|
OUTPATIENT EAPG 00086: PACEMAKER AND OTHER CARDIOVASCULAR DEVICE INSERTION AND REPLACEMENT
|
Facility
OP
|
$1,093.93
|
|
|
Service Code
|
EAPG 00086
|
| Hospital Charge Code |
EAPG 00086
|
| Min. Negotiated Rate |
$1,093.93 |
| Max. Negotiated Rate |
$1,093.93 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,093.93
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,093.93
|
|
|
OUTPATIENT EAPG 00087: REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES
|
Facility
OP
|
$867.71
|
|
|
Service Code
|
EAPG 00087
|
| Hospital Charge Code |
EAPG 00087
|
| Min. Negotiated Rate |
$867.71 |
| Max. Negotiated Rate |
$867.71 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$867.71
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$867.71
|
|
|
OUTPATIENT EAPG 00088: LEVEL I CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE
|
Facility
OP
|
$875.00
|
|
|
Service Code
|
EAPG 00088
|
| Hospital Charge Code |
EAPG 00088
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$875.00
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$875.00
|
|
|
OUTPATIENT EAPG 00089: LEVEL II CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE
|
Facility
OP
|
$1,002.07
|
|
|
Service Code
|
EAPG 00089
|
| Hospital Charge Code |
EAPG 00089
|
| Min. Negotiated Rate |
$1,002.07 |
| Max. Negotiated Rate |
$1,002.07 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,002.07
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,002.07
|
|
|
OUTPATIENT EAPG 00090: SECONDARY VARICOSE VEINS AND VASCULAR INJECTION
|
Facility
OP
|
$417.90
|
|
|
Service Code
|
EAPG 00090
|
| Hospital Charge Code |
EAPG 00090
|
| Min. Negotiated Rate |
$417.90 |
| Max. Negotiated Rate |
$417.90 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$417.90
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$417.90
|
|
|
OUTPATIENT EAPG 00091: LEVEL II VASCULAR LIGATION, REPAIR AND RECONSTRUCTION
|
Facility
OP
|
$1,483.21
|
|
|
Service Code
|
EAPG 00091
|
| Hospital Charge Code |
EAPG 00091
|
| Min. Negotiated Rate |
$1,483.21 |
| Max. Negotiated Rate |
$1,483.21 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,483.21
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,483.21
|
|
|
OUTPATIENT EAPG 00092: RESUSCITATION
|
Facility
OP
|
$281.92
|
|
|
Service Code
|
EAPG 00092
|
| Hospital Charge Code |
EAPG 00092
|
| Min. Negotiated Rate |
$281.92 |
| Max. Negotiated Rate |
$281.92 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$281.92
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$281.92
|
|
|
OUTPATIENT EAPG 00093: CARDIOVERSION
|
Facility
OP
|
$256.73
|
|
|
Service Code
|
EAPG 00093
|
| Hospital Charge Code |
EAPG 00093
|
| Min. Negotiated Rate |
$256.73 |
| Max. Negotiated Rate |
$256.73 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$256.73
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$256.73
|
|
|
OUTPATIENT EAPG 00094: CARDIAC REHABILITATION
|
Facility
OP
|
$46.97
|
|
|
Service Code
|
EAPG 00094
|
| Hospital Charge Code |
EAPG 00094
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$46.97
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$46.97
|
|
|
OUTPATIENT EAPG 00096: ATRIAL AND VENTRICULAR RECORDING AND PACING
|
Facility
OP
|
$344.59
|
|
|
Service Code
|
EAPG 00096
|
| Hospital Charge Code |
EAPG 00096
|
| Min. Negotiated Rate |
$344.59 |
| Max. Negotiated Rate |
$344.59 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$344.59
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$344.59
|
|
|
OUTPATIENT EAPG 00097: AICD IMPLANT
|
Facility
OP
|
$9,462.25
|
|
|
Service Code
|
EAPG 00097
|
| Hospital Charge Code |
EAPG 00097
|
| Min. Negotiated Rate |
$9,462.25 |
| Max. Negotiated Rate |
$9,462.25 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$9,462.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$9,462.25
|
|
|
OUTPATIENT EAPG 00099: CORONARY ANGIOPLASTY AND RELATED PROCEDURES
|
Facility
OP
|
$1,760.27
|
|
|
Service Code
|
EAPG 00099
|
| Hospital Charge Code |
EAPG 00099
|
| Min. Negotiated Rate |
$1,760.27 |
| Max. Negotiated Rate |
$1,760.27 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,760.27
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,760.27
|
|
|
OUTPATIENT EAPG 00101: LEVEL III CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE
|
Facility
OP
|
$1,445.65
|
|
|
Service Code
|
EAPG 00101
|
| Hospital Charge Code |
EAPG 00101
|
| Min. Negotiated Rate |
$1,445.65 |
| Max. Negotiated Rate |
