Cameron Memorial Community Hospital

All Charges

Charge

Type

Price

OUTPATIENT EAPG 00391: LEVEL II PATHOLOGY TESTS

Facility OP

$39.96

Service Code	EAPG 00391
Hospital Charge Code	EAPG 00391
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$39.96
Rate for Payer: Buckeye Health Medicaid OOS	$39.96
Rate for Payer: Molina Healthcare of OH Medicare	$39.96

OUTPATIENT EAPG 00392: PAP SMEARS

Facility OP

$14.00

Service Code	EAPG 00392
Hospital Charge Code	EAPG 00392
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$14.00
Rate for Payer: Buckeye Health Medicaid OOS	$14.00
Rate for Payer: Molina Healthcare of OH Medicare	$14.00

OUTPATIENT EAPG 00393: LEVEL II BLOOD AND TISSUE TYPING TESTS

Facility OP

$19.27

Service Code	EAPG 00393
Hospital Charge Code	EAPG 00393
Min. Negotiated Rate	$19.27
Max. Negotiated Rate	$19.27
Rate for Payer: Buckeye Health Medicaid OOS	$19.27
Rate for Payer: Molina Healthcare of OH Medicare	$19.27

OUTPATIENT EAPG 00394: LEVEL I IMMUNOLOGY TESTS

Facility OP

$24.80

Service Code	EAPG 00394
Hospital Charge Code	EAPG 00394
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$24.80
Rate for Payer: Buckeye Health Medicaid OOS	$24.80
Rate for Payer: Molina Healthcare of OH Medicare	$24.80

OUTPATIENT EAPG 00395: LEVEL II IMMUNOLOGY TESTS

Facility OP

$38.29

Service Code	EAPG 00395
Hospital Charge Code	EAPG 00395
Min. Negotiated Rate	$38.29
Max. Negotiated Rate	$38.29
Rate for Payer: Buckeye Health Medicaid OOS	$38.29
Rate for Payer: Molina Healthcare of OH Medicare	$38.29

OUTPATIENT EAPG 00396: LEVEL I MICROBIOLOGY TESTS

Facility OP

$17.08

Service Code	EAPG 00396
Hospital Charge Code	EAPG 00396
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$17.08
Rate for Payer: Buckeye Health Medicaid OOS	$17.08
Rate for Payer: Molina Healthcare of OH Medicare	$17.08

OUTPATIENT EAPG 00397: LEVEL II MICROBIOLOGY TESTS

Facility OP

$35.10

Service Code	EAPG 00397
Hospital Charge Code	EAPG 00397
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Buckeye Health Medicaid OOS	$35.10
Rate for Payer: Molina Healthcare of OH Medicare	$35.10

OUTPATIENT EAPG 00398: LEVEL I ENDOCRINOLOGY TESTS

Facility OP

$22.15

Service Code	EAPG 00398
Hospital Charge Code	EAPG 00398
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$22.15
Rate for Payer: Buckeye Health Medicaid OOS	$22.15
Rate for Payer: Molina Healthcare of OH Medicare	$22.15

OUTPATIENT EAPG 00399: LEVEL II ENDOCRINOLOGY TESTS

Facility OP

$27.14

Service Code	EAPG 00399
Hospital Charge Code	EAPG 00399
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$27.14
Rate for Payer: Buckeye Health Medicaid OOS	$27.14
Rate for Payer: Molina Healthcare of OH Medicare	$27.14

OUTPATIENT EAPG 00400: LEVEL I CHEMISTRY TESTS

Facility OP

$15.21

Service Code	EAPG 00400
Hospital Charge Code	EAPG 00400
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$15.21
Rate for Payer: Buckeye Health Medicaid OOS	$15.21
Rate for Payer: Molina Healthcare of OH Medicare	$15.21

OUTPATIENT EAPG 00401: LEVEL II CHEMISTRY TESTS

Facility OP

$21.50

Service Code	EAPG 00401
Hospital Charge Code	EAPG 00401
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$21.50
Rate for Payer: Buckeye Health Medicaid OOS	$21.50
Rate for Payer: Molina Healthcare of OH Medicare	$21.50

OUTPATIENT EAPG 00402: BASIC CHEMISTRY TESTS

Facility OP

$9.25

Service Code	EAPG 00402
Hospital Charge Code	EAPG 00402
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$9.25
Rate for Payer: Buckeye Health Medicaid OOS	$9.25
Rate for Payer: Molina Healthcare of OH Medicare	$9.25

