|
Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed
|
Facility
OP
|
$1,905.42
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
CPT-24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.42 |
| Max. Negotiated Rate |
$1,905.42 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,905.42
|
| Rate for Payer: Managed Health Services Medicaid |
$1,905.42
|
| Rate for Payer: MDWise Medicaid |
$1,905.42
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJ SOLN
|
Facility
IP
|
$101.56
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.17 |
| Max. Negotiated Rate |
$94.45 |
| Rate for Payer: Aetna Commercial |
$87.74
|
| Rate for Payer: Aetna Commercial |
$89.35
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: Cash Price |
$64.12
|
| Rate for Payer: Cigna All Commercial |
$89.25
|
| Rate for Payer: Cigna All Commercial |
$87.64
|
| Rate for Payer: CORVEL All Commercial |
$94.45
|
| Rate for Payer: CORVEL All Commercial |
$96.18
|
| Rate for Payer: Coventry All Commercial |
$89.37
|
| Rate for Payer: Coventry All Commercial |
$91.01
|
| Rate for Payer: Encore All Commercial |
$95.20
|
| Rate for Payer: Encore All Commercial |
$93.48
|
| Rate for Payer: Frontpath All Commercial |
$95.14
|
| Rate for Payer: Frontpath All Commercial |
$93.43
|
| Rate for Payer: Humana ChoiceCare |
$89.32
|
| Rate for Payer: Humana ChoiceCare |
$87.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.40
|
| Rate for Payer: PHCS All Commercial |
$76.17
|
| Rate for Payer: PHCS All Commercial |
$77.56
|
| Rate for Payer: PHP All Commercial |
$77.02
|
| Rate for Payer: PHP All Commercial |
$78.43
|
| Rate for Payer: Sagamore Health Network All Products |
$79.84
|
| Rate for Payer: Sagamore Health Network All Products |
$78.40
|
| Rate for Payer: Signature Care EPO |
$84.29
|
| Rate for Payer: Signature Care EPO |
$85.84
|
| Rate for Payer: Signature Care PPO |
$89.37
|
| Rate for Payer: Signature Care PPO |
$91.01
|
| Rate for Payer: United Healthcare Commercial |
$81.49
|
| Rate for Payer: United Healthcare Commercial |
$80.03
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJ SOLN
|
Facility
OP
|
$103.42
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$96.18 |
| Rate for Payer: Aetna Commercial |
$87.28
|
| Rate for Payer: Aetna Commercial |
$85.71
|
| Rate for Payer: Aetna Medicare |
$34.13
|
| Rate for Payer: Aetna Medicare |
$33.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$58.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.54
|
| Rate for Payer: Cash Price |
$62.96
|
| Rate for Payer: Cash Price |
$64.12
|
| Rate for Payer: Centivo All Commercial |
$51.79
|
| Rate for Payer: Centivo All Commercial |
$52.74
|
| Rate for Payer: Cigna All Commercial |
$89.25
|
| Rate for Payer: Cigna All Commercial |
$87.64
|
| Rate for Payer: CORVEL All Commercial |
$94.45
|
| Rate for Payer: CORVEL All Commercial |
$96.18
|
| Rate for Payer: Coventry All Commercial |
$89.37
|
| Rate for Payer: Coventry All Commercial |
$91.01
|
| Rate for Payer: Encore All Commercial |
$93.48
|
| Rate for Payer: Encore All Commercial |
$95.20
|
| Rate for Payer: Frontpath All Commercial |
$93.43
|
| Rate for Payer: Frontpath All Commercial |
$95.14
|
| Rate for Payer: Humana ChoiceCare |
$87.71
|
| Rate for Payer: Humana ChoiceCare |
$89.32
|
| Rate for Payer: Humana Medicare |
$52.74
|
| Rate for Payer: Humana Medicare |
$51.79
|
| Rate for Payer: Lucent All Commercial |
$51.79
|
| Rate for Payer: Lucent All Commercial |
$52.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.40
|
| Rate for Payer: PHCS All Commercial |
$76.17
|
| Rate for Payer: PHCS All Commercial |
$77.56
|
| Rate for Payer: PHP All Commercial |
$77.02
|
| Rate for Payer: PHP All Commercial |
$78.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.61
|
| Rate for Payer: Sagamore Health Network All Products |
$79.84
|
| Rate for Payer: Sagamore Health Network All Products |
$78.40
|
| Rate for Payer: Signature Care EPO |
$85.84
|
| Rate for Payer: Signature Care EPO |
$84.29
|
| Rate for Payer: Signature Care PPO |
$89.37
|
| Rate for Payer: Signature Care PPO |
$91.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.91
|
| Rate for Payer: United Healthcare Commercial |
$81.49
|
| Rate for Payer: United Healthcare Commercial |
$80.03
|
| Rate for Payer: United Healthcare Medicare |
$33.51
|
| Rate for Payer: United Healthcare Medicare |
$34.13
|
|
|
OSELTAMIVIR 30 MG ORAL CAP
|
Facility
OP
|
$5.83
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.12
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Centivo All Commercial |
