Cameron Memorial Community Hospital

All Charges

Charge

Type

Setting

Price

EAPG 3.18: LEVEL III BLOOD AND TISSUE TYPING TESTS

Facility

$23.86

Service Code	EAPG 02043
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 III BLOOD PRODUCT EXCHANGE SERVICES

Facility

$1,023.35

Service Code	EAPG 00155
Min. Negotiated Rate	$1,023.35
Max. Negotiated Rate	$1,023.35
Rate for Payer: Buckeye Health Medicaid OOS	$1,023.35
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,023.35

EAPG 3.18: LEVEL III BRACHYTHERAPY SOURCES

Facility

$7,204.73

Service Code	EAPG 00337
Min. Negotiated Rate	$7,204.73
Max. Negotiated Rate	$7,204.73
Rate for Payer: Buckeye Health Medicaid OOS	$7,204.73
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$7,204.73

EAPG 3.18: LEVEL III BREAST PROCEDURES

Facility

$1,591.47

Service Code	EAPG 00022
Min. Negotiated Rate	$1,591.47
Max. Negotiated Rate	$1,591.47
Rate for Payer: Buckeye Health Medicaid OOS	$1,591.47
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,591.47

EAPG 3.18: LEVEL III CHEMISTRY TESTS

Facility

$26.62

Service Code	EAPG 00384
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Buckeye Health Medicaid OOS	$26.62
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$26.62

EAPG 3.18: LEVEL III DENTAL RESTORATIONS

Facility

$215.68

Service Code	EAPG 00363
Min. Negotiated Rate	$215.68
Max. Negotiated Rate	$215.68
Rate for Payer: Buckeye Health Medicaid OOS	$215.68
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$215.68

EAPG 3.18: LEVEL III DEVICE PLACEMENT FOR RADIATION THERAPY

Facility

$911.38

Service Code	EAPG 00339
Min. Negotiated Rate	$911.38
Max. Negotiated Rate	$911.38
Rate for Payer: Buckeye Health Medicaid OOS	$911.38
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$911.38

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

Facility

$1,189.47

Service Code	EAPG 00254
Min. Negotiated Rate	$1,189.47
Max. Negotiated Rate	$1,189.47
Rate for Payer: Buckeye Health Medicaid OOS	$1,189.47
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,189.47

EAPG 3.18: LEVEL III ENDODONTICS

Facility

$103.71

Service Code	EAPG 00366
Min. Negotiated Rate	$103.71
Max. Negotiated Rate	$103.71
Rate for Payer: Buckeye Health Medicaid OOS	$103.71
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$103.71

EAPG 3.18: LEVEL III KIDNEY AND URETERAL PROCEDURES

Facility

$982.05

Service Code	EAPG 00172
Min. Negotiated Rate	$982.05
Max. Negotiated Rate	$982.05
Rate for Payer: Buckeye Health Medicaid OOS	$982.05
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$982.05

EAPG 3.18: LEVEL III LAPAROSCOPY

Facility

$1,615.33

Service Code	EAPG 00148
Min. Negotiated Rate	$1,615.33
Max. Negotiated Rate	$1,615.33
Rate for Payer: Buckeye Health Medicaid OOS	$1,615.33
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,615.33

EAPG 3.18: LEVEL III MICROBIOLOGY TESTS

Facility

$30.29

Service Code	EAPG 00388
Min. Negotiated Rate	$30.29
Max. Negotiated Rate	$30.29
Rate for Payer: Buckeye Health Medicaid OOS	$30.29
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$30.29

EAPG 3.18: LEVEL II IMMUNIZATION

Facility

$33.96

Service Code	EAPG 00415
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$33.96
Rate for Payer: Buckeye Health Medicaid OOS	$33.96
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$33.96

EAPG 3.18: LEVEL II IMMUNOLOGY TESTS

Facility

$21.11

Service Code	EAPG 00395
Min. Negotiated Rate	$21.11
Max. Negotiated Rate	$21.11
Rate for Payer: Buckeye Health Medicaid OOS	$21.11
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$21.11

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

Facility

$7,105.61

Service Code	EAPG 00223
Min. Negotiated Rate	$7,105.61
Max. Negotiated Rate	$7,105.61
Rate for Payer: Buckeye Health Medicaid OOS	$7,105.61
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$7,105.61

EAPG 3.18: LEVEL III ORAL AND MAXILLOFACIAL PROCEDURES

Facility

$190.90

Service Code	EAPG 00369
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 III PATHOLOGY TESTS

Facility

$43.14

Service Code	EAPG 00308
Min. Negotiated Rate	$43.14
Max. Negotiated Rate	$43.14
Rate for Payer: Buckeye Health Medicaid OOS	$43.14
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$43.14

EAPG 3.18: LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES

Facility

$1,337.23

Service Code	EAPG 00085
Min. Negotiated Rate	$1,337.23
Max. Negotiated Rate	$1,337.23
Rate for Payer: Buckeye Health Medicaid OOS	$1,337.23
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,337.23

EAPG 3.18: LEVEL III PROSTHODONTICS, FIXED

Facility

$193.66

Service Code	EAPG 00355
Min. Negotiated Rate	$193.66
Max. Negotiated Rate	$193.66
Rate for Payer: Buckeye Health Medicaid OOS	$193.66
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$193.66

EAPG 3.18: LEVEL III PROSTHODONTICS, REMOVABLE

Facility

$124.82

Service Code	EAPG 00358
Min. Negotiated Rate	$124.82
Max. Negotiated Rate	$124.82
Rate for Payer: Buckeye Health Medicaid OOS	$124.82
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$124.82

EAPG 3.18: LEVEL III RADIATION THERAPY

Facility

$386.39

Service Code	EAPG 00348
Min. Negotiated Rate	$386.39
Max. Negotiated Rate	$386.39
Rate for Payer: Buckeye Health Medicaid OOS	$386.39
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$386.39

EAPG 3.18: LEVEL III RADIATION TREATMENT PREPARATION & PLANNING

Facility

$84.44

Service Code	EAPG 00478
Min. Negotiated Rate	$84.44
Max. Negotiated Rate	$84.44
Rate for Payer: Buckeye Health Medicaid OOS	$84.44
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$84.44

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

Facility

$1,038.03

Service Code	EAPG 00011
Min. Negotiated Rate	$1,038.03
Max. Negotiated Rate	$1,038.03
Rate for Payer: Buckeye Health Medicaid OOS	$1,038.03
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,038.03

EAPG 3.18: LEVEL III SPINE PROCEDURES

Facility

$1,960.42

Service Code	EAPG 00057
Min. Negotiated Rate	$1,960.42
Max. Negotiated Rate	$1,960.42
Rate for Payer: Buckeye Health Medicaid OOS	$1,960.42
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$1,960.42

EAPG 3.18: LEVEL III UPPER GI ENDOSCOPY

Facility

$489.19

Service Code	EAPG 00154
Min. Negotiated Rate	$489.19
Max. Negotiated Rate	$489.19
Rate for Payer: Buckeye Health Medicaid OOS	$489.19
Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare	$489.19

Know your out-of-pocket cost for care.

All Charges