|
OUTPATIENT EAPG 00295: MAGNETIC RESONANCE IMAGING WITH CONTRAST
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
EAPG 00295
|
| Hospital Charge Code |
EAPG 00295
|
| Min. Negotiated Rate |
$183.15 |
| Max. Negotiated Rate |
$183.15 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$183.15
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$183.15
|
|
|
OUTPATIENT EAPG 00297: MAGNETOCEPHALOGRAPHY/CARDIOGRAPHY MCG
|
Facility
OP
|
$340.07
|
|
|
Service Code
|
EAPG 00297
|
| Hospital Charge Code |
EAPG 00297
|
| Min. Negotiated Rate |
$340.07 |
| Max. Negotiated Rate |
$340.07 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$340.07
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$340.07
|
|
|
OUTPATIENT EAPG 00299: LEVEL I COMPUTED TOMOGRAPHY
|
Facility
OP
|
$97.32
|
|
|
Service Code
|
EAPG 00299
|
| Hospital Charge Code |
EAPG 00299
|
| Min. Negotiated Rate |
$97.32 |
| Max. Negotiated Rate |
$97.32 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$97.32
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$97.32
|
|
|
OUTPATIENT EAPG 00300: LEVEL II COMPUTED TOMOGRAPHY
|
Facility
OP
|
$187.04
|
|
|
Service Code
|
EAPG 00300
|
| Hospital Charge Code |
EAPG 00300
|
| Min. Negotiated Rate |
$187.04 |
| Max. Negotiated Rate |
$187.04 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$187.04
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$187.04
|
|
|
OUTPATIENT EAPG 00301: COMPUTED TOMOGRAPHY- OTHER
|
Facility
OP
|
$35.19
|
|
|
Service Code
|
EAPG 00301
|
| Hospital Charge Code |
EAPG 00301
|
| Min. Negotiated Rate |
$35.19 |
| Max. Negotiated Rate |
$35.19 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$35.19
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$35.19
|
|
|
OUTPATIENT EAPG 00302: COMPUTED TOMOGRAPHIC ANGIOGRAPHY
|
Facility
OP
|
$186.55
|
|
|
Service Code
|
EAPG 00302
|
| Hospital Charge Code |
EAPG 00302
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$186.55 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$186.55
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$186.55
|
|
|
OUTPATIENT EAPG 00308: LEVEL III PATHOLOGY TESTS
|
Facility
OP
|
$90.21
|
|
|
Service Code
|
EAPG 00308
|
| Hospital Charge Code |
EAPG 00308
|
| Min. Negotiated Rate |
$90.21 |
| Max. Negotiated Rate |
$90.21 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$90.21
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$90.21
|
|
|
OUTPATIENT EAPG 00309: ADAPTIVE BEHAVIORAL HEALTH TREATMENT SERVICES
|
Facility
OP
|
$4.17
|
|
|
Service Code
|
EAPG 00309
|
| Hospital Charge Code |
EAPG 00309
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$4.17
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$4.17
|
|
|
OUTPATIENT EAPG 00310: DEVELOPMENTAL & NEUROPSYCHOLOGICAL TESTING
|
Facility
OP
|
$153.74
|
|
|
Service Code
|
EAPG 00310
|
| Hospital Charge Code |
EAPG 00310
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$153.74 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$153.74
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$153.74
|
|
|
OUTPATIENT EAPG 00311: FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE
|
Facility
OP
|
$13.07
|
|
|
Service Code
|
EAPG 00311
|
| Hospital Charge Code |
EAPG 00311
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$13.07
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$13.07
|
|
|
OUTPATIENT EAPG 00312: FULL DAY PARTIAL HOSPITALIZATION FOR BEHAVIORAL HEALTH
|
Facility
OP
|
$22.75
|
|
|
Service Code
|
EAPG 00312
|
| Hospital Charge Code |
EAPG 00312
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.75
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$22.75
|
|
|
OUTPATIENT EAPG 00315: COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY
|
Facility
OP
|
$68.07
|
|
|
Service Code
|
EAPG 00315
|
| Hospital Charge Code |
EAPG 00315
|
| Min. Negotiated Rate |
$68.07 |
| Max. Negotiated Rate |
$68.07 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$68.07
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$68.07
|
|
|
OUTPATIENT EAPG 00316: INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY
|
Facility
OP
|
$102.80
|
|
|
Service Code
|
EAPG 00316
|
| Hospital Charge Code |
EAPG 00316
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$102.80 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$102.80
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$102.80
|
|
|
OUTPATIENT EAPG 00317: FAMILY PSYCHOTHERAPY
|
Facility
OP
|
$134.79
|
|
|
Service Code
|
EAPG 00317
|
| Hospital Charge Code |
EAPG 00317
|
| Min. Negotiated Rate |
$134.79 |
| Max. Negotiated Rate |
$134.79 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$134.79
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$134.79
|
|
|
OUTPATIENT EAPG 00318: GROUP PSYCHOTHERAPY
|
Facility
OP
|
$65.77
|
|
|
Service Code
|
EAPG 00318
|
| Hospital Charge Code |
EAPG 00318
|
| Min. Negotiated Rate |
$65.77 |
| Max. Negotiated Rate |
$65.77 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$65.77
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$65.77
|
|
|
OUTPATIENT EAPG 00319: ACTIVITY THERAPY
|
Facility
OP
|
$23.11
|
|
|
Service Code
|
EAPG 00319
|
| Hospital Charge Code |
EAPG 00319
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$23.11
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$23.11
|
|
|
OUTPATIENT EAPG 00320: BEHAVIORAL HEALTH - CASE MANAGEMENT AND TREATMENT PLAN DEVELOPMENT
|
Facility
OP
|
$18.19
|
|
|
Service Code
|
EAPG 00320
|
| Hospital Charge Code |
EAPG 00320
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$18.19
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$18.19
|
|
|
OUTPATIENT EAPG 00321: CRISIS INTERVENTION
|
Facility
OP
|
$21.05
|
|
|
Service Code
|
EAPG 00321
|
| Hospital Charge Code |
EAPG 00321
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$21.05
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$21.05
|
|
|
OUTPATIENT EAPG 00322: MEDICATION ADMINISTRATION & OBSERVATION
|
Facility
OP
|
$15.13
|
|
|
Service Code
|
EAPG 00322
|
| Hospital Charge Code |
EAPG 00322
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$15.13
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$15.13
|
|
|
OUTPATIENT EAPG 00323: BEHAVIORAL HEATLH ASSESSMENT
|
Facility
OP
|
$167.42
|
|
|
Service Code
|
EAPG 00323
|
| Hospital Charge Code |
EAPG 00323
|
| Min. Negotiated Rate |
$167.42 |
| Max. Negotiated Rate |
$167.42 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$167.42
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$167.42
|
|
|
OUTPATIENT EAPG 00324: BEHAVIORAL HEALTH SCREENING AND BRIEF ASSESSMENT
|
Facility
OP
|
$82.40
|
|
|
Service Code
|
EAPG 00324
|
| Hospital Charge Code |
EAPG 00324
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$82.40
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$82.40
|
|
|
OUTPATIENT EAPG 00325: RISK ASSESSMENT AND PREVENTION COUNSELING
|
Facility
OP
|
$154.31
|
|
|
Service Code
|
EAPG 00325
|
| Hospital Charge Code |
EAPG 00325
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$154.31 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$154.31
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$154.31
|
|
|
OUTPATIENT EAPG 00327: INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT
|
Facility
OP
|
$81.06
|
|
|
Service Code
|
EAPG 00327
|
| Hospital Charge Code |
EAPG 00327
|
| Min. Negotiated Rate |
$81.06 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$81.06
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$81.06
|
|
|
OUTPATIENT EAPG 00328: DAY REHABILITATION, HALF DAY
|
Facility
OP
|
$52.95
|
|
|
Service Code
|
EAPG 00328
|
| Hospital Charge Code |
EAPG 00328
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$52.95 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$52.95
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$52.95
|
|
|
OUTPATIENT EAPG 00329: DAY REHABILITATION, FULL DAY
|
Facility
OP
|
$49.25
|
|
|
Service Code
|
EAPG 00329
|
| Hospital Charge Code |
EAPG 00329
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$49.25 |
| Rate for Payer: Buckeye Health Medicaid OOS |
$49.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$49.25
|
|
