Utility version: 2.4 Run started: 4/16/2021  9:21 AM Location: VAN WERT HEALTH Payer: CARESOURCE Ref Date: 4/16/2021
Procedure|Code Type|Code|NDC|Rev Code|Procedure Description|Quantity|Payer|Contract|Plan(s)|IP Price|IP Pricing Detail|IP Expected Reimbursement|IP XR Detail|OP Price|OP Pricing Detail|OP Expected Reimbursement|OP XR Detail
MS521|DRG|MS-DRG V38 (FY 2021) 521|||Hip Replacement With Principal Diagnosis Of Hip Fracture With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41,008.32|Repriced: HLB.310398505; Cases: 1||No price history available with this financial class||||
MS522|DRG|MS-DRG V38 (FY 2021) 522|||Hip Replacement With Principal Diagnosis Of Hip Fracture Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47,960.03|Repriced: HLB.307808389; Cases: 5||No price history available with this financial class||||
MS783|DRG|MS-DRG V38 (FY 2021) 783|||Cesarean Section With Sterilization With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,774.59|Repriced: HLB.242685221; Cases: 1|9,374.99|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS784|DRG|MS-DRG V38 (FY 2021) 784|||Cesarean Section With Sterilization With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,570.82|Repriced: HLB.273167874; Cases: 1||No price history available with this financial class||||
MS785|DRG|MS-DRG V38 (FY 2021) 785|||Cesarean Section With Sterilization Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,910.48|Repriced: HLB.278206064; Cases: 14|6,187.70|Historical reimbursement; Scope: Contract; Cases: 7||||
MS786|DRG|MS-DRG V38 (FY 2021) 786|||Cesarean Section Without Sterilization With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,917.84|Repriced: HLB.238853821; Cases: 3|9,101.93|Historical reimbursement; Scope: Contract; Cases: 2||||
MS787|DRG|MS-DRG V38 (FY 2021) 787|||Cesarean Section Without Sterilization With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,517.37|Repriced: HLB.289881245; Cases: 6|7,377.79|Historical reimbursement; Scope: Financial Class; Cases: 3; Failed to evaluate: HLB.276507018; Reason: No CLP on primary claim bucket||||
MS788|DRG|MS-DRG V38 (FY 2021) 788|||Cesarean Section Without Sterilization Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,335.77|Repriced: HLB.294447380; Cases: 29|7,342.22|Historical reimbursement; Scope: Contract; Cases: 10||||
MS805|DRG|MS-DRG V38 (FY 2021) 805|||Vaginal Delivery Without Sterilization Or D&C With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,435.07|Repriced: HLB.280053472; Cases: 3|5,215.47|Historical reimbursement; Scope: Contract; Cases: 1||||
MS806|DRG|MS-DRG V38 (FY 2021) 806|||Vaginal Delivery Without Sterilization Or D&C With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10,693.07|Repriced: HLB.252200523; Cases: 13|5,260.47|Historical reimbursement; Scope: Contract; Cases: 7||||
MS807|DRG|MS-DRG V38 (FY 2021) 807|||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,601.93|Repriced: HLB.317941211; Cases: 105|4,753.99|Historical reimbursement; Scope: Contract; Cases: 30||||
MS818|DRG|MS-DRG V38 (FY 2021) 818|||Other Antepartum Diagnoses With O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,870.70|Repriced: HLB.311261005; Cases: 1|7,888.92|Historical reimbursement; Scope: Contract; Cases: 1||||
MS819|DRG|MS-DRG V38 (FY 2021) 819|||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,946.34|Repriced: HLB.263642062; Cases: 1|5,640.00|Historical reimbursement; Scope: Contract; Cases: 1||||
MS831|DRG|MS-DRG V38 (FY 2021) 831|||Other Antepartum Diagnoses Without O.R. Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25,350.55|Repriced: HLB.246038705; Cases: 1|4,374.88|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS832|DRG|MS-DRG V38 (FY 2021) 832|||Other Antepartum Diagnoses Without O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,868.99|Repriced: HLB.265768478; Cases: 2|3,451.10|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS833|DRG|MS-DRG V38 (FY 2021) 833|||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,385.00|Repriced: HLB.258224402; Cases: 1||No price history available with this financial class||||
MS004|DRG|MS-DRG V38 (FY 2021) 004|||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|324,119.76|Repriced: HLB.272238747; Cases: 1||No price history available with this financial class||||
MS037|DRG|MS-DRG V38 (FY 2021) 037|||Extracranial Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,234.26|Repriced: HLB.276380862; Cases: 1||No price history available with this financial class||||
MS039|DRG|MS-DRG V38 (FY 2021) 039|||Extracranial Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,441.87|Repriced: HLB.299591074; Cases: 1||No price history available with this financial class||||
MS057|DRG|MS-DRG V38 (FY 2021) 057|||Degenerative Nervous System Disorders Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33,252.04|Repriced: HLB.234014932; Cases: 1||No price history available with this financial class||||
MS064|DRG|MS-DRG V38 (FY 2021) 064|||Intracranial Hemorrhage Or Cerebral Infarction With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46,969.94|Repriced: HLB.311229359; Cases: 1||No price history available with this financial class||||
MS065|DRG|MS-DRG V38 (FY 2021) 065|||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23,635.11|Repriced: HLB.246039342; Cases: 1||No price history available with this financial class||||
MS066|DRG|MS-DRG V38 (FY 2021) 066|||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,727.34|Repriced: HLB.247987841; Cases: 2|5,315.09|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS068|DRG|MS-DRG V38 (FY 2021) 068|||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24,417.14|Repriced: HLB.268474172; Cases: 1||No price history available with this financial class||||
MS069|DRG|MS-DRG V38 (FY 2021) 069|||Transient Ischemia Without Thrombolytic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,677.55|Repriced: HLB.292075795; Cases: 1||No price history available with this financial class||||
MS071|DRG|MS-DRG V38 (FY 2021) 071|||Nonspecific Cerebrovascular Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32,821.27|Repriced: HLB.273310962; Cases: 1||No price history available with this financial class||||
MS075|DRG|MS-DRG V38 (FY 2021) 075|||Viral Meningitis With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,352.91|Repriced: HLB.291877199; Cases: 1||No price history available with this financial class||||
MS079|DRG|MS-DRG V38 (FY 2021) 079|||Hypertensive Encephalopathy Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|8,019.93|Repriced: HLB.274707833; Cases: 1||No price history available with this financial class||||
MS092|DRG|MS-DRG V38 (FY 2021) 092|||Other Disorders Of Nervous System With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,732.81|Repriced: HLB.286386207; Cases: 2||No price history available with this financial class||||
MS100|DRG|MS-DRG V38 (FY 2021) 100|||Seizures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29,091.86|Repriced: HLB.232332597; Cases: 1||No price history available with this financial class||||
MS103|DRG|MS-DRG V38 (FY 2021) 103|||Headaches Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33,859.36|Repriced: HLB.228449780; Cases: 1||No price history available with this financial class||||
MS149|DRG|MS-DRG V38 (FY 2021) 149|||Dysequilibrium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,468.81|Repriced: HLB.282103505; Cases: 1||No price history available with this financial class||||
MS153|DRG|MS-DRG V38 (FY 2021) 153|||Otitis Media And Uri Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5,291.46|Repriced: HLB.259864054; Cases: 2||No price history available with this financial class||||
MS158|DRG|MS-DRG V38 (FY 2021) 158|||Dental And Oral Diseases With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27,360.44|Repriced: HLB.238992990; Cases: 1|4,807.16|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS165|DRG|MS-DRG V38 (FY 2021) 165|||Major Chest Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42,007.42|Repriced: HLB.255950353; Cases: 1||No price history available with this financial class||||
MS167|DRG|MS-DRG V38 (FY 2021) 167|||Other Respiratory System O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56,670.54|Repriced: HLB.231749479; Cases: 1||No price history available with this financial class||||
MS175|DRG|MS-DRG V38 (FY 2021) 175|||Pulmonary Embolism With McC Or Acute Cor Pulmonale|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24,990.84|Repriced: HLB.306992997; Cases: 1||No price history available with this financial class||||
MS176|DRG|MS-DRG V38 (FY 2021) 176|||Pulmonary Embolism Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,007.92|Repriced: HLB.247059233; Cases: 1||No price history available with this financial class||||
MS177|DRG|MS-DRG V38 (FY 2021) 177|||Respiratory Infections And Inflammations With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34,321.99|Repriced: HLB.287650297; Cases: 52|8,077.97|Historical reimbursement; Scope: Financial Class; Cases: 2||||
MS178|DRG|MS-DRG V38 (FY 2021) 178|||Respiratory Infections And Inflammations With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,569.21|Repriced: HLB.308318446; Cases: 8||No price history available with this financial class||||
MS179|DRG|MS-DRG V38 (FY 2021) 179|||Respiratory Infections And Inflammations Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|8,906.80|Repriced: HLB.287356001; Cases: 1||No price history available with this financial class||||
MS180|DRG|MS-DRG V38 (FY 2021) 180|||Respiratory Neoplasms With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28,900.56|Repriced: HLB.314840501; Cases: 1||No price history available with this financial class||||
MS183|DRG|MS-DRG V38 (FY 2021) 183|||Major Chest Trauma With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,148.62|Repriced: HLB.260596251; Cases: 1||No price history available with this financial class||||
MS187|DRG|MS-DRG V38 (FY 2021) 187|||Pleural Effusion With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,547.97|Repriced: HLB.255617286; Cases: 1||No price history available with this financial class||||
MS189|DRG|MS-DRG V38 (FY 2021) 189|||Pulmonary Edema And Respiratory Failure|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28,318.42|Repriced: HLB.304538513; Cases: 6|6,656.57|Historical reimbursement; Scope: Contract; Cases: 2||||
MS190|DRG|MS-DRG V38 (FY 2021) 190|||Chronic Obstructive Pulmonary Disease With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24,964.90|Repriced: HLB.293390710; Cases: 12|11,161.96|Historical reimbursement; Scope: Contract; Cases: 1||||
MS191|DRG|MS-DRG V38 (FY 2021) 191|||Chronic Obstructive Pulmonary Disease With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22,371.49|Repriced: HLB.266609776; Cases: 3||No price history available with this financial class||||
MS192|DRG|MS-DRG V38 (FY 2021) 192|||Chronic Obstructive Pulmonary Disease Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10,759.23|Repriced: HLB.277806419; Cases: 1||No price history available with this financial class||||
MS193|DRG|MS-DRG V38 (FY 2021) 193|||Simple Pneumonia And Pleurisy With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22,615.17|Repriced: HLB.298501631; Cases: 21||No price history available with this financial class||||
MS194|DRG|MS-DRG V38 (FY 2021) 194|||Simple Pneumonia And Pleurisy With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,843.44|Repriced: HLB.255341420; Cases: 11||No price history available with this financial class||||
MS197|DRG|MS-DRG V38 (FY 2021) 197|||Interstitial Lung Disease With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10,889.51|Repriced: HLB.264036972; Cases: 1||No price history available with this financial class||||
MS199|DRG|MS-DRG V38 (FY 2021) 199|||Pneumothorax With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29,542.48|Repriced: HLB.231608076; Cases: 2||No price history available with this financial class||||
MS200|DRG|MS-DRG V38 (FY 2021) 200|||Pneumothorax With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,859.92|Repriced: HLB.212147422; Cases: 2||No price history available with this financial class||||
MS202|DRG|MS-DRG V38 (FY 2021) 202|||Bronchitis And Asthma With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,407.52|Repriced: HLB.255975061; Cases: 1||No price history available with this financial class||||
MS203|DRG|MS-DRG V38 (FY 2021) 203|||Bronchitis And Asthma Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|6,953.80|Repriced: HLB.248698137; Cases: 1|5,072.59|Historical reimbursement; Scope: Contract; Cases: 1||||
MS208|DRG|MS-DRG V38 (FY 2021) 208|||Respiratory System Diagnosis With Ventilator Support <=96 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82,284.61|Repriced: HLB.276876712; Cases: 6||No price history available with this financial class||||
MS240|DRG|MS-DRG V38 (FY 2021) 240|||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29,711.52|Repriced: HLB.252507642; Cases: 1||No price history available with this financial class||||
MS256|DRG|MS-DRG V38 (FY 2021) 256|||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,263.98|Repriced: HLB.236754897; Cases: 1|10,078.22|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS280|DRG|MS-DRG V38 (FY 2021) 280|||Acute Myocardial Infarction, Discharged Alive With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,890.70|Repriced: HLB.223989395; Cases: 12|2,893.73|Historical reimbursement; Scope: Contract; Cases: 1||||
MS281|DRG|MS-DRG V38 (FY 2021) 281|||Acute Myocardial Infarction, Discharged Alive With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10,890.61|Repriced: HLB.256639335; Cases: 4||No price history available with this financial class||||
MS282|DRG|MS-DRG V38 (FY 2021) 282|||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,205.64|Repriced: HLB.254868423; Cases: 2||No price history available with this financial class||||
MS291|DRG|MS-DRG V38 (FY 2021) 291|||Heart Failure And Shock With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,631.25|Repriced: HLB.267018012; Cases: 27||No price history available with this financial class||||
MS292|DRG|MS-DRG V38 (FY 2021) 292|||Heart Failure And Shock With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,973.50|Repriced: HLB.263946757; Cases: 10||No price history available with this financial class||||
MS299|DRG|MS-DRG V38 (FY 2021) 299|||Peripheral Vascular Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22,281.68|Repriced: HLB.273026931; Cases: 2||No price history available with this financial class||||
MS304|DRG|MS-DRG V38 (FY 2021) 304|||Hypertension With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31,873.24|Repriced: HLB.218444424; Cases: 1||No price history available with this financial class||||
MS305|DRG|MS-DRG V38 (FY 2021) 305|||Hypertension Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,623.55|Repriced: HLB.275399034; Cases: 1||No price history available with this financial class||||
MS308|DRG|MS-DRG V38 (FY 2021) 308|||Cardiac Arrhythmia And Conduction Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,901.03|Repriced: HLB.292558786; Cases: 4||No price history available with this financial class||||
MS309|DRG|MS-DRG V38 (FY 2021) 309|||Cardiac Arrhythmia And Conduction Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,911.77|Repriced: HLB.264151758; Cases: 3||No price history available with this financial class||||
MS310|DRG|MS-DRG V38 (FY 2021) 310|||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23,801.41|Repriced: HLB.234318720; Cases: 2||No price history available with this financial class||||
MS311|DRG|MS-DRG V38 (FY 2021) 311|||Angina Pectoris|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,434.04|Repriced: HLB.301857375; Cases: 1||No price history available with this financial class||||
MS312|DRG|MS-DRG V38 (FY 2021) 312|||Syncope And Collapse|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,532.06|Repriced: HLB.199389375; Cases: 2||No price history available with this financial class||||
MS315|DRG|MS-DRG V38 (FY 2021) 315|||Other Circulatory System Diagnoses With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,358.23|Repriced: HLB.281966549; Cases: 1||No price history available with this financial class||||
MS326|DRG|MS-DRG V38 (FY 2021) 326|||Stomach, Esophageal And Duodenal Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51,933.96|Repriced: HLB.292694176; Cases: 5|27,011.01|Historical reimbursement; Scope: Contract; Cases: 1||||
MS327|DRG|MS-DRG V38 (FY 2021) 327|||Stomach, Esophageal And Duodenal Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30,972.64|Repriced: HLB.277919438; Cases: 1||No price history available with this financial class||||
MS328|DRG|MS-DRG V38 (FY 2021) 328|||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34,456.91|Repriced: HLB.266154840; Cases: 1|27,046.58|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS329|DRG|MS-DRG V38 (FY 2021) 329|||Major Small And Large Bowel Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70,554.30|Repriced: HLB.250648853; Cases: 9||No price history available with this financial class||||