$1,445.65 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,445.65
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,445.65
|
|
|
OUTPATIENT EAPG 00110: PHARMACOTHERAPY BY EXTENDED INFUSION
|
Facility
OP
|
$235.09
|
|
|
Service Code
|
EAPG 00110
|
| Hospital Charge Code |
EAPG 00110
|
| Min. Negotiated Rate |
$235.09 |
| Max. Negotiated Rate |
$235.09 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$235.09
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$235.09
|
|
|
OUTPATIENT EAPG 00111: PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION
|
Facility
OP
|
$202.61
|
|
|
Service Code
|
EAPG 00111
|
| Hospital Charge Code |
EAPG 00111
|
| Min. Negotiated Rate |
$202.61 |
| Max. Negotiated Rate |
$202.61 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$202.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$202.61
|
|
|
OUTPATIENT EAPG 00113: LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE
|
Facility
OP
|
$246.68
|
|
|
Service Code
|
EAPG 00113
|
| Hospital Charge Code |
EAPG 00113
|
| Min. Negotiated Rate |
$246.68 |
| Max. Negotiated Rate |
$246.68 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$246.68
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$246.68
|
|
|
OUTPATIENT EAPG 00114: LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE
|
Facility
OP
|
$1,126.30
|
|
|
Service Code
|
EAPG 00114
|
| Hospital Charge Code |
EAPG 00114
|
| Min. Negotiated Rate |
$1,126.30 |
| Max. Negotiated Rate |
$1,126.30 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$1,126.30
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$1,126.30
|
|
|
OUTPATIENT EAPG 00115: DEEP LYMPH STRUCTURE AND THYROID PROCEDURES
|
Facility
OP
|
$886.65
|
|
|
Service Code
|
EAPG 00115
|
| Hospital Charge Code |
EAPG 00115
|
| Min. Negotiated Rate |
$886.65 |
| Max. Negotiated Rate |
$886.65 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$886.65
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$886.65
|
|
|
OUTPATIENT EAPG 00116: ALLERGY TESTS
|
Facility
OP
|
$308.39
|
|
|
Service Code
|
EAPG 00116
|
| Hospital Charge Code |
EAPG 00116
|
| Min. Negotiated Rate |
$308.39 |
| Max. Negotiated Rate |
$308.39 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$308.39
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$308.39
|
|
|
OUTPATIENT EAPG 00118: NUTRITION THERAPY
|
Facility
OP
|
$48.98
|
|
|
Service Code
|
EAPG 00118
|
| Hospital Charge Code |
EAPG 00118
|
| Min. Negotiated Rate |
$48.98 |
| Max. Negotiated Rate |
$48.98 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$48.98
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$48.98
|
|
|
OUTPATIENT EAPG 00130: ALIMENTARY TESTS AND TUBE INSERTION OR PLACEMENT
|
Facility
OP
|
$185.48
|
|
|
Service Code
|
EAPG 00130
|
| Hospital Charge Code |
EAPG 00130
|
| Min. Negotiated Rate |
$185.48 |
| Max. Negotiated Rate |
$185.48 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$185.48
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$185.48
|
|
|
OUTPATIENT EAPG 00131: ESOPHAGEAL DILATION WITHOUT ENDOSCOPY
|
Facility
OP
|
$399.10
|
|
|
Service Code
|
EAPG 00131
|
| Hospital Charge Code |
EAPG 00131
|
| Min. Negotiated Rate |
$399.10 |
| Max. Negotiated Rate |
$399.10 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$399.10
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$399.10
|
|
|
OUTPATIENT EAPG 00132: ANOSCOPY WITH BIOPSY AND DIAGNOSTIC PROCTOSIGMOIDOSCOPY
|
Facility
OP
|
$315.01
|
|
|
Service Code
|
EAPG 00132
|
| Hospital Charge Code |
EAPG 00132
|
| Min. Negotiated Rate |
$315.01 |
| Max. Negotiated Rate |
$315.01 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$315.01
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$315.01
|
|
|
OUTPATIENT EAPG 00133: PROCTOSIGMOIDOSCOPY WITH EXCISION OR BIOPSY
|
Facility
OP
|
$384.58
|
|
|
Service Code
|
EAPG 00133
|
| Hospital Charge Code |
EAPG 00133
|
| Min. Negotiated Rate |
$384.58 |
| Max. Negotiated Rate |
$384.58 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$384.58
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$384.58
|
|
|
OUTPATIENT EAPG 00134: LEVEL I UPPER GI ENDOSCOPY
|
Facility
OP
|
$297.91
|
|
|
Service Code
|
EAPG 00134
|
| Hospital Charge Code |
EAPG 00134
|
| Min. Negotiated Rate |
$297.91 |
| Max. Negotiated Rate |
$297.91 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$297.91
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$297.91
|
|
