Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

OUTPATIENT EAPG 00135: LEVEL II UPPER GI ENDOSCOPY

Facility OP

$589.23

Service Code	EAPG 00135
Hospital Charge Code	EAPG 00135
Min. Negotiated Rate	$589.23
Max. Negotiated Rate	$589.23
Rate for Payer: Buckeye Health Medicaid OOS	$589.23
Rate for Payer: Molina Healthcare of OH Medicare	$589.23

OUTPATIENT EAPG 00136: DIAGNOSTIC LOWER GASTROINTESTINAL ENDOSCOPY

Facility OP

$311.89

Service Code	EAPG 00136
Hospital Charge Code	EAPG 00136
Min. Negotiated Rate	$311.89
Max. Negotiated Rate	$311.89
Rate for Payer: Buckeye Health Medicaid OOS	$311.89
Rate for Payer: Molina Healthcare of OH Medicare	$311.89

OUTPATIENT EAPG 00137: THERAPEUTIC COLONOSCOPY

Facility OP

$423.00

Service Code	EAPG 00137
Hospital Charge Code	EAPG 00137
Min. Negotiated Rate	$423.00
Max. Negotiated Rate	$423.00
Rate for Payer: Buckeye Health Medicaid OOS	$423.00
Rate for Payer: Molina Healthcare of OH Medicare	$423.00

OUTPATIENT EAPG 00138: LEVEL I ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility OP

$665.37

Service Code	EAPG 00138
Hospital Charge Code	EAPG 00138
Min. Negotiated Rate	$665.37
Max. Negotiated Rate	$665.37
Rate for Payer: Buckeye Health Medicaid OOS	$665.37
Rate for Payer: Molina Healthcare of OH Medicare	$665.37

OUTPATIENT EAPG 00139: LEVEL I HERNIA REPAIR

Facility OP

$959.95

Service Code	EAPG 00139
Hospital Charge Code	EAPG 00139
Min. Negotiated Rate	$959.95
Max. Negotiated Rate	$959.95
Rate for Payer: Buckeye Health Medicaid OOS	$959.95
Rate for Payer: Molina Healthcare of OH Medicare	$959.95

OUTPATIENT EAPG 00140: LEVEL II HERNIA REPAIR

Facility OP

$1,085.50

Service Code	EAPG 00140
Hospital Charge Code	EAPG 00140
Min. Negotiated Rate	$1,085.50
Max. Negotiated Rate	$1,085.50
Rate for Payer: Buckeye Health Medicaid OOS	$1,085.50
Rate for Payer: Molina Healthcare of OH Medicare	$1,085.50

OUTPATIENT EAPG 00141: LEVEL I ANAL AND RECTAL PROCEDURES

Facility OP

$531.92

Service Code	EAPG 00141
Hospital Charge Code	EAPG 00141
Min. Negotiated Rate	$531.92
Max. Negotiated Rate	$531.92
Rate for Payer: Buckeye Health Medicaid OOS	$531.92
Rate for Payer: Molina Healthcare of OH Medicare	$531.92

OUTPATIENT EAPG 00142: LEVEL II ANAL AND RECTAL PROCEDURES

Facility OP

$763.53

Service Code	EAPG 00142
Hospital Charge Code	EAPG 00142
Min. Negotiated Rate	$763.53
Max. Negotiated Rate	$763.53
Rate for Payer: Buckeye Health Medicaid OOS	$763.53
Rate for Payer: Molina Healthcare of OH Medicare	$763.53

OUTPATIENT EAPG 00143: LEVEL I GASTROINTESTINAL PROCEDURES

Facility OP

$725.47

Service Code	EAPG 00143
Hospital Charge Code	EAPG 00143
Min. Negotiated Rate	$725.47
Max. Negotiated Rate	$725.47
Rate for Payer: Buckeye Health Medicaid OOS	$725.47
Rate for Payer: Molina Healthcare of OH Medicare	$725.47

OUTPATIENT EAPG 00144: LEVEL II GASTROINTESTINAL PROCEDURES

Facility OP

$877.42

Service Code	EAPG 00144
Hospital Charge Code	EAPG 00144
Min. Negotiated Rate	$877.42
Max. Negotiated Rate	$877.42
Rate for Payer: Buckeye Health Medicaid OOS	$877.42
Rate for Payer: Molina Healthcare of OH Medicare	$877.42

OUTPATIENT EAPG 00145: LEVEL I LAPAROSCOPY

Facility OP

$855.87

Service Code	EAPG 00145
Hospital Charge Code	EAPG 00145
Min. Negotiated Rate	$855.87
Max. Negotiated Rate	$855.87
Rate for Payer: Buckeye Health Medicaid OOS	$855.87
Rate for Payer: Molina Healthcare of OH Medicare	$855.87

OUTPATIENT EAPG 00146: LEVEL II LAPAROSCOPY

Facility OP

$1,244.16

Service Code	EAPG 00146
Hospital Charge Code	EAPG 00146
Min. Negotiated Rate	$1,244.16
Max. Negotiated Rate	$1,244.16
Rate for Payer: Buckeye Health Medicaid OOS	$1,244.16
Rate for Payer: Molina Healthcare of OH Medicare	$1,244.16