$2.97
|
| Rate for Payer: Cigna All Commercial |
$5.03
|
| Rate for Payer: CORVEL All Commercial |
$5.42
|
| Rate for Payer: Coventry All Commercial |
$5.13
|
| Rate for Payer: Encore All Commercial |
$5.37
|
| Rate for Payer: Frontpath All Commercial |
$5.36
|
| Rate for Payer: Humana ChoiceCare |
$5.04
|
| Rate for Payer: Humana Medicare |
$2.97
|
| Rate for Payer: Lucent All Commercial |
$2.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.25
|
| Rate for Payer: PHCS All Commercial |
$4.37
|
| Rate for Payer: PHP All Commercial |
$4.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.27
|
| Rate for Payer: Sagamore Health Network All Products |
$4.50
|
| Rate for Payer: Signature Care EPO |
$4.84
|
| Rate for Payer: Signature Care PPO |
$5.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.96
|
| Rate for Payer: United Healthcare Commercial |
$4.59
|
| Rate for Payer: United Healthcare Medicare |
$1.92
|
|
|
OSELTAMIVIR 30 MG ORAL CAP
|
Facility
IP
|
$5.83
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cigna All Commercial |
$5.03
|
| Rate for Payer: CORVEL All Commercial |
$5.42
|
| Rate for Payer: Coventry All Commercial |
$5.13
|
| Rate for Payer: Encore All Commercial |
$5.37
|
| Rate for Payer: Frontpath All Commercial |
$5.36
|
| Rate for Payer: Humana ChoiceCare |
$5.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.25
|
| Rate for Payer: PHCS All Commercial |
$4.37
|
| Rate for Payer: PHP All Commercial |
$4.42
|
| Rate for Payer: Sagamore Health Network All Products |
$4.50
|
| Rate for Payer: Signature Care EPO |
$4.84
|
| Rate for Payer: Signature Care PPO |
$5.13
|
| Rate for Payer: United Healthcare Commercial |
$4.59
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSR
|
Facility
IP
|
$140.28
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
152586
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Aetna Commercial |
$121.20
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cigna All Commercial |
$121.06
|
| Rate for Payer: CORVEL All Commercial |
$130.46
|
| Rate for Payer: Coventry All Commercial |
$123.45
|
| Rate for Payer: Encore All Commercial |
$129.13
|
| Rate for Payer: Frontpath All Commercial |
$129.06
|
| Rate for Payer: Humana ChoiceCare |
$121.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.25
|
| Rate for Payer: PHCS All Commercial |
$105.21
|
| Rate for Payer: PHP All Commercial |
$106.39
|
| Rate for Payer: Sagamore Health Network All Products |
$108.30
|
| Rate for Payer: Signature Care EPO |
$116.43
|
| Rate for Payer: Signature Care PPO |
$123.45
|
| Rate for Payer: United Healthcare Commercial |
$110.54
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSR
|
Facility
OP
|
$140.28
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
152586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.29 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Aetna Commercial |
$118.40
|
| Rate for Payer: Aetna Medicare |
$46.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$80.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$87.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.92
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Centivo All Commercial |
$71.54
|
| Rate for Payer: Cigna All Commercial |
$121.06
|
| Rate for Payer: CORVEL All Commercial |
$130.46
|
| Rate for Payer: Coventry All Commercial |
$123.45
|
| Rate for Payer: Encore All Commercial |
$129.13
|
| Rate for Payer: Frontpath All Commercial |
$129.06
|
| Rate for Payer: Humana ChoiceCare |
$121.16
|
| Rate for Payer: Humana Medicare |
$71.54
|
| Rate for Payer: Lucent All Commercial |
$71.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.25
|
| Rate for Payer: PHCS All Commercial |
$105.21
|
| Rate for Payer: PHP All Commercial |
$106.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.71
|
| Rate for Payer: Sagamore Health Network All Products |
$108.30
|
| Rate for Payer: Signature Care EPO |
$116.43
|
| Rate for Payer: Signature Care PPO |
$123.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$119.24
|
| Rate for Payer: United Healthcare Commercial |
$110.54
|
| Rate for Payer: United Healthcare Medicare |
$46.29
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSR 60 ML ED PACK
|
Facility
OP
|
$559.44
|
|
|
Service Code
|
NDC 47781384
|
| Hospital Charge Code |
800685
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$520.28 |
| Rate for Payer: Aetna Commercial |
$472.17
|
| Rate for Payer: Aetna Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$349.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.08
