|
Facility
|
OP
|
$546.09
|
|
|
Service Code
|
EAPG 00141
|
| Min. Negotiated Rate |
$546.09 |
| Max. Negotiated Rate |
$546.09 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$546.09
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$546.09
|
|
|
EAPG 3.18: LEVEL I ANCILLARY THERAPEUTIC SERVICES
|
Facility
|
OP
|
$12.85
|
|
|
Service Code
|
EAPG 00493
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$12.85
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$12.85
|
|
|
EAPG 3.18: LEVEL I ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
|
OP
|
$819.60
|
|
|
Service Code
|
EAPG 00234
|
| Min. Negotiated Rate |
$819.60 |
| Max. Negotiated Rate |
$819.60 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$819.60
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$819.60
|
|
|
EAPG 3.18: LEVEL I ARTHROPLASTY
|
Facility
|
OP
|
$1,522.63
|
|
|
Service Code
|
EAPG 00046
|
| Min. Negotiated Rate |
$1,522.63 |
| Max. Negotiated Rate |
$1,522.63 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,522.63
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$1,522.63
|
|
|
EAPG 3.18: LEVEL I ARTHROSCOPY
|
Facility
|
OP
|
$913.21
|
|
|
Service Code
|
EAPG 00037
|
| Min. Negotiated Rate |
$913.21 |
| Max. Negotiated Rate |
$913.21 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$913.21
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$913.21
|
|