MS330|DRG|MS-DRG V38 (FY 2021) 330|||Major Small And Large Bowel Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34,947.66|Repriced: HLB.288630653; Cases: 10|16,019.22|Historical reimbursement; Scope: Contract; Cases: 1||||
MS331|DRG|MS-DRG V38 (FY 2021) 331|||Major Small And Large Bowel Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38,174.07|Repriced: HLB.286728854; Cases: 1||No price history available with this financial class||||
MS335|DRG|MS-DRG V38 (FY 2021) 335|||Peritoneal Adhesiolysis With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32,478.50|Repriced: HLB.264338704; Cases: 2||No price history available with this financial class||||
MS336|DRG|MS-DRG V38 (FY 2021) 336|||Peritoneal Adhesiolysis With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28,184.87|Repriced: HLB.256992210; Cases: 4|13,344.63|Historical reimbursement; Scope: Contract; Cases: 1||||
MS337|DRG|MS-DRG V38 (FY 2021) 337|||Peritoneal Adhesiolysis Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24,720.14|Repriced: HLB.232423569; Cases: 1||No price history available with this financial class||||
MS339|DRG|MS-DRG V38 (FY 2021) 339|||Appendectomy With Complicated Principal Diagnosis With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27,845.87|Repriced: HLB.267801930; Cases: 2|13,017.13|Historical reimbursement; Scope: Contract; Cases: 1||||
MS340|DRG|MS-DRG V38 (FY 2021) 340|||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,181.59|Repriced: HLB.274443813; Cases: 2|11,074.31|Historical reimbursement; Scope: Contract; Cases: 2||||
MS343|DRG|MS-DRG V38 (FY 2021) 343|||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,114.03|Repriced: HLB.271240364; Cases: 2|11,074.31|Historical reimbursement; Scope: Contract; Cases: 1||||
MS345|DRG|MS-DRG V38 (FY 2021) 345|||Minor Small And Large Bowel Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,550.59|Repriced: HLB.231190950; Cases: 2||No price history available with this financial class||||
MS348|DRG|MS-DRG V38 (FY 2021) 348|||Anal And Stomal Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,816.98|Repriced: HLB.266079896; Cases: 2||No price history available with this financial class||||
MS351|DRG|MS-DRG V38 (FY 2021) 351|||Inguinal And Femoral Hernia Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24,341.38|Repriced: HLB.308421969; Cases: 1||No price history available with this financial class||||
MS353|DRG|MS-DRG V38 (FY 2021) 353|||Hernia Procedures Except Inguinal And Femoral With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54,116.47|Repriced: HLB.243749340; Cases: 2||No price history available with this financial class||||
MS354|DRG|MS-DRG V38 (FY 2021) 354|||Hernia Procedures Except Inguinal And Femoral With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,292.21|Repriced: HLB.291111868; Cases: 2|11,663.07|Historical reimbursement; Scope: Financial Class; Cases: 2||||
MS355|DRG|MS-DRG V38 (FY 2021) 355|||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32,527.73|Repriced: HLB.302865076; Cases: 2||No price history available with this financial class||||
MS357|DRG|MS-DRG V38 (FY 2021) 357|||Other Digestive System O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25,880.68|Repriced: HLB.316686467; Cases: 2||No price history available with this financial class||||
MS358|DRG|MS-DRG V38 (FY 2021) 358|||Other Digestive System O.R. Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27,196.45|Repriced: HLB.267039723; Cases: 1||No price history available with this financial class||||
MS369|DRG|MS-DRG V38 (FY 2021) 369|||Major Esophageal Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10,086.76|Repriced: HLB.297167437; Cases: 2|5,823.37|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS372|DRG|MS-DRG V38 (FY 2021) 372|||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41,507.85|Repriced: HLB.241008004; Cases: 1||No price history available with this financial class||||
MS373|DRG|MS-DRG V38 (FY 2021) 373|||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,520.18|Repriced: HLB.276505602; Cases: 1||No price history available with this financial class||||
MS374|DRG|MS-DRG V38 (FY 2021) 374|||Digestive Malignancy With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40,580.87|Repriced: HLB.286789640; Cases: 1||No price history available with this financial class||||
MS375|DRG|MS-DRG V38 (FY 2021) 375|||Digestive Malignancy With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25,097.31|Repriced: HLB.284738262; Cases: 1||No price history available with this financial class||||
MS377|DRG|MS-DRG V38 (FY 2021) 377|||Gastrointestinal Hemorrhage With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30,080.05|Repriced: HLB.297046809; Cases: 9|8,934.42|Historical reimbursement; Scope: Contract; Cases: 1||||
MS378|DRG|MS-DRG V38 (FY 2021) 378|||Gastrointestinal Hemorrhage With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,269.91|Repriced: HLB.281881911; Cases: 18||No price history available with this financial class||||
MS379|DRG|MS-DRG V38 (FY 2021) 379|||Gastrointestinal Hemorrhage Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,383.55|Repriced: HLB.266086933; Cases: 1||No price history available with this financial class||||
MS381|DRG|MS-DRG V38 (FY 2021) 381|||Complicated Peptic Ulcer With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,049.83|Repriced: HLB.298961295; Cases: 1||No price history available with this financial class||||
MS382|DRG|MS-DRG V38 (FY 2021) 382|||Complicated Peptic Ulcer Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,254.06|Repriced: HLB.280914878; Cases: 1||No price history available with this financial class||||
MS386|DRG|MS-DRG V38 (FY 2021) 386|||Inflammatory Bowel Disease With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,508.14|Repriced: HLB.309827736; Cases: 1||No price history available with this financial class||||
MS387|DRG|MS-DRG V38 (FY 2021) 387|||Inflammatory Bowel Disease Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25,076.73|Repriced: HLB.245323729; Cases: 1|6,483.30|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS389|DRG|MS-DRG V38 (FY 2021) 389|||Gastrointestinal Obstruction With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,583.23|Repriced: HLB.274793619; Cases: 8||No price history available with this financial class||||
MS390|DRG|MS-DRG V38 (FY 2021) 390|||Gastrointestinal Obstruction Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,100.27|Repriced: HLB.277421065; Cases: 5||No price history available with this financial class||||
MS391|DRG|MS-DRG V38 (FY 2021) 391|||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54,269.31|Repriced: HLB.301861064; Cases: 1||No price history available with this financial class||||
MS392|DRG|MS-DRG V38 (FY 2021) 392|||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,744.67|Repriced: HLB.279973578; Cases: 9|4,637.38|Historical reimbursement; Scope: Contract; Cases: 2||||
MS393|DRG|MS-DRG V38 (FY 2021) 393|||Other Digestive System Diagnoses With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,256.52|Repriced: HLB.235804166; Cases: 1|6,372.21|Historical reimbursement; Scope: Plan; Cases: 1||||
MS394|DRG|MS-DRG V38 (FY 2021) 394|||Other Digestive System Diagnoses With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,264.91|Repriced: HLB.276445333; Cases: 3|6,085.88|Historical reimbursement; Scope: Contract; Cases: 1||||
MS412|DRG|MS-DRG V38 (FY 2021) 412|||Cholecystectomy With C.D.E. With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61,526.59|Repriced: HLB.219768081; Cases: 1||No price history available with this financial class||||
MS415|DRG|MS-DRG V38 (FY 2021) 415|||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42,296.64|Repriced: HLB.271251181; Cases: 1||No price history available with this financial class||||
MS417|DRG|MS-DRG V38 (FY 2021) 417|||Laparoscopic Cholecystectomy Without C.D.E. With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46,418.12|Repriced: HLB.307823284; Cases: 7||No price history available with this financial class||||
MS418|DRG|MS-DRG V38 (FY 2021) 418|||Laparoscopic Cholecystectomy Without C.D.E. With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,225.13|Repriced: HLB.308478188; Cases: 6|10,204.16|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS419|DRG|MS-DRG V38 (FY 2021) 419|||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,753.41|Repriced: HLB.245247415; Cases: 2||No price history available with this financial class||||
MS432|DRG|MS-DRG V38 (FY 2021) 432|||Cirrhosis And Alcoholic Hepatitis With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,445.13|Repriced: HLB.273654086; Cases: 1|2,193.51|Historical reimbursement; Scope: Contract; Cases: 1||||
MS438|DRG|MS-DRG V38 (FY 2021) 438|||Disorders Of Pancreas Except Malignancy With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34,548.32|Repriced: HLB.243352755; Cases: 1||No price history available with this financial class||||
MS439|DRG|MS-DRG V38 (FY 2021) 439|||Disorders Of Pancreas Except Malignancy With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,729.04|Repriced: HLB.247632551; Cases: 10|4,789.30|Historical reimbursement; Scope: Financial Class; Cases: 5; Failed to evaluate: HLB.247632551; Reason: No CLP on primary claim bucket||||
MS440|DRG|MS-DRG V38 (FY 2021) 440|||Disorders Of Pancreas Except Malignancy Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,440.27|Repriced: HLB.282716240; Cases: 1||No price history available with this financial class||||
MS441|DRG|MS-DRG V38 (FY 2021) 441|||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,100.12|Repriced: HLB.245945234; Cases: 2|2,495.98|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS442|DRG|MS-DRG V38 (FY 2021) 442|||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,463.92|Repriced: HLB.262943200; Cases: 1||No price history available with this financial class||||
MS444|DRG|MS-DRG V38 (FY 2021) 444|||Disorders Of The Biliary Tract With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22,337.12|Repriced: HLB.266578829; Cases: 1||No price history available with this financial class||||
MS445|DRG|MS-DRG V38 (FY 2021) 445|||Disorders Of The Biliary Tract With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,586.86|Repriced: HLB.284143795; Cases: 1|4,310.21|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS463|DRG|MS-DRG V38 (FY 2021) 463|||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160,660.37|Repriced: HLB.242874881; Cases: 1|23,981.25|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS464|DRG|MS-DRG V38 (FY 2021) 464|||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,098.87|Repriced: HLB.267193343; Cases: 1||No price history available with this financial class||||
MS465|DRG|MS-DRG V38 (FY 2021) 465|||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27,403.14|Repriced: HLB.268036185; Cases: 1||No price history available with this financial class||||
MS467|DRG|MS-DRG V38 (FY 2021) 467|||Revision Of Hip Or Knee Replacement With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68,979.80|Repriced: HLB.295648978; Cases: 1||No price history available with this financial class||||
MS469|DRG|MS-DRG V38 (FY 2021) 469|||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36,444.11|Repriced: HLB.304089423; Cases: 1||No price history available with this financial class||||
MS470|DRG|MS-DRG V38 (FY 2021) 470|||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28,919.80|Repriced: HLB.289675847; Cases: 58|15,220.83|Historical reimbursement; Scope: Contract; Cases: 2||||
MS480|DRG|MS-DRG V38 (FY 2021) 480|||Hip And Femur Procedures Except Major Joint With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35,412.50|Repriced: HLB.277616298; Cases: 4||No price history available with this financial class||||
MS481|DRG|MS-DRG V38 (FY 2021) 481|||Hip And Femur Procedures Except Major Joint With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37,043.49|Repriced: HLB.271326296; Cases: 26|15,648.10|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS482|DRG|MS-DRG V38 (FY 2021) 482|||Hip And Femur Procedures Except Major Joint Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33,171.28|Repriced: HLB.247293148; Cases: 2||No price history available with this financial class||||
MS483|DRG|MS-DRG V38 (FY 2021) 483|||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46,918.40|Repriced: HLB.275897125; Cases: 1||No price history available with this financial class||||
MS487|DRG|MS-DRG V38 (FY 2021) 487|||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,853.52|Repriced: HLB.259226950; Cases: 1||No price history available with this financial class||||
MS489|DRG|MS-DRG V38 (FY 2021) 489|||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,554.48|Repriced: HLB.251062267; Cases: 1||No price history available with this financial class||||
MS492|DRG|MS-DRG V38 (FY 2021) 492|||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37,232.26|Repriced: HLB.260915068; Cases: 2||No price history available with this financial class||||
MS493|DRG|MS-DRG V38 (FY 2021) 493|||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41,290.52|Repriced: HLB.266658510; Cases: 3||No price history available with this financial class||||
MS494|DRG|MS-DRG V38 (FY 2021) 494|||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34,240.90|Repriced: HLB.253454718; Cases: 3||No price history available with this financial class||||
MS498|DRG|MS-DRG V38 (FY 2021) 498|||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31,882.41|Repriced: HLB.280673146; Cases: 1||No price history available with this financial class||||
MS501|DRG|MS-DRG V38 (FY 2021) 501|||Soft Tissue Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25,549.43|Repriced: HLB.301087312; Cases: 3|11,121.58|Historical reimbursement; Scope: Contract; Cases: 1||||
MS533|DRG|MS-DRG V38 (FY 2021) 533|||Fractures Of Femur With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,594.18|Repriced: HLB.272788494; Cases: 1||No price history available with this financial class||||
MS534|DRG|MS-DRG V38 (FY 2021) 534|||Fractures Of Femur Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,044.03|Repriced: HLB.241946415; Cases: 1||No price history available with this financial class||||
MS535|DRG|MS-DRG V38 (FY 2021) 535|||Fractures Of Hip And Pelvis With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,535.96|Repriced: HLB.266586029; Cases: 1||No price history available with this financial class||||
MS536|DRG|MS-DRG V38 (FY 2021) 536|||Fractures Of Hip And Pelvis Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,222.12|Repriced: HLB.257066656; Cases: 2||No price history available with this financial class||||
MS547|DRG|MS-DRG V38 (FY 2021) 547|||Connective Tissue Disorders Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,589.32|Repriced: HLB.271756079; Cases: 1||No price history available with this financial class||||
MS548|DRG|MS-DRG V38 (FY 2021) 548|||Septic Arthritis With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,302.27|Repriced: HLB.218467180; Cases: 1|18,281.31|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS551|DRG|MS-DRG V38 (FY 2021) 551|||Medical Back Problems With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,123.87|Repriced: HLB.266094695; Cases: 1||No price history available with this financial class||||
MS552|DRG|MS-DRG V38 (FY 2021) 552|||Medical Back Problems Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,900.48|Repriced: HLB.240468010; Cases: 1||No price history available with this financial class||||
MS560|DRG|MS-DRG V38 (FY 2021) 560|||Aftercare, Musculoskeletal System And Connective Tissue With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,168.00|Repriced: HLB.275351223; Cases: 1||No price history available with this financial class||||
MS563|DRG|MS-DRG V38 (FY 2021) 563|||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,765.37|Repriced: HLB.281960039; Cases: 1||No price history available with this financial class||||
MS564|DRG|MS-DRG V38 (FY 2021) 564|||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,559.42|Repriced: HLB.315720625; Cases: 1||No price history available with this financial class||||
MS565|DRG|MS-DRG V38 (FY 2021) 565|||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,577.81|Repriced: HLB.280618002; Cases: 1||No price history available with this financial class||||
MS580|DRG|MS-DRG V38 (FY 2021) 580|||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,138.22|Repriced: HLB.277012795; Cases: 6||No price history available with this financial class||||
MS581|DRG|MS-DRG V38 (FY 2021) 581|||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,244.00|Repriced: HLB.264887176; Cases: 1||No price history available with this financial class||||
MS596|DRG|MS-DRG V38 (FY 2021) 596|||Major Skin Disorders Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,904.24|Repriced: HLB.293142056; Cases: 1||No price history available with this financial class||||
MS603|DRG|MS-DRG V38 (FY 2021) 603|||Cellulitis Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,015.26|Repriced: HLB.275637588; Cases: 8||No price history available with this financial class||||