OUTPATIENT EAPG 00403: ORGAN OR DISEASE ORIENTED PANELS

Facility OP

$20.57

Service Code	EAPG 00403
Hospital Charge Code	EAPG 00403
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$20.57
Rate for Payer: Buckeye Health Medicaid OOS	$20.57
Rate for Payer: Molina Healthcare of OH Medicare	$20.57

OUTPATIENT EAPG 00404: TOXICOLOGY TESTS

Facility OP

$16.58

Service Code	EAPG 00404
Hospital Charge Code	EAPG 00404
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$16.58
Rate for Payer: Buckeye Health Medicaid OOS	$16.58
Rate for Payer: Molina Healthcare of OH Medicare	$16.58

OUTPATIENT EAPG 00405: THERAPEUTIC DRUG MONITORING

Facility OP

$17.14

Service Code	EAPG 00405
Hospital Charge Code	EAPG 00405
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$17.14
Rate for Payer: Buckeye Health Medicaid OOS	$17.14
Rate for Payer: Molina Healthcare of OH Medicare	$17.14

OUTPATIENT EAPG 00406: LEVEL I CLOTTING TESTS

Facility OP

$8.38

Service Code	EAPG 00406
Hospital Charge Code	EAPG 00406
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$8.38
Rate for Payer: Buckeye Health Medicaid OOS	$8.38
Rate for Payer: Molina Healthcare of OH Medicare	$8.38

OUTPATIENT EAPG 00407: LEVEL II CLOTTING TESTS

Facility OP

$53.81

Service Code	EAPG 00407
Hospital Charge Code	EAPG 00407
Min. Negotiated Rate	$53.81
Max. Negotiated Rate	$53.81
Rate for Payer: Buckeye Health Medicaid OOS	$53.81
Rate for Payer: Molina Healthcare of OH Medicare	$53.81

OUTPATIENT EAPG 00408: LEVEL I HEMATOLOGY TESTS

Facility OP

$8.18

Service Code	EAPG 00408
Hospital Charge Code	EAPG 00408
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$8.18
Rate for Payer: Buckeye Health Medicaid OOS	$8.18
Rate for Payer: Molina Healthcare of OH Medicare	$8.18

OUTPATIENT EAPG 00409: LEVEL II HEMATOLOGY TESTS

Facility OP

$15.93

Service Code	EAPG 00409
Hospital Charge Code	EAPG 00409
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$15.93
Rate for Payer: Buckeye Health Medicaid OOS	$15.93
Rate for Payer: Molina Healthcare of OH Medicare	$15.93

OUTPATIENT EAPG 00410: URINALYSIS

Facility OP

$6.13

Service Code	EAPG 00410
Hospital Charge Code	EAPG 00410
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Buckeye Health Medicaid OOS	$6.13
Rate for Payer: Molina Healthcare of OH Medicare	$6.13

OUTPATIENT EAPG 00412: SIMPLE PULMONARY FUNCTION TESTS

Facility OP

$123.07

Service Code	EAPG 00412
Hospital Charge Code	EAPG 00412
Min. Negotiated Rate	$123.07
Max. Negotiated Rate	$123.07
Rate for Payer: Buckeye Health Medicaid OOS	$123.07
Rate for Payer: Molina Healthcare of OH Medicare	$123.07

OUTPATIENT EAPG 00413: CARDIOGRAM

Facility OP

$23.58

Service Code	EAPG 00413
Hospital Charge Code	EAPG 00413
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$23.58
Rate for Payer: Buckeye Health Medicaid OOS	$23.58
Rate for Payer: Molina Healthcare of OH Medicare	$23.58

OUTPATIENT EAPG 00414: LEVEL I IMMUNIZATION

Facility OP

$13.09

Service Code	EAPG 00414
Hospital Charge Code	EAPG 00414
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$13.09
Rate for Payer: Buckeye Health Medicaid OOS	$13.09
Rate for Payer: Molina Healthcare of OH Medicare	$13.09

OUTPATIENT EAPG 00415: LEVEL II IMMUNIZATION

Facility OP

$192.65

Service Code	EAPG 00415
Hospital Charge Code	EAPG 00415
Min. Negotiated Rate	$192.65
Max. Negotiated Rate	$192.65
Rate for Payer: Buckeye Health Medicaid OOS	$192.65
Rate for Payer: Molina Healthcare of OH Medicare	$192.65

OUTPATIENT EAPG 00416: LEVEL III IMMUNIZATION

Facility OP

$49.59

Service Code	EAPG 00416
Hospital Charge Code	EAPG 00416
Min. Negotiated Rate	$49.59
Max. Negotiated Rate	$49.59
Rate for Payer: Buckeye Health Medicaid OOS	$49.59
Rate for Payer: Molina Healthcare of OH Medicare	$49.59

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All Charges