|
| Rate for Payer: Cash Price |
$346.85
|
| Rate for Payer: Centivo All Commercial |
$285.31
|
| Rate for Payer: Cigna All Commercial |
$482.80
|
| Rate for Payer: CORVEL All Commercial |
$520.28
|
| Rate for Payer: Coventry All Commercial |
$492.31
|
| Rate for Payer: Encore All Commercial |
$514.96
|
| Rate for Payer: Frontpath All Commercial |
$514.68
|
| Rate for Payer: Humana ChoiceCare |
$483.19
|
| Rate for Payer: Humana Medicare |
$285.31
|
| Rate for Payer: Lucent All Commercial |
$285.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.50
|
| Rate for Payer: PHCS All Commercial |
$419.58
|
| Rate for Payer: PHP All Commercial |
$424.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.18
|
| Rate for Payer: Sagamore Health Network All Products |
$431.89
|
| Rate for Payer: Signature Care EPO |
$464.34
|
| Rate for Payer: Signature Care PPO |
$492.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$475.52
|
| Rate for Payer: United Healthcare Commercial |
$440.84
|
| Rate for Payer: United Healthcare Medicare |
$184.62
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSR 60 ML ED PACK
|
Facility
IP
|
$559.44
|
|
|
Service Code
|
NDC 47781384
|
| Hospital Charge Code |
800685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$419.58 |
| Max. Negotiated Rate |
$520.28 |
| Rate for Payer: Aetna Commercial |
$483.36
|
| Rate for Payer: Cash Price |
$346.85
|
| Rate for Payer: Cigna All Commercial |
$482.80
|
| Rate for Payer: CORVEL All Commercial |
$520.28
|
| Rate for Payer: Coventry All Commercial |
$492.31
|
| Rate for Payer: Encore All Commercial |
$514.96
|
| Rate for Payer: Frontpath All Commercial |
$514.68
|
| Rate for Payer: Humana ChoiceCare |
$483.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$503.50
|
| Rate for Payer: PHCS All Commercial |
$419.58
|
| Rate for Payer: PHP All Commercial |
$424.28
|
| Rate for Payer: Sagamore Health Network All Products |
$431.89
|
| Rate for Payer: Signature Care EPO |
$464.34
|
| Rate for Payer: Signature Care PPO |
$492.31
|
| Rate for Payer: United Healthcare Commercial |
$440.84
|
|
|
OSELTAMIVIR 75 MG ORAL CAP
|
Facility
OP
|
$7.40
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna Commercial |
$6.24
|
| Rate for Payer: Aetna Medicare |
$2.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.69
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Centivo All Commercial |
$3.77
|
| Rate for Payer: Cigna All Commercial |
$6.39
|
| Rate for Payer: CORVEL All Commercial |
$6.88
|
| Rate for Payer: Coventry All Commercial |
$6.51
|
| Rate for Payer: Encore All Commercial |
$6.81
|
| Rate for Payer: Frontpath All Commercial |
$6.81
|
| Rate for Payer: Humana ChoiceCare |
$6.39
|
| Rate for Payer: Humana Medicare |
$3.77
|
| Rate for Payer: Lucent All Commercial |
$3.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.66
|
| Rate for Payer: PHCS All Commercial |
$5.55
|
| Rate for Payer: PHP All Commercial |
$5.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.89
|
| Rate for Payer: Sagamore Health Network All Products |
$5.71
|
| Rate for Payer: Signature Care EPO |
$6.14
|
| Rate for Payer: Signature Care PPO |
$6.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.29
|
| Rate for Payer: United Healthcare Commercial |
$5.83
|
| Rate for Payer: United Healthcare Medicare |
$2.44
|
|
|
OSELTAMIVIR 75 MG ORAL CAP
|
Facility
IP
|
$7.40
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$6.88 |
| Rate for Payer: Aetna Commercial |
$6.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cigna All Commercial |
$6.39
|
| Rate for Payer: CORVEL All Commercial |
$6.88
|
| Rate for Payer: Coventry All Commercial |
$6.51
|
| Rate for Payer: Encore All Commercial |
$6.81
|
| Rate for Payer: Frontpath All Commercial |
$6.81
|
| Rate for Payer: Humana ChoiceCare |
$6.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.66
|
| Rate for Payer: PHCS All Commercial |
$5.55
|
| Rate for Payer: PHP All Commercial |
$5.61
|
| Rate for Payer: Sagamore Health Network All Products |
$5.71
|
| Rate for Payer: Signature Care EPO |
$6.14
|
| Rate for Payer: Signature Care PPO |
$6.51
|
| Rate for Payer: United Healthcare Commercial |
$5.83
|
|
|
Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
|
Facility
OP
|
$1,905.42
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
CPT-28110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.42 |
| Max. Negotiated Rate |
$1,905.42 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,905.42
|
| Rate for Payer: Managed Health Services Medicaid |
