Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL II CONVENTIONAL RADIOLOGY

Facility

$127.57

Service Code	EAPG 00389
Min. Negotiated Rate	$127.57
Max. Negotiated Rate	$127.57
Rate for Payer: Buckeye Health Medicaid OOS	$127.57
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$127.57

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

Facility

$1,474.90

Service Code	EAPG 00248
Min. Negotiated Rate	$1,474.90
Max. Negotiated Rate	$1,474.90
Rate for Payer: Buckeye Health Medicaid OOS	$1,474.90
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,474.90

EAPG 3.18: LEVEL II CRANIOFACIAL BONE PROCEDURES

Facility

$1,603.40

Service Code	EAPG 00228
Min. Negotiated Rate	$1,603.40
Max. Negotiated Rate	$1,603.40
Rate for Payer: Buckeye Health Medicaid OOS	$1,603.40
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,603.40

EAPG 3.18: LEVEL II DENTAL FILM

Facility

$42.22

Service Code	EAPG 00374
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 II DENTAL RESTORATIONS

Facility

$89.94

Service Code	EAPG 00362
Min. Negotiated Rate	$89.94
Max. Negotiated Rate	$89.94
Rate for Payer: Buckeye Health Medicaid OOS	$89.94
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$89.94

EAPG 3.18: LEVEL II DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$638.79

Service Code	EAPG 00338
Min. Negotiated Rate	$638.79
Max. Negotiated Rate	$638.79
Rate for Payer: Buckeye Health Medicaid OOS	$638.79
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$638.79

EAPG 3.18: LEVEL II DIAGNOSTIC NUCLEAR MEDICINE

Facility

$373.54

Service Code	EAPG 00332
Min. Negotiated Rate	$373.54
Max. Negotiated Rate	$373.54
Rate for Payer: Buckeye Health Medicaid OOS	$373.54
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$373.54

EAPG 3.18: LEVEL II DIAGNOSTIC ULTRASOUND

Facility

$320.31

Service Code	EAPG 00289
Min. Negotiated Rate	$320.31
Max. Negotiated Rate	$320.31
Rate for Payer: Buckeye Health Medicaid OOS	$320.31
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$320.31

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

Facility

$838.87

Service Code	EAPG 00253
Min. Negotiated Rate	$838.87
Max. Negotiated Rate	$838.87
Rate for Payer: Buckeye Health Medicaid OOS	$838.87
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$838.87

EAPG 3.18: LEVEL II ENDOCRINOLOGY TESTS

Facility

$20.19

Service Code	EAPG 00399
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$20.19
Rate for Payer: Buckeye Health Medicaid OOS	$20.19
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$20.19

EAPG 3.18: LEVEL II ENDODONTICS

Facility

$102.79

Service Code	EAPG 00365
Min. Negotiated Rate	$102.79
Max. Negotiated Rate	$102.79
Rate for Payer: Buckeye Health Medicaid OOS	$102.79
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$102.79

EAPG 3.18: LEVEL II ENDOSCOPY OF THE UPPER AIRWAY

Facility

$844.38

Service Code	EAPG 00063
Min. Negotiated Rate	$844.38
Max. Negotiated Rate	$844.38
Rate for Payer: Buckeye Health Medicaid OOS	$844.38
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$844.38

EAPG 3.18: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility

$716.80

Service Code	EAPG 00153
Min. Negotiated Rate	$716.80
Max. Negotiated Rate	$716.80
Rate for Payer: Buckeye Health Medicaid OOS	$716.80
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$716.80

EAPG 3.18: LEVEL II ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES

Facility

$1,202.32

Service Code	EAPG 00126
Min. Negotiated Rate	$1,202.32
Max. Negotiated Rate	$1,202.32
Rate for Payer: Buckeye Health Medicaid OOS	$1,202.32
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,202.32

EAPG 3.18: LEVEL II EYELID, LACRIMAL AND CONJUNCTIVAL PROCEDURES

Facility

$901.28

Service Code	EAPG 00259
Min. Negotiated Rate	$901.28
Max. Negotiated Rate	$901.28
Rate for Payer: Buckeye Health Medicaid OOS	$901.28
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$901.28

EAPG 3.18: LEVEL II FETAL PROCEDURES

Facility

$357.02

Service Code	EAPG 00192
Min. Negotiated Rate	$357.02
Max. Negotiated Rate	$357.02
Rate for Payer: Buckeye Health Medicaid OOS	$357.02
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$357.02

EAPG 3.18: LEVEL II FOOT PROCEDURES

Facility

$1,044.46

Service Code	EAPG 00036
Min. Negotiated Rate	$1,044.46
Max. Negotiated Rate	$1,044.46
Rate for Payer: Buckeye Health Medicaid OOS	$1,044.46
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,044.46

EAPG 3.18: LEVEL II FOREARM AND WRIST PROCEDURES

Facility

$1,134.40

Service Code	EAPG 00024
Min. Negotiated Rate	$1,134.40
Max. Negotiated Rate	$1,134.40
Rate for Payer: Buckeye Health Medicaid OOS	$1,134.40
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,134.40

EAPG 3.18: LEVEL II GASTROINTESTINAL PROCEDURES

Facility

$1,210.58

Service Code	EAPG 00144
Min. Negotiated Rate	$1,210.58
Max. Negotiated Rate	$1,210.58
Rate for Payer: Buckeye Health Medicaid OOS	$1,210.58
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,210.58

EAPG 3.18: LEVEL II HAND PROCEDURES

Facility

$1,048.13

Service Code	EAPG 00034
Min. Negotiated Rate	$1,048.13
Max. Negotiated Rate	$1,048.13
Rate for Payer: Buckeye Health Medicaid OOS	$1,048.13
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,048.13

EAPG 3.18: LEVEL II HEMATOLOGY TESTS

Facility

$15.60

Service Code	EAPG 00409
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Buckeye Health Medicaid OOS	$15.60
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$15.60

EAPG 3.18: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES

Facility

$1,150.00

Service Code	EAPG 00152
Min. Negotiated Rate	$1,150.00
Max. Negotiated Rate	$1,150.00
Rate for Payer: Buckeye Health Medicaid OOS	$1,150.00
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,150.00

EAPG 3.18: LEVEL II HIP AND FEMUR PROCEDURES

Facility

$1,097.69

Service Code	EAPG 00055
Min. Negotiated Rate	$1,097.69
Max. Negotiated Rate	$1,097.69
Rate for Payer: Buckeye Health Medicaid OOS	$1,097.69
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,097.69

EAPG 3.18: LEVEL II HYSTERECTOMY AND MYOMECTOMY PROCEDURES

Facility

$1,028.85

Service Code	EAPG 00206
Min. Negotiated Rate	$1,028.85
Max. Negotiated Rate	$1,028.85
Rate for Payer: Buckeye Health Medicaid OOS	$1,028.85
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,028.85

EAPG 3.18: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES

Facility

$1,583.20

Service Code	EAPG 00236
Min. Negotiated Rate	$1,583.20
Max. Negotiated Rate	$1,583.20
Rate for Payer: Buckeye Health Medicaid OOS	$1,583.20
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,583.20

Know your out-of-pocket cost for care.

All Charges