Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL I BLADDER AND URETERAL PROCEDURES

Facility

$812.25

Service Code	EAPG 00173
Min. Negotiated Rate	$812.25
Max. Negotiated Rate	$812.25
Rate for Payer: Buckeye Health Medicaid OOS	$812.25
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$812.25

EAPG 3.18: LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE

Facility

$271.67

Service Code	EAPG 00113
Min. Negotiated Rate	$271.67
Max. Negotiated Rate	$271.67
Rate for Payer: Buckeye Health Medicaid OOS	$271.67
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$271.67

EAPG 3.18: LEVEL I BLOOD AND TISSUE TYPING TESTS

Facility

$23.86

Service Code	EAPG 00486
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$23.86
Rate for Payer: Buckeye Health Medicaid OOS	$23.86
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$23.86

EAPG 3.18: LEVEL I BLOOD PRODUCTS

Facility

$271.67

Service Code	EAPG 02061
Min. Negotiated Rate	$271.67
Max. Negotiated Rate	$271.67
Rate for Payer: Buckeye Health Medicaid OOS	$271.67
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$271.67

EAPG 3.18: LEVEL I BRACHYTHERAPY SOURCES

Facility

$493.78

Service Code	EAPG 00335
Min. Negotiated Rate	$493.78
Max. Negotiated Rate	$493.78
Rate for Payer: Buckeye Health Medicaid OOS	$493.78
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$493.78

EAPG 3.18: LEVEL I BREAST PROCEDURES

Facility

$786.55

Service Code	EAPG 00020
Min. Negotiated Rate	$786.55
Max. Negotiated Rate	$786.55
Rate for Payer: Buckeye Health Medicaid OOS	$786.55
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$786.55

EAPG 3.18: LEVEL I CENTRAL VENOUS ACCESS PROCEDURES

Facility

$116.56

Service Code	EAPG 00075
Min. Negotiated Rate	$116.56
Max. Negotiated Rate	$116.56
Rate for Payer: Buckeye Health Medicaid OOS	$116.56
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$116.56

EAPG 3.18: LEVEL I CHEMISTRY TESTS

Facility

$6.42

Service Code	EAPG 00400
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$6.42
Rate for Payer: Buckeye Health Medicaid OOS	$6.42
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$6.42

EAPG 3.18: LEVEL I CLOTTING TESTS

Facility

$7.34

Service Code	EAPG 00406
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$7.34
Rate for Payer: Buckeye Health Medicaid OOS	$7.34
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$7.34

EAPG 3.18: LEVEL I COMPUTED TOMOGRAPHY

Facility

$149.60

Service Code	EAPG 00299
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$149.60
Rate for Payer: Buckeye Health Medicaid OOS	$149.60
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$149.60

EAPG 3.18: LEVEL I CONVENTIONAL RADIOLOGY

Facility

$17.44

Service Code	EAPG 00471
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$17.44
Rate for Payer: Buckeye Health Medicaid OOS	$17.44
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$17.44

EAPG 3.18: LEVEL I CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES

Facility

$806.75

Service Code	EAPG 00247
Min. Negotiated Rate	$806.75
Max. Negotiated Rate	$806.75
Rate for Payer: Buckeye Health Medicaid OOS	$806.75
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$806.75

EAPG 3.18: LEVEL I CRANIOFACIAL BONE PROCEDURES

Facility

$1,273.91

Service Code	EAPG 00227
Min. Negotiated Rate	$1,273.91
Max. Negotiated Rate	$1,273.91
Rate for Payer: Buckeye Health Medicaid OOS	$1,273.91
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,273.91

EAPG 3.18: LEVEL I DENTAL FILM

Facility

$11.93

Service Code	EAPG 00373
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$11.93
Rate for Payer: Buckeye Health Medicaid OOS	$11.93
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$11.93

EAPG 3.18: LEVEL I DENTAL RESTORATIONS

Facility

$60.57

Service Code	EAPG 00361
Min. Negotiated Rate	$60.57
Max. Negotiated Rate	$60.57
Rate for Payer: Buckeye Health Medicaid OOS	$60.57
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$60.57

EAPG 3.18: LEVEL I DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$415.76

Service Code	EAPG 00334
Min. Negotiated Rate	$415.76
Max. Negotiated Rate	$415.76
Rate for Payer: Buckeye Health Medicaid OOS	$415.76
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$415.76

EAPG 3.18: LEVEL I DIAGNOSTIC NUCLEAR MEDICINE

Facility

$170.71

Service Code	EAPG 00331
Min. Negotiated Rate	$170.71
Max. Negotiated Rate	$170.71
Rate for Payer: Buckeye Health Medicaid OOS	$170.71
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$170.71

EAPG 3.18: LEVEL I DIAGNOSTIC ULTRASOUND

Facility

$74.34

Service Code	EAPG 00288
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$74.34
Rate for Payer: Buckeye Health Medicaid OOS	$74.34
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$74.34

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

Facility

$624.10

Service Code	EAPG 00252
Min. Negotiated Rate	$624.10
Max. Negotiated Rate	$624.10
Rate for Payer: Buckeye Health Medicaid OOS	$624.10
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$624.10

EAPG 3.18: LEVEL I ENDOCRINOLOGY TESTS

Facility

$14.68

Service Code	EAPG 00398
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$14.68
Rate for Payer: Buckeye Health Medicaid OOS	$14.68
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$14.68

EAPG 3.18: LEVEL I ENDODONTICS

Facility

$57.82

Service Code	EAPG 00364
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: LEVEL I ENDOSCOPY OF THE UPPER AIRWAY

Facility

$190.90

Service Code	EAPG 00062
Min. Negotiated Rate	$190.90
Max. Negotiated Rate	$190.90
Rate for Payer: Buckeye Health Medicaid OOS	$190.90
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$190.90

EAPG 3.18: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$651.64

Service Code	EAPG 00138
Min. Negotiated Rate	$651.64
Max. Negotiated Rate	$651.64
Rate for Payer: Buckeye Health Medicaid OOS	$651.64
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$651.64

EAPG 3.18: LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$897.61

Service Code	EAPG 00125
Min. Negotiated Rate	$897.61
Max. Negotiated Rate	$897.61
Rate for Payer: Buckeye Health Medicaid OOS	$897.61
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$897.61

EAPG 3.18: LEVEL I EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$596.57

Service Code	EAPG 00258
Min. Negotiated Rate	$596.57
Max. Negotiated Rate	$596.57
Rate for Payer: Buckeye Health Medicaid OOS	$596.57
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$596.57

Know your out-of-pocket cost for care.

All Charges