MS605|DRG|MS-DRG V38 (FY 2021) 605|||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,037.61|Repriced: HLB.304899251; Cases: 1||No price history available with this financial class||||
MS607|DRG|MS-DRG V38 (FY 2021) 607|||Minor Skin Disorders Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,454.44|Repriced: HLB.315842676; Cases: 1||No price history available with this financial class||||
MS616|DRG|MS-DRG V38 (FY 2021) 616|||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23,118.20|Repriced: HLB.300740227; Cases: 1||No price history available with this financial class||||
MS617|DRG|MS-DRG V38 (FY 2021) 617|||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24,194.35|Repriced: HLB.293198793; Cases: 5|11,175.64|Historical reimbursement; Scope: Financial Class; Cases: 2||||
MS623|DRG|MS-DRG V38 (FY 2021) 623|||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10,894.44|Repriced: HLB.277062708; Cases: 2||No price history available with this financial class||||
MS637|DRG|MS-DRG V38 (FY 2021) 637|||Diabetes With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,691.04|Repriced: HLB.292496755; Cases: 5|7,192.20|Historical reimbursement; Scope: Contract; Cases: 3||||
MS638|DRG|MS-DRG V38 (FY 2021) 638|||Diabetes With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,568.10|Repriced: HLB.244574772; Cases: 9|5,241.74|Historical reimbursement; Scope: Financial Class; Cases: 5||||
MS640|DRG|MS-DRG V38 (FY 2021) 640|||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,135.77|Repriced: HLB.225192219; Cases: 2||No price history available with this financial class||||
MS641|DRG|MS-DRG V38 (FY 2021) 641|||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,395.95|Repriced: HLB.253696360; Cases: 7|2,178.96|Historical reimbursement; Scope: Financial Class; Cases: 2||||
MS643|DRG|MS-DRG V38 (FY 2021) 643|||Endocrine Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,139.46|Repriced: HLB.274054659; Cases: 1||No price history available with this financial class||||
MS644|DRG|MS-DRG V38 (FY 2021) 644|||Endocrine Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42,843.52|Repriced: HLB.246047160; Cases: 1||No price history available with this financial class||||
MS656|DRG|MS-DRG V38 (FY 2021) 656|||Kidney And Ureter Procedures For Neoplasm With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31,968.58|Repriced: HLB.302144688; Cases: 1||No price history available with this financial class||||
MS660|DRG|MS-DRG V38 (FY 2021) 660|||Kidney And Ureter Procedures For Non-Neoplasm With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,948.36|Repriced: HLB.288090099; Cases: 2||No price history available with this financial class||||
MS673|DRG|MS-DRG V38 (FY 2021) 673|||Other Kidney And Urinary Tract Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33,271.60|Repriced: HLB.236398446; Cases: 1||No price history available with this financial class||||
MS682|DRG|MS-DRG V38 (FY 2021) 682|||Renal Failure With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,396.28|Repriced: HLB.249951471; Cases: 3||No price history available with this financial class||||
MS683|DRG|MS-DRG V38 (FY 2021) 683|||Renal Failure With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,271.08|Repriced: HLB.312532001; Cases: 7|5,391.19|Historical reimbursement; Scope: Contract; Cases: 1||||
MS689|DRG|MS-DRG V38 (FY 2021) 689|||Kidney And Urinary Tract Infections With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,826.61|Repriced: HLB.231416012; Cases: 9||No price history available with this financial class||||
MS690|DRG|MS-DRG V38 (FY 2021) 690|||Kidney And Urinary Tract Infections Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,035.53|Repriced: HLB.282770743; Cases: 11|4,737.60|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS698|DRG|MS-DRG V38 (FY 2021) 698|||Other Kidney And Urinary Tract Diagnoses With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,172.53|Repriced: HLB.263023993; Cases: 10||No price history available with this financial class||||
MS708|DRG|MS-DRG V38 (FY 2021) 708|||Major Male Pelvic Procedures Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,364.17|Repriced: HLB.308232772; Cases: 1||No price history available with this financial class||||
MS717|DRG|MS-DRG V38 (FY 2021) 717|||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26,092.46|Repriced: HLB.276470593; Cases: 1||No price history available with this financial class||||
MS741|DRG|MS-DRG V38 (FY 2021) 741|||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,323.84|Repriced: HLB.284830373; Cases: 2|8,054.73|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS742|DRG|MS-DRG V38 (FY 2021) 742|||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,588.57|Repriced: HLB.271019645; Cases: 2||No price history available with this financial class||||
MS743|DRG|MS-DRG V38 (FY 2021) 743|||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,137.68|Repriced: HLB.256237769; Cases: 8|7,713.38|Historical reimbursement; Scope: Contract; Cases: 1||||
MS759|DRG|MS-DRG V38 (FY 2021) 759|||Infections, Female Reproductive System Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,751.83|Repriced: HLB.205111671; Cases: 1||No price history available with this financial class||||
MS760|DRG|MS-DRG V38 (FY 2021) 760|||Menstrual And Other Female Reproductive System Disorders With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,606.03|Repriced: HLB.281761898; Cases: 1||No price history available with this financial class||||
MS768|DRG|MS-DRG V38 (FY 2021) 768|||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13,296.23|Repriced: HLB.299109541; Cases: 4||No price history available with this financial class||||
MS776|DRG|MS-DRG V38 (FY 2021) 776|||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,569.35|Repriced: HLB.310122130; Cases: 2|3,013.43|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS779|DRG|MS-DRG V38 (FY 2021) 779|||Abortion Without D&C|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,989.85|Repriced: HLB.287592054; Cases: 1|4,483.68|Historical reimbursement; Scope: Contract; Cases: 1||||
MS789|DRG|MS-DRG V38 (FY 2021) 789|||Neonates, Died Or Transferred To Another Acute Care Facility|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,675.76|Repriced: HLB.246962315; Cases: 5|1,426.07|Historical reimbursement; Scope: Financial Class; Cases: 4||||
MS792|DRG|MS-DRG V38 (FY 2021) 792|||Prematurity Without Major Problems|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,803.30|Repriced: HLB.295396414; Cases: 6|2,070.50|Historical reimbursement; Scope: Financial Class; Cases: 3||||
MS793|DRG|MS-DRG V38 (FY 2021) 793|||Full Term Neonate With Major Problems|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,757.35|Repriced: HLB.299621388; Cases: 4|9,475.79|Historical reimbursement; Scope: Financial Class; Cases: 3||||
MS794|DRG|MS-DRG V38 (FY 2021) 794|||Neonate With Other Significant Problems|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|6,997.56|Repriced: HLB.271662565; Cases: 25|2,070.50|Historical reimbursement; Scope: Contract; Cases: 12||||
MS795|DRG|MS-DRG V38 (FY 2021) 795|||Normal Newborn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5,110.25|Repriced: HLB.277409224; Cases: 154|2,070.50|Historical reimbursement; Scope: Contract; Cases: 50||||
MS808|DRG|MS-DRG V38 (FY 2021) 808|||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32,048.29|Repriced: HLB.235501153; Cases: 1||No price history available with this financial class||||
MS809|DRG|MS-DRG V38 (FY 2021) 809|||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22,171.18|Repriced: HLB.305441073; Cases: 3||No price history available with this financial class||||
MS811|DRG|MS-DRG V38 (FY 2021) 811|||Red Blood Cell Disorders With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29,241.18|Repriced: HLB.262742141; Cases: 3|8,415.88|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS812|DRG|MS-DRG V38 (FY 2021) 812|||Red Blood Cell Disorders Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,812.98|Repriced: HLB.281651516; Cases: 2|5,896.19|Historical reimbursement; Scope: Contract; Cases: 1||||
MS813|DRG|MS-DRG V38 (FY 2021) 813|||Coagulation Disorders|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,106.79|Repriced: HLB.264434666; Cases: 4||No price history available with this financial class||||
MS821|DRG|MS-DRG V38 (FY 2021) 821|||Lymphoma And Leukemia With Major O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17,104.82|Repriced: HLB.280464954; Cases: 1||No price history available with this financial class||||
MS853|DRG|MS-DRG V38 (FY 2021) 853|||Infectious And Parasitic Diseases With O.R. Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55,628.85|Repriced: HLB.263605463; Cases: 13|3,125.22|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS854|DRG|MS-DRG V38 (FY 2021) 854|||Infectious And Parasitic Diseases With O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,470.51|Repriced: HLB.260460461; Cases: 4||No price history available with this financial class||||
MS856|DRG|MS-DRG V38 (FY 2021) 856|||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35,546.11|Repriced: HLB.290099635; Cases: 1|39,966.98|Historical reimbursement; Scope: Contract; Cases: 1||||
MS857|DRG|MS-DRG V38 (FY 2021) 857|||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,890.01|Repriced: HLB.290121139; Cases: 2||No price history available with this financial class||||
MS863|DRG|MS-DRG V38 (FY 2021) 863|||Postoperative And Post-Traumatic Infections Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,814.15|Repriced: HLB.254992081; Cases: 1||No price history available with this financial class||||
MS866|DRG|MS-DRG V38 (FY 2021) 866|||Viral Illness Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,707.26|Repriced: HLB.193584733; Cases: 1||No price history available with this financial class||||
MS870|DRG|MS-DRG V38 (FY 2021) 870|||Septicemia Or Severe Sepsis With Mv >96 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|109,850.42|Repriced: HLB.256569191; Cases: 2||No price history available with this financial class||||
MS871|DRG|MS-DRG V38 (FY 2021) 871|||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25,103.77|Repriced: HLB.210134145; Cases: 82|9,885.78|Historical reimbursement; Scope: Financial Class; Cases: 3||||
MS872|DRG|MS-DRG V38 (FY 2021) 872|||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,951.51|Repriced: HLB.283986197; Cases: 19|2,318.42|Historical reimbursement; Scope: Financial Class; Cases: 2||||
MS885|DRG|MS-DRG V38 (FY 2021) 885|||Psychoses|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,765.71|Repriced: HLB.313186223; Cases: 1||No price history available with this financial class||||
MS896|DRG|MS-DRG V38 (FY 2021) 896|||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,190.92|Repriced: HLB.242018330; Cases: 2|7,967.93|Historical reimbursement; Scope: Contract; Cases: 1||||
MS902|DRG|MS-DRG V38 (FY 2021) 902|||Wound Debridements For Injuries With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36,232.93|Repriced: HLB.231437966; Cases: 1||No price history available with this financial class||||
MS904|DRG|MS-DRG V38 (FY 2021) 904|||Skin Grafts For Injuries With Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|77,610.95|Repriced: HLB.234677661; Cases: 1||No price history available with this financial class||||
MS907|DRG|MS-DRG V38 (FY 2021) 907|||Other O.R. Procedures For Injuries With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28,984.41|Repriced: HLB.259155146; Cases: 4|25,194.37|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS909|DRG|MS-DRG V38 (FY 2021) 909|||Other O.R. Procedures For Injuries Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27,204.98|Repriced: HLB.252722782; Cases: 1||No price history available with this financial class||||
MS914|DRG|MS-DRG V38 (FY 2021) 914|||Traumatic Injury Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12,427.88|Repriced: HLB.269534250; Cases: 1|5,038.92|Historical reimbursement; Scope: Contract; Cases: 1||||
MS915|DRG|MS-DRG V38 (FY 2021) 915|||Allergic Reactions With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32,107.24|Repriced: HLB.276183529; Cases: 1|5,415.22|Historical reimbursement; Scope: Contract; Cases: 1||||
MS917|DRG|MS-DRG V38 (FY 2021) 917|||Poisoning And Toxic Effects Of Drugs With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,037.98|Repriced: HLB.263945799; Cases: 3|4,536.05|Historical reimbursement; Scope: Financial Class; Cases: 2||||
MS918|DRG|MS-DRG V38 (FY 2021) 918|||Poisoning And Toxic Effects Of Drugs Without McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,259.74|Repriced: HLB.288101521; Cases: 2||No price history available with this financial class||||
MS920|DRG|MS-DRG V38 (FY 2021) 920|||Complications Of Treatment With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15,690.17|Repriced: HLB.265929404; Cases: 1||No price history available with this financial class||||
MS957|DRG|MS-DRG V38 (FY 2021) 957|||Other O.R. Procedures For Multiple Significant Trauma With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53,809.69|Repriced: HLB.271252197; Cases: 1|25,026.58|Historical reimbursement; Scope: Financial Class; Cases: 1||||
MS975|DRG|MS-DRG V38 (FY 2021) 975|||Hiv With Major Related Condition With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44,802.37|Repriced: HLB.235817149; Cases: 1||No price history available with this financial class||||
MS982|DRG|MS-DRG V38 (FY 2021) 982|||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,923.00|Repriced: HLB.261199833; Cases: 3|12,287.96|Historical reimbursement; Scope: Contract; Cases: 1||||
MS988|DRG|MS-DRG V38 (FY 2021) 988|||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21,504.34|Repriced: HLB.312603608; Cases: 2||No price history available with this financial class||||
MS570|DRG|MS-DRG V38 (FY 2021) 570|||Skin Debridement With McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22,453.88|Repriced: HLB.279554943; Cases: 1||No price history available with this financial class||||
MS571|DRG|MS-DRG V38 (FY 2021) 571|||Skin Debridement With Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18,960.94|Repriced: HLB.287757894; Cases: 3||No price history available with this financial class||||
MS572|DRG|MS-DRG V38 (FY 2021) 572|||Skin Debridement Without Cc/McC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19,661.28|Repriced: HLB.282451497; Cases: 1||No price history available with this financial class||||
25605|EAP|CPT® 25605|||Pr Closed Rx Dist Rad/ulna Fx,manipul|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|799.00|FSC: 46100; BFG: 52||Not reimbursed separately|799.00|FSC: 46100; BFG: 52||External grouping not supported
26010|EAP|CPT® 26010||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Drain Finger Abscess,simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|595.00|FSC: 46100; BFG: 52||Not reimbursed separately|595.00|FSC: 46100; BFG: 52||External grouping not supported
26055|EAP|CPT® 26055|||Pr Incise Finger Tendon Sheath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|807.00|FSC: 46100; BFG: 52||Not reimbursed separately|807.00|FSC: 46100; BFG: 52||External grouping not supported
26160|EAP|CPT® 26160|||Pr Excis Tendon Sheath Lesion, Hand/finger|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|835.00|FSC: 46100; BFG: 52||Not reimbursed separately|835.00|FSC: 46100; BFG: 52||External grouping not supported
26418|EAP|CPT® 26418|||Pr Repair Exten Tendon,dorsum Fingr,ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|831.00|FSC: 46100; BFG: 52||Not reimbursed separately|831.00|FSC: 46100; BFG: 52||External grouping not supported
32551|EAP|CPT® 32551|||TUBE THORACOSTOMY INCLUDES WATER SEAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|285.00|FSC: 46100; BFG: 52||Not reimbursed separately|285.00|FSC: 46100; BFG: 52||External grouping not supported
99406|EAP|CPT® 99406|||PR SMOKE/TOBACCO COUNSELING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.00|FSC: 46100; BFG: 52||Not reimbursed separately|25.00|FSC: 46100; BFG: 52||External grouping not supported
99441|EAP|CPT® 99441||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|PHYS/QHP TELEPHONE EVALUATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.00|FSC: 46100; BFG: 52||Not reimbursed separately|34.00|FSC: 46100; BFG: 52||External grouping not supported
99442|EAP|CPT® 99442||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|PHYS/QHP TELEPHONE EVALUATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.00|FSC: 46100; BFG: 52||Not reimbursed separately|68.00|FSC: 46100; BFG: 52||External grouping not supported
99443|EAP|CPT® 99443||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|PHYS/QHP TELEPHONE EVALUATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.00|FSC: 46100; BFG: 52||Not reimbursed separately|102.00|FSC: 46100; BFG: 52||External grouping not supported
NCNC|EAP|Custom NCNC0|||No Charge|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 46100||Not reimbursed separately|0.00|FSC: 46100||External grouping not supported
S2083|EAP|HCPCS S2083|||Pr Adjustment Gastric Band|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|215.00|FSC: 46100; BFG: 52||Not reimbursed separately|215.00|FSC: 46100; BFG: 52||External grouping not supported