$1,905.42
|
| Rate for Payer: MDWise Medicaid |
$1,905.42
|
|
|
Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
|
Facility
OP
|
$1,905.42
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
CPT-28288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,905.42 |
| Max. Negotiated Rate |
$1,905.42 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,905.42
|
| Rate for Payer: Managed Health Services Medicaid |
$1,905.42
|
| Rate for Payer: MDWise Medicaid |
$1,905.42
|
|
|
OUTPATIENT EAPG 00001: PHOTOCHEMOTHERAPY
|
Facility
OP
|
$22.97
|
|
|
Service Code
|
EAPG 00001
|
| Hospital Charge Code |
EAPG 00001
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.97
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.97
|
|
|
OUTPATIENT EAPG 00002: SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION
|
Facility
OP
|
$295.35
|
|
|
Service Code
|
EAPG 00002
|
| Hospital Charge Code |
EAPG 00002
|
| Min. Negotiated Rate |
$295.35 |
| Max. Negotiated Rate |
$295.35 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$295.35
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$295.35
|
|
|
OUTPATIENT EAPG 00003: LEVEL I SKIN INCISION AND DRAINAGE
|
Facility
OP
|
$109.25
|
|
|
Service Code
|
EAPG 00003
|
| Hospital Charge Code |
EAPG 00003
|
| Min. Negotiated Rate |
$109.25 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$109.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$109.25
|
|
|
OUTPATIENT EAPG 00004: LEVEL II SKIN INCISION AND DRAINAGE
|
Facility
OP
|
$371.50
|
|
|
Service Code
|
EAPG 00004
|
| Hospital Charge Code |
EAPG 00004
|
| Min. Negotiated Rate |
$371.50 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$371.50
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$371.50
|
|
|
OUTPATIENT EAPG 00005: NAIL PROCEDURES
|
Facility
OP
|
$42.58
|
|
|
Service Code
|
EAPG 00005
|
| Hospital Charge Code |
EAPG 00005
|
| Min. Negotiated Rate |
$42.58 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$42.58
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$42.58
|
|
|
OUTPATIENT EAPG 00006: LEVEL I SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
OP
|
$118.38
|
|
|
Service Code
|
EAPG 00006
|
| Hospital Charge Code |
EAPG 00006
|
| Min. Negotiated Rate |
$118.38 |
| Max. Negotiated Rate |
$118.38 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$118.38
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$118.38
|
|
|
OUTPATIENT EAPG 00007: LEVEL II SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
OP
|
$312.58
|
|
|
Service Code
|
EAPG 00007
|
| Hospital Charge Code |
EAPG 00007
|
| Min. Negotiated Rate |
$312.58 |
| Max. Negotiated Rate |
$312.58 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$312.58
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$312.58
|
|
|
OUTPATIENT EAPG 00008: LEVEL III SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
OP
|
$458.32
|
|
|
Service Code
|
EAPG 00008
|
| Hospital Charge Code |
EAPG 00008
|
| Min. Negotiated Rate |
$458.32 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$458.32
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$458.32
|
|
|
OUTPATIENT EAPG 00009: LEVEL I EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
|
Facility
OP
|
$334.94
|
|
|
Service Code
|
EAPG 00009
|
| Hospital Charge Code |
EAPG 00009
|
| Min. Negotiated Rate |
$334.94 |
| Max. Negotiated Rate |
$334.94 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$334.94
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$334.94
|
|
|
OUTPATIENT EAPG 00010: LEVEL II EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
|
Facility
OP
|
$749.09
|
|
|
Service Code
|
EAPG 00010
|
| Hospital Charge Code |
EAPG 00010
|
| Min. Negotiated Rate |
$749.09 |
| Max. Negotiated Rate |
$749.09 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$749.09
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$749.09
|
|
|
OUTPATIENT EAPG 00011: LEVEL III EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
|
Facility
OP
|
$1,570.77
|
|
|
Service Code
|
EAPG 00011
|
| Hospital Charge Code |
EAPG 00011
|
| Min. Negotiated Rate |
$1,570.77 |
| Max. Negotiated Rate |
$1,570.77 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,570.77
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,570.77
|
|
|
OUTPATIENT EAPG 00012: LEVEL I SKIN REPAIR
|
Facility
OP
|
$92.16
|
|
|
Service Code
|
EAPG 00012
|
| Hospital Charge Code |
EAPG 00012
|
| Min. Negotiated Rate |
$92.16 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$92.16
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$92.16
|
|