OUTPATIENT EAPG 00147: LEVEL III LAPAROSCOPY

Facility OP

$1,358.05

Service Code	EAPG 00147
Hospital Charge Code	EAPG 00147
Min. Negotiated Rate	$1,358.05
Max. Negotiated Rate	$1,358.05
Rate for Payer: Buckeye Health Medicaid OOS	$1,358.05
Rate for Payer: Molina Healthcare of OH Medicare	$1,358.05

OUTPATIENT EAPG 00148: LEVEL IV LAPAROSCOPY

Facility OP

$1,429.44

Service Code	EAPG 00148
Hospital Charge Code	EAPG 00148
Min. Negotiated Rate	$1,429.44
Max. Negotiated Rate	$1,429.44
Rate for Payer: Buckeye Health Medicaid OOS	$1,429.44
Rate for Payer: Molina Healthcare of OH Medicare	$1,429.44

OUTPATIENT EAPG 00149: SCREENING COLORECTAL SERVICES

Facility OP

$286.18

Service Code	EAPG 00149
Hospital Charge Code	EAPG 00149
Min. Negotiated Rate	$286.18
Max. Negotiated Rate	$286.18
Rate for Payer: Buckeye Health Medicaid OOS	$286.18
Rate for Payer: Molina Healthcare of OH Medicare	$286.18

OUTPATIENT EAPG 00150: ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES

Facility OP

$284.23

Service Code	EAPG 00150
Hospital Charge Code	EAPG 00150
Min. Negotiated Rate	$284.23
Max. Negotiated Rate	$284.23
Rate for Payer: Buckeye Health Medicaid OOS	$284.23
Rate for Payer: Molina Healthcare of OH Medicare	$284.23

OUTPATIENT EAPG 00151: LEVEL I HEPATOBILIARY AND PANCREAS PROCEDURES

Facility OP

$540.48

Service Code	EAPG 00151
Hospital Charge Code	EAPG 00151
Min. Negotiated Rate	$540.48
Max. Negotiated Rate	$540.48
Rate for Payer: Buckeye Health Medicaid OOS	$540.48
Rate for Payer: Molina Healthcare of OH Medicare	$540.48

OUTPATIENT EAPG 00152: LEVEL II HEPATOBILIARY AND PANCREAS PROCEDURES

Facility OP

$906.95

Service Code	EAPG 00152
Hospital Charge Code	EAPG 00152
Min. Negotiated Rate	$906.95
Max. Negotiated Rate	$906.95
Rate for Payer: Buckeye Health Medicaid OOS	$906.95
Rate for Payer: Molina Healthcare of OH Medicare	$906.95

OUTPATIENT EAPG 00153: LEVEL II ERCP AND RELATED ENDOSCOPIC PROCEDURES

Facility OP

$979.26

Service Code	EAPG 00153
Hospital Charge Code	EAPG 00153
Min. Negotiated Rate	$979.26
Max. Negotiated Rate	$979.26
Rate for Payer: Buckeye Health Medicaid OOS	$979.26
Rate for Payer: Molina Healthcare of OH Medicare	$979.26

OUTPATIENT EAPG 00154: LEVEL III UPPER GI ENDOSCOPY

Facility OP

$616.53

Service Code	EAPG 00154
Hospital Charge Code	EAPG 00154
Min. Negotiated Rate	$616.53
Max. Negotiated Rate	$616.53
Rate for Payer: Buckeye Health Medicaid OOS	$616.53
Rate for Payer: Molina Healthcare of OH Medicare	$616.53

OUTPATIENT EAPG 00160: EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Facility OP

$1,122.71

Service Code	EAPG 00160
Hospital Charge Code	EAPG 00160
Min. Negotiated Rate	$1,122.71
Max. Negotiated Rate	$1,122.71
Rate for Payer: Buckeye Health Medicaid OOS	$1,122.71
Rate for Payer: Molina Healthcare of OH Medicare	$1,122.71

OUTPATIENT EAPG 00161: URINARY STUDIES AND PROCEDURES

Facility OP

$183.28

Service Code	EAPG 00161
Hospital Charge Code	EAPG 00161
Min. Negotiated Rate	$183.28
Max. Negotiated Rate	$183.28
Rate for Payer: Buckeye Health Medicaid OOS	$183.28
Rate for Payer: Molina Healthcare of OH Medicare	$183.28

OUTPATIENT EAPG 00162: URINARY DILATATION

Facility OP

$323.74

Service Code	EAPG 00162
Hospital Charge Code	EAPG 00162
Min. Negotiated Rate	$323.74
Max. Negotiated Rate	$323.74
Rate for Payer: Buckeye Health Medicaid OOS	$323.74
Rate for Payer: Molina Healthcare of OH Medicare	$323.74

OUTPATIENT EAPG 00163: LEVEL I BLADDER AND KIDNEY PROCEDURES

Facility OP

$499.34

Service Code	EAPG 00163
Hospital Charge Code	EAPG 00163
Min. Negotiated Rate	$499.34
Max. Negotiated Rate	$499.34
Rate for Payer: Buckeye Health Medicaid OOS	$499.34
Rate for Payer: Molina Healthcare of OH Medicare	$499.34

OUTPATIENT EAPG 00164: LEVEL II BLADDER AND KIDNEY PROCEDURES

Facility OP

$822.04

Service Code	EAPG 00164
Hospital Charge Code	EAPG 00164
Min. Negotiated Rate	$822.04
Max. Negotiated Rate	$822.04
Rate for Payer: Buckeye Health Medicaid OOS	$822.04
Rate for Payer: Molina Healthcare of OH Medicare	$822.04

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