45000001|EAP|CPT® 99281||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Emergency Room Level 1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|199.50|FSC: 400601; BFG: 52||Not reimbursed separately|199.50|FSC: 400601; BFG: 52||External grouping not supported
45000002|EAP|CPT® 99282||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Emergency Room Level 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|279.30|FSC: 400601; BFG: 52||Not reimbursed separately|279.30|FSC: 400601; BFG: 52||External grouping not supported
45000003|EAP|CPT® 99283||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Emergency Room Level 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|837.90|FSC: 400601; BFG: 52||Not reimbursed separately|837.90|FSC: 400601; BFG: 52||External grouping not supported
45000004|EAP|CPT® 99284||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Emergency Room Level 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,421.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,421.70|FSC: 400601; BFG: 52||External grouping not supported
45000005|EAP|CPT® 99285||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Emergency Room Level 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,575.00|FSC: 400601; BFG: 52||Not reimbursed separately|1,575.00|FSC: 400601; BFG: 52||External grouping not supported
45000006|EAP|CPT® 99291||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Emergency Room Critical Care|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,431.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,431.80|FSC: 400601; BFG: 52||External grouping not supported
26000002|EAP|CPT® 96361||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Hydration Each Additional Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.80|FSC: 400601; BFG: 52||Not reimbursed separately|121.80|FSC: 400601; BFG: 52||External grouping not supported
26000001|EAP|CPT® 96360||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Hydration Initial Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|420.00|FSC: 400601; BFG: 52||Not reimbursed separately|420.00|FSC: 400601; BFG: 52||External grouping not supported
26000004|EAP|CPT® 96366||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Iv Infusion Non-chemo Each Additional Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|123.90|FSC: 400601; BFG: 52||Not reimbursed separately|123.90|FSC: 400601; BFG: 52||External grouping not supported
26000003|EAP|CPT® 96365||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Iv Infusion Non-chemo Initial Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|420.00|FSC: 400601; BFG: 52||Not reimbursed separately|420.00|FSC: 400601; BFG: 52||External grouping not supported
26000005|EAP|CPT® 96367||0260 - IV THERAPY - GENERAL CLASSIFICATION|HC IV INFUSION NON-CHEMO SEQUENTIAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|331.80|FSC: 400601; BFG: 52||Not reimbursed separately|331.80|FSC: 400601; BFG: 52||External grouping not supported
26000007|EAP|CPT® 96374||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Iv Push Non-chemo Initial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|531.30|FSC: 400601; BFG: 52||Not reimbursed separately|531.30|FSC: 400601; BFG: 52||External grouping not supported
26000008|EAP|CPT® 96375||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Iv Push Non-chemo Sequential Different Drug|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.10|FSC: 400601; BFG: 52||Not reimbursed separately|128.10|FSC: 400601; BFG: 52||External grouping not supported
26000009|EAP|CPT® 96376||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Iv Push Non-chemo Sequential Same Drug|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|107.10|FSC: 400601; BFG: 52||Not reimbursed separately|107.10|FSC: 400601; BFG: 52||External grouping not supported
32000195|EAP|CPT® 76377||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc 3d Rendering Postprocessing W/ Independent Workstation Diag Rad|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
32000194|EAP|CPT® 76376||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc 3d Rendering Postprocessing W/o Independent Workstation Diag Rad|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
32000092|EAP|CPT® 73615||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Arthrography Ankle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,222.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,222.20|FSC: 400601; BFG: 52||External grouping not supported
32000070|EAP|CPT® 73085||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Arthrography Elbow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,222.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,222.20|FSC: 400601; BFG: 52||External grouping not supported
32000081|EAP|CPT® 73525||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Arthrography Hip|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,222.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,222.20|FSC: 400601; BFG: 52||External grouping not supported
32000088|EAP|CPT® 73580||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Arthrography Knee|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,222.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,222.20|FSC: 400601; BFG: 52||External grouping not supported
32000065|EAP|CPT® 73040||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Arthrography Shoulder|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,222.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,222.20|FSC: 400601; BFG: 52||External grouping not supported
32000074|EAP|CPT® 73115||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Arthrography Wrist|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000113|EAP|CPT® 74300||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cholangiography Pancreatography Intraoperative|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|285.60|FSC: 400601; BFG: 52||Not reimbursed separately|285.60|FSC: 400601; BFG: 52||External grouping not supported
32000114|EAP|CPT® 74301||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cholangiography Pancreatography Intraoperative Additional Set|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.20|FSC: 400601; BFG: 52||Not reimbursed separately|130.20|FSC: 400601; BFG: 52||External grouping not supported
32000058|EAP|CPT® 72285||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Discography Cervical Thoracic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
32000060|EAP|CPT® 72295||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Discography Lumbar|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
32000183|EAP|CPT® 75989||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Placement Percutaneous Drainage Catheter Fluoro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|985.95|FSC: 400601; BFG: 52||Not reimbursed separately|985.95|FSC: 400601; BFG: 52||External grouping not supported
32000191|EAP|CPT® 76080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Abscess Fistula Sinus Tract Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000204|EAP|CPT® 77072||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Bone Age Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000210|EAP|CPT® 77081||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Bone Density Study Appendicular|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000209|EAP|CPT® 77080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Bone Density Study Axial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000205|EAP|CPT® 77073||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Bone Length Studies|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000182|EAP|CPT® 75984||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Change Percutaneous Drainage Catheter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|687.75|FSC: 400601; BFG: 52||Not reimbursed separately|687.75|FSC: 400601; BFG: 52||External grouping not supported
32000130|EAP|CPT® 74430||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Cystography Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,013.25|FSC: 400601; BFG: 52||Not reimbursed separately|1,013.25|FSC: 400601; BFG: 52||External grouping not supported
32000097|EAP|CPT® 74018||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Abdomen Single View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000066|EAP|CPT® 73050||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Acromioclavicular Joints Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000090|EAP|CPT® 73600||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Ankle 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000091|EAP|CPT® 73610||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Ankle Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000095|EAP|CPT® 73650||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Calcaneus Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000036|EAP|CPT® 72040||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Cervical Spine 2 Or 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000037|EAP|CPT® 72050||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|HC RADIOLOGY EXAM CERVICAL SPINE MIN 4 VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000038|EAP|CPT® 72052||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|HC RADIOLOGY EXAM CERVICAL SPINE, COMPLETE, OBLIQUE, FLEXION, OR EXTENSION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000061|EAP|CPT® 73000||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Clavicle- Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000111|EAP|CPT® 74280||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Colon Incl Scout Abdominal W/double-contrast (barium)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000110|EAP|CPT® 74270||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Colon Incl Scout Abdominal W/single-contrast (barium)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000099|EAP|CPT® 74022||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Acute Abdomen Series Complete 2 Or More Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000068|EAP|CPT® 73070||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Elbow 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000069|EAP|CPT® 73080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Elbow Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000101|EAP|CPT® 74220||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Esophagus Incl Scout Neck W/single-contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000002|EAP|CPT® 70030||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Eye For Fb Detection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000008|EAP|CPT® 70140||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Facial Bones < 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000009|EAP|CPT® 70150||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Facial Bones Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000077|EAP|CPT® 73140||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Finger(s) Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000093|EAP|CPT® 73620||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Foot 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000094|EAP|CPT® 73630||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Foot Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000071|EAP|CPT® 73090||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Forearm 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000075|EAP|CPT® 73120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Hand 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000076|EAP|CPT® 73130||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Hand Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000067|EAP|CPT® 73060||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Humerus Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000084|EAP|CPT® 73560||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Knee 1 Or 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000085|EAP|CPT® 73562||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Knee 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000086|EAP|CPT® 73564||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Knee Complete- 4 Or More Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000087|EAP|CPT® 73565||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Knees Bilateral Standing Ap|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000048|EAP|CPT® 72120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Lumbosacral Bending Only 2 Or 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000045|EAP|CPT® 72100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Lumbosacral Spine 2 Or 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000046|EAP|CPT® 72110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Lumbosacral Spine Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000047|EAP|CPT® 72114||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|HC RADIOLOGY EXAM LUMBOSACRAL SPINE, COMPLETE, INCLUDING BENDING VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000004|EAP|CPT® 70110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Mandible Complete- Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000003|EAP|CPT® 70100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Mandible Partial < 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000006|EAP|CPT® 70130||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Mastoids Complete- Min 3 Views Per Side|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000010|EAP|CPT® 70160||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Nasal Bones Complete-min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000024|EAP|CPT® 70360||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Neck Soft Tissue|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000012|EAP|CPT® 70200||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Orbits Complete- Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000013|EAP|CPT® 70210||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Paranasal Sinuses < 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000014|EAP|CPT® 70220||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Paranasal Sinuses Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000049|EAP|CPT® 72170||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Pelvis 1 Or 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000050|EAP|CPT® 72190||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Pelvis Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000100|EAP|CPT® 74210||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Pharynx Cervical Esophagus Incl Scout Neck W/contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000030|EAP|CPT® 71110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Ribs Bilateral 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000031|EAP|CPT® 71111||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Ribs Bilateral W/ Pa Chest Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000028|EAP|CPT® 71100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Ribs Unilateral 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000029|EAP|CPT® 71101||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Ribs Unilateral W/ Pa Chest Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000052|EAP|CPT® 72202||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Sacroiliac Joint 3 Or More Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000053|EAP|CPT® 72220||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Sacrum & Coccyx Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000025|EAP|CPT® 70380||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Salivary Gland Calculus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000062|EAP|CPT® 73010||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Scapula- Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000015|EAP|CPT® 70240||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Sella Turcica|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000063|EAP|CPT® 73020||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Shoulder 1 View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000064|EAP|CPT® 73030||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Shoulder Complete- Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000016|EAP|CPT® 70250||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Skull < 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000017|EAP|CPT® 70260||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Skull Complete- Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000107|EAP|CPT® 74250||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Small Intestine Incl Scout Abdominal W/single-contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000108|EAP|CPT® 74251||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Small Int Via Entercolysis Tube Incl Scout Abd Dbl-contst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|605.85|FSC: 400601; BFG: 52||Not reimbursed separately|605.85|FSC: 400601; BFG: 52||External grouping not supported
32000035|EAP|CPT® 72020||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Spine Single View- Specify Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000033|EAP|CPT® 71130||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Sternoclavicular Joint Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000032|EAP|CPT® 71120||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Sternum Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000040|EAP|CPT® 72070||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Thoracic Spine 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000041|EAP|CPT® 72072||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Thoracic Spine 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000042|EAP|CPT® 72074||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Thoracic Spine Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000043|EAP|CPT® 72080||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Thoracolumbar Spine 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000089|EAP|CPT® 73590||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Tibia Fibula 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000021|EAP|CPT® 70330||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Tmj Open & Closed Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000096|EAP|CPT® 73660||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Toe(s) Min 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000106|EAP|CPT® 74249||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Upper Gi W/ Air Contrast W/ Small Bowel Follow-through|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000105|EAP|CPT® 74246||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Upper Gi Incl Scout Abdominal W/double-contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000104|EAP|CPT® 74245||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Upper Gi W/ Small Intestine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000103|EAP|CPT® 74240||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Upper Gi Incl Scout Abdominal W/single-contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000072|EAP|CPT® 73100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Wrist 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000073|EAP|CPT® 73110||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Wrist Complete- Min 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000197|EAP|CPT® 77001||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Fluoroscopic Guidance For Central Venous Access Device|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|386.40|FSC: 400601; BFG: 52||Not reimbursed separately|386.40|FSC: 400601; BFG: 52||External grouping not supported
32000198|EAP|CPT® 77002||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Fluoroscopic Guidance For Needle Placement Bx Or Fna|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|348.60|FSC: 400601; BFG: 52||Not reimbursed separately|348.60|FSC: 400601; BFG: 52||External grouping not supported
32000199|EAP|CPT® 77003||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Fluoroscopic Guidance For Spinal Injection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|413.70|FSC: 400601; BFG: 52||Not reimbursed separately|413.70|FSC: 400601; BFG: 52||External grouping not supported
32000189|EAP|CPT® 76000||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Fluoroscopy Up To 1 Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000136|EAP|CPT® 74740||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Hysterosalpingography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000123|EAP|CPT® 74360||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Intraluminal Dilation Stricture Obstruction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|408.45|FSC: 400601; BFG: 52||Not reimbursed separately|408.45|FSC: 400601; BFG: 52||External grouping not supported
32000121|EAP|CPT® 74340||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Introduction Of Long Gi Tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|337.05|FSC: 400601; BFG: 52||Not reimbursed separately|337.05|FSC: 400601; BFG: 52||External grouping not supported
32000202|EAP|CPT® 77053||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Mammary Ductogram|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000207|EAP|CPT® 77075||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Osseous Survey- Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000206|EAP|CPT® 77074||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Osseous Survey- Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000124|EAP|CPT® 74363||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Percutaneous Transhepatic Dilation Biliary Duct|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|788.55|FSC: 400601; BFG: 52||Not reimbursed separately|788.55|FSC: 400601; BFG: 52||External grouping not supported
32000131|EAP|CPT® 74450||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Retrograde Urethrocystography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000128|EAP|CPT® 74420||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Retrograde Urography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,222.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,222.20|FSC: 400601; BFG: 52||External grouping not supported
32000193|EAP|CPT® 76100||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Single Plane Body Section|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000208|EAP|CPT® 77077||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Single View Joint Survey 2+ Joints|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000192|EAP|CPT® 76098||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Surgical Specimen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,303.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,303.05|FSC: 400601; BFG: 52||External grouping not supported
32000127|EAP|CPT® 74415||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Urography Infusion W/ Tomography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000125|EAP|CPT® 74400||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Urography Intravenous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000140|EAP|CPT® 75822||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Venography Extremity Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,632.35|FSC: 400601; BFG: 52||Not reimbursed separately|2,632.35|FSC: 400601; BFG: 52||External grouping not supported
32000139|EAP|CPT® 75820||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Venography Extremity Unilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,640.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,640.10|FSC: 400601; BFG: 52||External grouping not supported
32000102|EAP|CPT® 74230||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Swalowing Function Incl Scout Neck W/contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000132|EAP|CPT® 74455||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Voiding Urethrocystography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32000026|EAP|CPT® 70390||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Sialography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
32400002|EAP|CPT® 71046||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hc Radiology X-ray Chest 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32400004|EAP|CPT® 71048||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hc Radiology X-ray Chest Min 4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32400001|EAP|CPT® 71045||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hc Radiology X-ray Chest Single View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
61000020|EAP|CPT® 76377||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc 3d Rendering Postprocessing W/ Independent Workstation Mri|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
61000019|EAP|CPT® 76376||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc 3d Rendering Postprocessing W/o Independent Workstation Mri|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
61000013|EAP|CPT® 74181||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Abdomen W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,547.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,547.70|FSC: 400601; BFG: 52||External grouping not supported
61000022|EAP|CPT® 77084||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Bone Marrow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,795.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,795.50|FSC: 400601; BFG: 52||External grouping not supported
61000025|EAP|HCPCS C8908||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Breast W & W/o Contrast Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,795.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,795.50|FSC: 400601; BFG: 52||External grouping not supported
61000024|EAP|HCPCS C8905||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Breast W & W/o Contrast Unilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,078.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,078.35|FSC: 400601; BFG: 52||External grouping not supported
61000016|EAP|CPT® 75561||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Cardiac Morphology & Function W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,078.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,078.35|FSC: 400601; BFG: 52||External grouping not supported
61000017|EAP|CPT® 75563||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Cardiac Morphology & Function W/ & W/o Contrast W/ Stress|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,607.55|FSC: 400601; BFG: 52||Not reimbursed separately|1,607.55|FSC: 400601; BFG: 52||External grouping not supported
61000014|EAP|CPT® 75557||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Cardiac Morphology & Function W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,795.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,795.50|FSC: 400601; BFG: 52||External grouping not supported
61000015|EAP|CPT® 75559||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Cardiac Morphology & Function W/o Contrast W/ Stress|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,795.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,795.50|FSC: 400601; BFG: 52||External grouping not supported
61000018|EAP|CPT® 75565||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Cardiac Velocity Flow Mapping|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|850.50|FSC: 400601; BFG: 52||Not reimbursed separately|850.50|FSC: 400601; BFG: 52||External grouping not supported
61000005|EAP|CPT® 71550||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Chest W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,941.45|FSC: 400601; BFG: 52||Not reimbursed separately|1,941.45|FSC: 400601; BFG: 52||External grouping not supported
61000012|EAP|CPT® 73721||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Lower Extremity Joint W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,883.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,883.70|FSC: 400601; BFG: 52||External grouping not supported
61000011|EAP|CPT® 73720||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Lower Extremity Other Than Joint W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,698.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,698.50|FSC: 400601; BFG: 52||External grouping not supported
61000004|EAP|CPT® 70543||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Orbit Face Neck W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,698.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,698.50|FSC: 400601; BFG: 52||External grouping not supported
61000002|EAP|CPT® 70540||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Orbit Face Neck W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,972.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,972.95|FSC: 400601; BFG: 52||External grouping not supported
61000008|EAP|CPT® 72197||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Pelvis W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,311.05|FSC: 400601; BFG: 52||Not reimbursed separately|2,311.05|FSC: 400601; BFG: 52||External grouping not supported
61000006|EAP|CPT® 72195||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Pelvis W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,588.65|FSC: 400601; BFG: 52||Not reimbursed separately|1,588.65|FSC: 400601; BFG: 52||External grouping not supported
61000001|EAP|CPT® 70336||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Tempromandibular Joint|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,356.20|FSC: 400601; BFG: 52||Not reimbursed separately|2,356.20|FSC: 400601; BFG: 52||External grouping not supported
61000010|EAP|CPT® 73221||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Upper Extremity Joint W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,713.60|FSC: 400601; BFG: 52||Not reimbursed separately|1,713.60|FSC: 400601; BFG: 52||External grouping not supported
61000009|EAP|CPT® 73220||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Upper Extremity Other Than Joint W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,698.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,698.50|FSC: 400601; BFG: 52||External grouping not supported
61100003|EAP|CPT® 70553||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN (INCLUDING BRAINSTEM)|Hc Mri Brain W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,798.25|FSC: 400601; BFG: 52||Not reimbursed separately|2,798.25|FSC: 400601; BFG: 52||External grouping not supported
61100002|EAP|CPT® 70552||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN (INCLUDING BRAINSTEM)|Hc Mri Brain W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,107.35|FSC: 400601; BFG: 52||Not reimbursed separately|2,107.35|FSC: 400601; BFG: 52||External grouping not supported
61100001|EAP|CPT® 70551||0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN (INCLUDING BRAINSTEM)|Hc Mri Brain W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,615.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,615.95|FSC: 400601; BFG: 52||External grouping not supported
61200007|EAP|CPT® 72156||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/ & W/o Contrast Cervical|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,702.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,702.70|FSC: 400601; BFG: 52||External grouping not supported
61200009|EAP|CPT® 72158||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/ & W/o Contrast Lumbar|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,731.05|FSC: 400601; BFG: 52||Not reimbursed separately|2,731.05|FSC: 400601; BFG: 52||External grouping not supported
61200008|EAP|CPT® 72157||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/ & W/o Contrast Thoracic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,702.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,702.70|FSC: 400601; BFG: 52||External grouping not supported
61200002|EAP|CPT® 72142||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/ Contrast Cervical|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,846.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,846.95|FSC: 400601; BFG: 52||External grouping not supported
61200006|EAP|CPT® 72149||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/ Contrast Lumbar|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,918.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,918.35|FSC: 400601; BFG: 52||External grouping not supported
61200004|EAP|CPT® 72147||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/ Contrast Thoracic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,078.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,078.35|FSC: 400601; BFG: 52||External grouping not supported
61200001|EAP|CPT® 72141||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/o Contrast Cervical|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,825.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,825.95|FSC: 400601; BFG: 52||External grouping not supported
61200005|EAP|CPT® 72148||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/o Contrast Lumbar|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,560.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,560.30|FSC: 400601; BFG: 52||External grouping not supported
61200003|EAP|CPT® 72146||0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD (INCLUDING SPINE)|Hc Mri Spine W/o Contrast Thoracic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,560.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,560.30|FSC: 400601; BFG: 52||External grouping not supported
61400003|EAP|CPT® 71552||0614 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - OTHER|Hc Mri Chest W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,681.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,681.70|FSC: 400601; BFG: 52||External grouping not supported
61500003|EAP|CPT® 70546||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hc Mra Head W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,969.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,969.80|FSC: 400601; BFG: 52||External grouping not supported
61500002|EAP|CPT® 70545||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hc Mra Head W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,179.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,179.80|FSC: 400601; BFG: 52||External grouping not supported
61500001|EAP|CPT® 70544||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hc Mra Head W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,549.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,549.80|FSC: 400601; BFG: 52||External grouping not supported
61500006|EAP|CPT® 70549||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hc Mra Neck W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,179.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,179.80|FSC: 400601; BFG: 52||External grouping not supported
61500005|EAP|CPT® 70548||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hc Mra Neck W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61500004|EAP|CPT® 70547||0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK|Hc Mra Neck W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,549.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,549.80|FSC: 400601; BFG: 52||External grouping not supported
61600003|EAP|HCPCS C8914||0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - LOWER EXTREMITIES|Hc Mra Lower Extremity W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61600001|EAP|HCPCS C8912||0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - LOWER EXTREMITIES|Hc Mra Lower Extremity W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,179.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,179.80|FSC: 400601; BFG: 52||External grouping not supported
61600002|EAP|HCPCS C8913||0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - LOWER EXTREMITIES|Hc Mra Lower Extremity W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,549.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,549.80|FSC: 400601; BFG: 52||External grouping not supported
61800005|EAP|HCPCS C8902||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Abdomen W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61800003|EAP|HCPCS C8900||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Abdomen W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,599.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,599.80|FSC: 400601; BFG: 52||External grouping not supported
61800004|EAP|HCPCS C8901||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Abdomen W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,549.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,549.80|FSC: 400601; BFG: 52||External grouping not supported
61800008|EAP|HCPCS C8911||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Chest W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61800006|EAP|HCPCS C8909||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Chest W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61800007|EAP|HCPCS C8910||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Chest W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,549.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,549.80|FSC: 400601; BFG: 52||External grouping not supported
61800011|EAP|HCPCS C8920||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Pelvis W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61800009|EAP|HCPCS C8918||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Pelvis W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,284.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,284.80|FSC: 400601; BFG: 52||External grouping not supported
61800010|EAP|HCPCS C8919||0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER|Hc Mra Pelvis W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,549.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,549.80|FSC: 400601; BFG: 52||External grouping not supported
75000076|EAP|CPT® 45378||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,900.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,900.50|FSC: 400601; BFG: 52||External grouping not supported
75000081|EAP|CPT® 45388||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Ablation Tumor Polyp Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000078|EAP|CPT® 45380||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000080|EAP|CPT® 45382||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Control Of Bleeding|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000077|EAP|CPT® 45379||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Removal Fb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000082|EAP|CPT® 45384||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Removal Tumor Polyp Lesion By Hot Bx Forcep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000083|EAP|CPT® 45385||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Removal Tumor Polyp Lesion By Snare|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000079|EAP|CPT® 45381||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Submucosal Injection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000103|EAP|HCPCS G0121||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Screening|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,900.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,900.50|FSC: 400601; BFG: 52||External grouping not supported
75000102|EAP|HCPCS G0105||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Screening High Risk|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,900.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,900.50|FSC: 400601; BFG: 52||External grouping not supported
75000058|EAP|CPT® 44388||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Through Stoma Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,919.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,919.40|FSC: 400601; BFG: 52||External grouping not supported
75000060|EAP|CPT® 44401||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Through Stoma W/ Ablation Tumor Polyp Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000059|EAP|CPT® 44389||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Through Stoma W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000039|EAP|CPT® 43450||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Dilation Esophagus Unguided Sound Or Bougie|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,009.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,009.70|FSC: 400601; BFG: 52||External grouping not supported
75000008|EAP|CPT® 43235||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,009.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,009.70|FSC: 400601; BFG: 52||External grouping not supported
75000012|EAP|CPT® 43239||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,009.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,009.70|FSC: 400601; BFG: 52||External grouping not supported
75000025|EAP|CPT® 43255||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Control Bleeding|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000021|EAP|CPT® 43248||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Dilation Esophagus Over Guide Wire|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,009.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,009.70|FSC: 400601; BFG: 52||External grouping not supported
75000018|EAP|CPT® 43245||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Dilation Gastric Outlet Obstruction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000019|EAP|CPT® 43246||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Placement Percutaneous G-tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000014|EAP|CPT® 43241||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Placement Tube/cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000020|EAP|CPT® 43247||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Removal Fb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,009.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,009.70|FSC: 400601; BFG: 52||External grouping not supported
75000023|EAP|CPT® 43250||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Removal Tumor Polyp Lesion By Hot Bx Forcep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000024|EAP|CPT® 43251||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Removal Tumor Polyp Lesion By Snare|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000009|EAP|CPT® 43236||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Submucosal Injection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,009.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,009.70|FSC: 400601; BFG: 52||External grouping not supported
75000043|EAP|CPT® 44360||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000048|EAP|CPT® 44369||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum W/ Ablation Tumor Polyp Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000044|EAP|CPT® 44361||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000047|EAP|CPT® 44366||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum W/ Control Bleeding|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000049|EAP|CPT® 44372||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum W/ Placement Percutaneous J-tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000045|EAP|CPT® 44363||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum W/ Removal Fb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000046|EAP|CPT® 44364||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine No Ileum W/ Removal Tumor Polyp Lesion By Snare|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000051|EAP|CPT® 44376||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine W/ Ileum Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000052|EAP|CPT® 44377||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine W/ Ileum W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000053|EAP|CPT® 44378||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Endo Small Intestine W/ Ileum W/ Control Bleeding|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,859.80|FSC: 400601; BFG: 52||Not reimbursed separately|3,859.80|FSC: 400601; BFG: 52||External grouping not supported
75000097|EAP|CPT® 43753||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Gastric Intubation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
75000042|EAP|CPT® 43761||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc G-tube Repositioning For Enteric Nutrition|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|620.55|FSC: 400601; BFG: 52||Not reimbursed separately|620.55|FSC: 400601; BFG: 52||External grouping not supported
75000064|EAP|CPT® 45330||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,919.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,919.40|FSC: 400601; BFG: 52||External grouping not supported
75000101|EAP|HCPCS G0104||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible Screening|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,900.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,900.50|FSC: 400601; BFG: 52||External grouping not supported
75000072|EAP|CPT® 45346||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Ablation Tumor Polyp Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000065|EAP|CPT® 45331||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,919.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,919.40|FSC: 400601; BFG: 52||External grouping not supported
75000068|EAP|CPT® 45334||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Control Bleeding|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000070|EAP|CPT® 45337||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Decompression|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000066|EAP|CPT® 45332||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Removal Fb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000067|EAP|CPT® 45333||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Removal Tumor Polyp Lesion By Hot Bx Forcep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,919.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,919.40|FSC: 400601; BFG: 52||External grouping not supported
75000071|EAP|CPT® 45338||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Removal Tumor Polyp Lesion By Snare|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
75000069|EAP|CPT® 45335||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Submucosal Injection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,919.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,919.40|FSC: 400601; BFG: 52||External grouping not supported
75000062|EAP|CPT® 45300||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Rigid Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,919.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,919.40|FSC: 400601; BFG: 52||External grouping not supported
75000063|EAP|CPT® 45305||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Rigid W/ Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,531.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,531.55|FSC: 400601; BFG: 52||External grouping not supported
47100003|EAP|CPT® 92587||0471 - AUDIOLOGY - DIAGNOSTIC|Hc Evoked Otoacoustic Emissions Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
48000002|EAP|CPT® 92960||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hc Cardioversion Elective|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,372.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,372.35|FSC: 400601; BFG: 52||External grouping not supported
48000001|EAP|CPT® 92950||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hc Cpr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
48300014|EAP|CPT® 93325||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Doppler Color Flow Velocity Mapping|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|366.45|FSC: 400601; BFG: 52||Not reimbursed separately|366.45|FSC: 400601; BFG: 52||External grouping not supported
48300015|EAP|CPT® 93320||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Doppler Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|330.75|FSC: 400601; BFG: 52||Not reimbursed separately|330.75|FSC: 400601; BFG: 52||External grouping not supported
48300016|EAP|CPT® 93321||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Doppler Limited Or Follow-up|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|220.50|FSC: 400601; BFG: 52||Not reimbursed separately|220.50|FSC: 400601; BFG: 52||External grouping not supported
48000057|EAP|HCPCS C8923||0480 - CARDIOLOGY - GENERAL CLASSIFICATION|Hc Echo M-mode Complete W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,821.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,821.75|FSC: 400601; BFG: 52||External grouping not supported
48300017|EAP|CPT® 93307||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo M-mode Complete W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,303.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,303.05|FSC: 400601; BFG: 52||External grouping not supported
48300018|EAP|CPT® 93308||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo M-mode Follow-up Or Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
48300019|EAP|CPT® 93350||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Stress|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,303.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,303.05|FSC: 400601; BFG: 52||External grouping not supported
48300020|EAP|CPT® 93312||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Tee Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,303.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,303.05|FSC: 400601; BFG: 52||External grouping not supported
48200001|EAP|CPT® 93017||0482 - CARDIOLOGY - STRESS TEST|Hc Stress Test W/ Continuous Ekg Monitoring|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|880.95|FSC: 400601; BFG: 52||Not reimbursed separately|880.95|FSC: 400601; BFG: 52||External grouping not supported
48300001|EAP|CPT® 93303||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Complete Congenital Anomalies W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,149.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,149.75|FSC: 400601; BFG: 52||External grouping not supported
48300004|EAP|CPT® 93306||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Complete W/ Bubble Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,025.45|FSC: 400601; BFG: 52||Not reimbursed separately|2,025.45|FSC: 400601; BFG: 52||External grouping not supported
48300013|EAP|HCPCS C8929||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Complete W/ Doppler W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,607.55|FSC: 400601; BFG: 52||Not reimbursed separately|1,607.55|FSC: 400601; BFG: 52||External grouping not supported
48300003|EAP|CPT® 93306||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Complete W/ Doppler W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,025.45|FSC: 400601; BFG: 52||Not reimbursed separately|2,025.45|FSC: 400601; BFG: 52||External grouping not supported
48300010|EAP|HCPCS C8924||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo F/u Or Ltd W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,078.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,078.35|FSC: 400601; BFG: 52||External grouping not supported
33100005|EAP|CPT® 96409||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hc Chemo Admin Initial Iv Push|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|527.10|FSC: 400601; BFG: 52||Not reimbursed separately|527.10|FSC: 400601; BFG: 52||External grouping not supported
33100002|EAP|CPT® 96402||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hc Chemo Admin Sq/im Hormonal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|164.85|FSC: 400601; BFG: 52||Not reimbursed separately|164.85|FSC: 400601; BFG: 52||External grouping not supported
33100001|EAP|CPT® 96401||0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED|Hc Chemo Admin Sq/im Non-hormonal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.65|FSC: 400601; BFG: 52||Not reimbursed separately|160.65|FSC: 400601; BFG: 52||External grouping not supported
33500002|EAP|CPT® 96415||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hc Chemo Admin Iv Each Additional Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.65|FSC: 400601; BFG: 52||Not reimbursed separately|160.65|FSC: 400601; BFG: 52||External grouping not supported
33500001|EAP|CPT® 96413||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hc Chemo Admin Iv Initial Up To 1 Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|820.05|FSC: 400601; BFG: 52||Not reimbursed separately|820.05|FSC: 400601; BFG: 52||External grouping not supported
33500003|EAP|CPT® 96416||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hc Chemo Admin Iv Prolonged Infusion W/ Implantable Pump|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|820.05|FSC: 400601; BFG: 52||Not reimbursed separately|820.05|FSC: 400601; BFG: 52||External grouping not supported
33500004|EAP|CPT® 96417||0335 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV|Hc Chemo Admin Iv Sequential Up To 1 Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.65|FSC: 400601; BFG: 52||Not reimbursed separately|160.65|FSC: 400601; BFG: 52||External grouping not supported
34000002|EAP|CPT® 78102||0340 - NUCLEAR MEDICINE - GENERAL CLASSIFICATION|Hc Nuc Med Bone Marrow Imaging Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100026|EAP|CPT® 78278||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Acute Gi Blood Loss Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100031|EAP|CPT® 78306||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Bone Joint Imaging Whole Body|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100032|EAP|CPT® 78315||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Bone Imaging 3 Phase Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100029|EAP|CPT® 78300||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Bone Joint Imaging- Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100030|EAP|CPT® 78305||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Bone Joint Imaging- Multiple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100052|EAP|CPT® 78605||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Brain Imaging Static|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
34100044|EAP|CPT® 78472||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Cardiac Blood Pool Single Wall Motion + Ef|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100056|EAP|CPT® 78630||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Csf Flow Cisternography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
34100025|EAP|CPT® 78264||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Gastric Emptying Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100027|EAP|CPT® 78290||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Intestine Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100062|EAP|CPT® 78709||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Kidney Imaging W/ Vascular Flow And Function Multiple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
34100061|EAP|CPT® 78707||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Kidney Imaging W/ Vascular Flow And Function Single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
34100018|EAP|CPT® 78215||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Liver And Spleen Imaging Static|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100015|EAP|CPT® 78201||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Liver Imaging Static|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
34100016|EAP|CPT® 78202||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Liver Imaging W/ Vascular Flow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
34100014|EAP|CPT® 78195||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Lymphatic And Lymph Node Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
34100037|EAP|CPT® 78452||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Myocardial Perfusion Spect Multiple Rest Or Stress|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
34100036|EAP|CPT® 78451||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Myocardial Perfusion Spect Single Rest Or Stress|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
34100008|EAP|CPT® 78070||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|HC NUC MED PARATHYROID IMAGING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100048|EAP|CPT® 78580||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Pulmonary Perfusion Imaging Particulate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100012|EAP|CPT® 78185||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Spleen Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100066|EAP|CPT® 78761||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Testicular Imaging W/ Vascular Flow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100067|EAP|CPT® 78800||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Tumor Loc/inflammatory Process W/ Radiopharm Single Area /day|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100068|EAP|CPT® 78801||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Tumor Loc/inflammatory Process W/ Radiopharm 2 Or More Area/days|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100070|EAP|CPT® 78803||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Tumor Loc/inflamatory Process W/ Radiopharm Singl Area/day Spect|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,156.30|FSC: 400601; BFG: 52||Not reimbursed separately|3,156.30|FSC: 400601; BFG: 52||External grouping not supported
34100069|EAP|CPT® 78802||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Tumor Loc/inflamatory Process W/ Radiopharm Whole Body Singl Day|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
34100065|EAP|CPT® 78740||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Ureteral Reflux Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
40100004|EAP|CPT® 77066||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hc Mammogram Diagnostic  Bilateral Including Cad|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|415.80|FSC: 400601; BFG: 52||Not reimbursed separately|415.80|FSC: 400601; BFG: 52||External grouping not supported
40100005|EAP|CPT® 77065||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hc Mammogram Diagnostic  Unilateral Including Cad|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|337.05|FSC: 400601; BFG: 52||Not reimbursed separately|337.05|FSC: 400601; BFG: 52||External grouping not supported
40200003|EAP|CPT® 76377||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc 3d Rendering Postprocessing W/ Independent Workstation Us|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
40200002|EAP|CPT® 76376||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc 3d Rendering Postprocessing W/o Independent Workstation Us|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
40200032|EAP|CPT® 76936||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Guidance For Compression Repair Arterial Aneurysm Or Av Fistuale|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
40200033|EAP|CPT® 76937||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Guidance For Vascular Access|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|317.10|FSC: 400601; BFG: 52||Not reimbursed separately|317.10|FSC: 400601; BFG: 52||External grouping not supported
40200015|EAP|CPT® 76801||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us 1st Trimester Transabdominal Single/first Gestation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200016|EAP|CPT® 76802||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us 1st Trimester Transabdominal Each Additional Fetus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|216.30|FSC: 400601; BFG: 52||Not reimbursed separately|216.30|FSC: 400601; BFG: 52||External grouping not supported
40200043|EAP|HCPCS 76706||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Aaa Screening|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200010|EAP|CPT® 76700||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Abdominal Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|526.05|FSC: 400601; BFG: 52||Not reimbursed separately|526.05|FSC: 400601; BFG: 52||External grouping not supported
40200011|EAP|CPT® 76705||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Abdominal Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|384.30|FSC: 400601; BFG: 52||Not reimbursed separately|384.30|FSC: 400601; BFG: 52||External grouping not supported
40200026|EAP|CPT® 76818||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Bpp W/ Non-stress Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200027|EAP|CPT® 76819||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Bpp W/o Non-stress Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200008|EAP|CPT® 76604||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Chest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200004|EAP|CPT® 76506||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Echoencephalography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200037|EAP|CPT® 76870||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Scrotum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200035|EAP|CPT® 76856||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Pelvic Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|413.70|FSC: 400601; BFG: 52||Not reimbursed separately|413.70|FSC: 400601; BFG: 52||External grouping not supported
40200036|EAP|CPT® 76857||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Pelvic Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200034|EAP|CPT® 76830||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Transvaginal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200007|EAP|CPT® 76536||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Head And Neck|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200017|EAP|CPT® 76805||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Ob After 1st Trimester Transabdominal Single/first Gestation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200018|EAP|CPT® 76810||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Ob After 1st Trimester Transabdominal Each Additional Fetus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|249.90|FSC: 400601; BFG: 52||Not reimbursed separately|249.90|FSC: 400601; BFG: 52||External grouping not supported
40200024|EAP|CPT® 76816||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Ob Follow-up Transabdominal Per Fetus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200023|EAP|CPT® 76815||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Ob Limited 1 Or More Fetuses|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200019|EAP|CPT® 76811||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Ob Transabdominal W/ Detailed Fetal Exam|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|602.70|FSC: 400601; BFG: 52||Not reimbursed separately|602.70|FSC: 400601; BFG: 52||External grouping not supported
40200025|EAP|CPT® 76817||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Ob Transvaginal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
40200012|EAP|CPT® 76770||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Retroperitoneal Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200013|EAP|CPT® 76775||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Retroperitoneal Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200014|EAP|CPT® 76776||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Transplanted Kidney W/ Doppler|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200028|EAP|CPT® 76820||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Umbilical Artery Doppler|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40300003|EAP|CPT® 77067||0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY|Hc Mammogram Screening Bilateral Including Cad|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|346.50|FSC: 400601; BFG: 52||Not reimbursed separately|346.50|FSC: 400601; BFG: 52||External grouping not supported
40400003|EAP|CPT® 78608||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hc Pet Brain Metabolic Eval|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
40400004|EAP|CPT® 78814||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hc Pet Ct Limited Area|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
40400005|EAP|CPT® 78815||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hc Pet Ct Skull Base To Mid-thigh|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
40400006|EAP|CPT® 78816||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hc Pet Ct Whole Body|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
40400001|EAP|CPT® 78459||0404 - OTHER IMAGING SERVICES - POSITRON EMISSION TOMOGRAPHY|Hc Pet Myocardial Metabolic Eval Single Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,220.35|FSC: 400601; BFG: 52||Not reimbursed separately|3,220.35|FSC: 400601; BFG: 52||External grouping not supported
35000022|EAP|CPT® 76377||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc 3d Rendering Postprocessing W/ Independent Workstation Ct|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
35000021|EAP|CPT® 76376||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc 3d Rendering Postprocessing W/o Independent Workstation Ct|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
35000006|EAP|CPT® 72127||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Cervical Spine W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,493.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,493.10|FSC: 400601; BFG: 52||External grouping not supported
35000005|EAP|CPT® 72126||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Cervical Spine W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,493.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,493.10|FSC: 400601; BFG: 52||External grouping not supported
35000004|EAP|CPT® 72125||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Cervical Spine W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,383.90|FSC: 400601; BFG: 52||Not reimbursed separately|1,383.90|FSC: 400601; BFG: 52||External grouping not supported
35000010|EAP|CPT® 72133||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Lumbar Spine W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,531.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,531.95|FSC: 400601; BFG: 52||External grouping not supported
35000009|EAP|CPT® 72132||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Lumbar Spine W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,463.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,463.70|FSC: 400601; BFG: 52||External grouping not supported
35000008|EAP|CPT® 72130||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Thoracic Spine W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,493.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,493.10|FSC: 400601; BFG: 52||External grouping not supported
35000007|EAP|CPT® 72129||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Thoracic Spine W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,493.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,493.10|FSC: 400601; BFG: 52||External grouping not supported
35000014|EAP|CPT® 74175||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Abdomen W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,711.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,711.50|FSC: 400601; BFG: 52||External grouping not supported
35000019|EAP|CPT® 75635||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Abdominal Aorta W/ Bilateral Iliofemoral Run-off & Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,711.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,711.50|FSC: 400601; BFG: 52||External grouping not supported
35000003|EAP|CPT® 71275||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Chest (non-coronary) W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,875.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,875.30|FSC: 400601; BFG: 52||External grouping not supported
35000001|EAP|CPT® 70496||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Head W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|871.50|FSC: 400601; BFG: 52||Not reimbursed separately|871.50|FSC: 400601; BFG: 52||External grouping not supported
35000013|EAP|CPT® 73706||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Lower Extremity W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,493.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,493.10|FSC: 400601; BFG: 52||External grouping not supported
35000002|EAP|CPT® 70498||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Neck W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,373.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,373.40|FSC: 400601; BFG: 52||External grouping not supported
35000011|EAP|CPT® 72191||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Pelvis W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,085.30|FSC: 400601; BFG: 52||Not reimbursed separately|2,085.30|FSC: 400601; BFG: 52||External grouping not supported
35000012|EAP|CPT® 73206||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Upper Extremity W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,362.90|FSC: 400601; BFG: 52||Not reimbursed separately|1,362.90|FSC: 400601; BFG: 52||External grouping not supported
35000024|EAP|CPT® 77012||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Ct Guided Needle Placement|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,380.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,380.75|FSC: 400601; BFG: 52||External grouping not supported
35100004|EAP|CPT® 70470||0351 - CT SCAN - HEAD SCAN|Hc Ct Head/brain W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|756.00|FSC: 400601; BFG: 52||Not reimbursed separately|756.00|FSC: 400601; BFG: 52||External grouping not supported
35100003|EAP|CPT® 70460||0351 - CT SCAN - HEAD SCAN|Hc Ct Head/brain W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|744.45|FSC: 400601; BFG: 52||Not reimbursed separately|744.45|FSC: 400601; BFG: 52||External grouping not supported
35100002|EAP|CPT® 70450||0351 - CT SCAN - HEAD SCAN|Hc Ct Head/brain W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|696.15|FSC: 400601; BFG: 52||Not reimbursed separately|696.15|FSC: 400601; BFG: 52||External grouping not supported
35100010|EAP|CPT® 70488||0351 - CT SCAN - HEAD SCAN|Hc Ct Maxillofacial W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,402.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,402.80|FSC: 400601; BFG: 52||External grouping not supported
35100009|EAP|CPT® 70487||0351 - CT SCAN - HEAD SCAN|Hc Ct Maxillofacial W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,402.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,402.80|FSC: 400601; BFG: 52||External grouping not supported
35100008|EAP|CPT® 70486||0351 - CT SCAN - HEAD SCAN|Hc Ct Maxillofacial W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,293.60|FSC: 400601; BFG: 52||Not reimbursed separately|1,293.60|FSC: 400601; BFG: 52||External grouping not supported
35100013|EAP|CPT® 70492||0351 - CT SCAN - HEAD SCAN|Hc Ct Neck W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
35100012|EAP|CPT® 70491||0351 - CT SCAN - HEAD SCAN|Hc Ct Neck W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
35100011|EAP|CPT® 70490||0351 - CT SCAN - HEAD SCAN|Hc Ct Neck W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|826.35|FSC: 400601; BFG: 52||Not reimbursed separately|826.35|FSC: 400601; BFG: 52||External grouping not supported
35100007|EAP|CPT® 70482||0351 - CT SCAN - HEAD SCAN|Hc Ct Orbit Sella Posterior Fossa Ear W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,402.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,402.80|FSC: 400601; BFG: 52||External grouping not supported
35100006|EAP|CPT® 70481||0351 - CT SCAN - HEAD SCAN|Hc Ct Orbit Sella Posterior Fossa Ear W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,402.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,402.80|FSC: 400601; BFG: 52||External grouping not supported
35100005|EAP|CPT® 70480||0351 - CT SCAN - HEAD SCAN|Hc Ct Orbit Sella Posterior Fossa Ear W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,293.60|FSC: 400601; BFG: 52||Not reimbursed separately|1,293.60|FSC: 400601; BFG: 52||External grouping not supported
35200017|EAP|CPT® 74170||0352 - CT SCAN - BODY SCAN|Hc Ct Abdomen W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,056.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,056.30|FSC: 400601; BFG: 52||External grouping not supported
35200016|EAP|CPT® 74160||0352 - CT SCAN - BODY SCAN|Hc Ct Abdomen W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,017.45|FSC: 400601; BFG: 52||Not reimbursed separately|1,017.45|FSC: 400601; BFG: 52||External grouping not supported
35200015|EAP|CPT® 74150||0352 - CT SCAN - BODY SCAN|Hc Ct Abdomen W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|858.90|FSC: 400601; BFG: 52||Not reimbursed separately|858.90|FSC: 400601; BFG: 52||External grouping not supported
35200014|EAP|CPT® 73702||0352 - CT SCAN - BODY SCAN|Hc Ct Lower Extremity W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,411.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,411.20|FSC: 400601; BFG: 52||External grouping not supported
35200013|EAP|CPT® 73701||0352 - CT SCAN - BODY SCAN|Hc Ct Lower Extremity W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,411.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,411.20|FSC: 400601; BFG: 52||External grouping not supported
35200012|EAP|CPT® 73700||0352 - CT SCAN - BODY SCAN|Hc Ct Lower Extremity W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,192.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,192.80|FSC: 400601; BFG: 52||External grouping not supported
35200005|EAP|CPT® 72131||0352 - CT SCAN - BODY SCAN|Hc Ct Lumbar Spine W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,473.15|FSC: 400601; BFG: 52||Not reimbursed separately|1,473.15|FSC: 400601; BFG: 52||External grouping not supported
35200008|EAP|CPT® 72194||0352 - CT SCAN - BODY SCAN|Hc Ct Pelvis W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,206.45|FSC: 400601; BFG: 52||Not reimbursed separately|1,206.45|FSC: 400601; BFG: 52||External grouping not supported
35200007|EAP|CPT® 72193||0352 - CT SCAN - BODY SCAN|Hc Ct Pelvis W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,205.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,205.40|FSC: 400601; BFG: 52||External grouping not supported
35200006|EAP|CPT® 72192||0352 - CT SCAN - BODY SCAN|Hc Ct Pelvis W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,118.25|FSC: 400601; BFG: 52||Not reimbursed separately|1,118.25|FSC: 400601; BFG: 52||External grouping not supported
35200004|EAP|CPT® 72128||0352 - CT SCAN - BODY SCAN|Hc Ct Thoracic Spine W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|717.15|FSC: 400601; BFG: 52||Not reimbursed separately|717.15|FSC: 400601; BFG: 52||External grouping not supported
35200003|EAP|CPT® 71270||0352 - CT SCAN - BODY SCAN|Hc Ct Thorax W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
35200002|EAP|CPT® 71260||0352 - CT SCAN - BODY SCAN|Hc Ct Thorax W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
35200001|EAP|CPT® 71250||0352 - CT SCAN - BODY SCAN|Hc Ct Thorax W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|826.35|FSC: 400601; BFG: 52||Not reimbursed separately|826.35|FSC: 400601; BFG: 52||External grouping not supported
35200011|EAP|CPT® 73202||0352 - CT SCAN - BODY SCAN|Hc Ct Upper Extremity W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,411.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,411.20|FSC: 400601; BFG: 52||External grouping not supported
35200010|EAP|CPT® 73201||0352 - CT SCAN - BODY SCAN|Hc Ct Upper Extremity W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,411.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,411.20|FSC: 400601; BFG: 52||External grouping not supported
35200009|EAP|CPT® 73200||0352 - CT SCAN - BODY SCAN|Hc Ct Upper Extremity W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,192.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,192.80|FSC: 400601; BFG: 52||External grouping not supported
73000001|EAP|CPT® 93005||0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION|Hc Ekg 12-lead|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|212.10|FSC: 400601; BFG: 52||Not reimbursed separately|212.10|FSC: 400601; BFG: 52||External grouping not supported
73100003|EAP|CPT® 93270||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hc Event Recorder Patient Activated Per 30 Days|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.80|FSC: 400601; BFG: 52||Not reimbursed separately|100.80|FSC: 400601; BFG: 52||External grouping not supported
73100001|EAP|CPT® 93225||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hc Holter Monitor Hook-up Up To 48 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|484.05|FSC: 400601; BFG: 52||Not reimbursed separately|484.05|FSC: 400601; BFG: 52||External grouping not supported
73100002|EAP|CPT® 93226||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hc Holter Monitor Scan Up To 48 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
21552|EAP|CPT® 21552|||Pr Exc Tumor Soft Tissue Neck/ant Thorax Subq 3+cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|735.00|FSC: 46100; BFG: 52||Not reimbursed separately|735.00|FSC: 46100; BFG: 52||External grouping not supported
64490|EAP|CPT® 64490|||Pr Inj Dx/ther Agnt Paravert Facet Joint, Cerv/thorac, 1st Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|274.00|FSC: 46100; BFG: 52||Not reimbursed separately|274.00|FSC: 46100; BFG: 52||External grouping not supported
64491|EAP|CPT® 64491|||Pr Inj Dx/ther Agnt Paravert Facet Joint, Cerv/thorac, 2nd Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|136.00|FSC: 46100; BFG: 52||Not reimbursed separately|136.00|FSC: 46100; BFG: 52||External grouping not supported
64492|EAP|CPT® 64492|||Pr Inj Dx/ther Agnt Paravert Facet Joint, Cerv/thorac, Add Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|137.00|FSC: 46100; BFG: 52||Not reimbursed separately|137.00|FSC: 46100; BFG: 52||External grouping not supported
64493|EAP|CPT® 64493|||Pr Inj Dx/ther Agnt Paravert Facet Joint, Lumbar/sac, 1st Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|248.00|FSC: 46100; BFG: 52||Not reimbursed separately|248.00|FSC: 46100; BFG: 52||External grouping not supported
64494|EAP|CPT® 64494|||Pr Inj Dx/ther Agnt Paravert Facet Joint, Lumbar/sac, 2nd Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.00|FSC: 46100; BFG: 52||Not reimbursed separately|126.00|FSC: 46100; BFG: 52||External grouping not supported
64495|EAP|CPT® 64495|||Pr Inj Dx/ther Agnt Paravert Facet Joint, Lumbar/sac, Add Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.00|FSC: 46100; BFG: 52||Not reimbursed separately|126.00|FSC: 46100; BFG: 52||External grouping not supported
30200197|EAP|CPT® 86612||0302 - LABORATORY - IMMUNOLOGY|Hc So Blastomyces Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.95|FSC: 400601; BFG: 52||Not reimbursed separately|61.95|FSC: 400601; BFG: 52||External grouping not supported
30200198|EAP|CPT® 86635||0302 - LABORATORY - IMMUNOLOGY|Hc So Coccidioides Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
30100488|EAP|CPT® 83615||0301 - LABORATORY - CHEMISTRY|Hc So Lactate Dehydrogenase (ld) (ldh)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
30100489|EAP|CPT® 83625||0301 - LABORATORY - CHEMISTRY|Hc So Ldh Isoenzymes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|163.80|FSC: 400601; BFG: 52||Not reimbursed separately|163.80|FSC: 400601; BFG: 52||External grouping not supported
30100490|EAP|CPT® 84488||0301 - LABORATORY - CHEMISTRY|Hc So Trypsin Feces Qual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.75|FSC: 400601; BFG: 52||Not reimbursed separately|78.75|FSC: 400601; BFG: 52||External grouping not supported
30200199|EAP|CPT® 86023||0302 - LABORATORY - IMMUNOLOGY|Hc So Platelet Associated Ig Assay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
30200200|EAP|CPT® 86757||0302 - LABORATORY - IMMUNOLOGY|Hc So Richettisiae Antibody - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|93.45|FSC: 400601; BFG: 52||Not reimbursed separately|93.45|FSC: 400601; BFG: 52||External grouping not supported
30200201|EAP|CPT® 86713||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Legionella|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
27000099|EAP|Custom 27000099||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Cch Broncho Brush|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|91.35|FSC: 400601; BFG: 52||Not reimbursed separately|91.35|FSC: 400601; BFG: 52||External grouping not supported
27204243|EAP|Custom 27204243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Arterial Blood Gas Kit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.25|FSC: 400601; BFG: 52||Not reimbursed separately|140.25|FSC: 400601; BFG: 52||External grouping not supported
94800001|EAP|HCPCS G0424||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Pulmonary Rehab Exercise Per Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
30200202|EAP|CPT® 86674||0302 - LABORATORY - IMMUNOLOGY|Hc So Giardia Lamblia Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.40|FSC: 400601; BFG: 52||Not reimbursed separately|71.40|FSC: 400601; BFG: 52||External grouping not supported
27100011|EAP|Custom 27100011||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hc Cch Aerosol Nebulizer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
27204279|EAP|Custom 27204279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sterile Urinary Leg Bag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.50|FSC: 400601; BFG: 52||Not reimbursed separately|14.50|FSC: 400601; BFG: 52||External grouping not supported
26000011|EAP|CPT® 96368||0260 - IV THERAPY - GENERAL CLASSIFICATION|Hc Iv Infusion Concurrent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|134.40|FSC: 400601; BFG: 52||Not reimbursed separately|134.40|FSC: 400601; BFG: 52||External grouping not supported
75000158|EAP|CPT® 45350||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Sigmoidoscopy Flexible W/ Band Ligation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
27000136|EAP|Custom 27000136||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Cch Pulse Ox|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|114.45|FSC: 400601; BFG: 52||Not reimbursed separately|114.45|FSC: 400601; BFG: 52||External grouping not supported
30100498|EAP|CPT® 83993||0301 - LABORATORY - CHEMISTRY|Hc So Calprotectin Fecal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.10|FSC: 400601; BFG: 52||Not reimbursed separately|65.10|FSC: 400601; BFG: 52||External grouping not supported
30100499|EAP|CPT® 82664||0301 - LABORATORY - CHEMISTRY|Hc So Electrophoresis Nes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|153.30|FSC: 400601; BFG: 52||Not reimbursed separately|153.30|FSC: 400601; BFG: 52||External grouping not supported
30100500|EAP|CPT® 83013||0301 - LABORATORY - CHEMISTRY|Hc So H Pylori (c-13) Breath Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|218.40|FSC: 400601; BFG: 52||Not reimbursed separately|218.40|FSC: 400601; BFG: 52||External grouping not supported
27204313|EAP|Custom 27204313||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Warming Blanket|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.65|FSC: 400601; BFG: 52||Not reimbursed separately|98.65|FSC: 400601; BFG: 52||External grouping not supported
30200205|EAP|CPT® 86800||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Thyroglobulin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.50|FSC: 400601; BFG: 52||Not reimbursed separately|52.50|FSC: 400601; BFG: 52||External grouping not supported
30600157|EAP|CPT® 87486||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Chlamydia P Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|151.20|FSC: 400601; BFG: 52||Not reimbursed separately|151.20|FSC: 400601; BFG: 52||External grouping not supported
30100502|EAP|CPT® 84140||0301 - LABORATORY - CHEMISTRY|Hc So Pregnenolone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.10|FSC: 400601; BFG: 52||Not reimbursed separately|86.10|FSC: 400601; BFG: 52||External grouping not supported
77100006|EAP|HCPCS G0010||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hc Hepatitis B Vaccine Administration|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
49000838|EAP|CPT® 64510||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Stellate Ganglion (cervical Sympathetic) For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000839|EAP|CPT® 64517||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Superior Hypogastric Plexus For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000840|EAP|CPT® 64520||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Lumbar Or Thoracic (paravertebral Sympathetic) For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000843|EAP|CPT® 64479||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Inj Anesthetic/steroid Epidural W/ Img Guid Cervical Or Thoracic Single Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000844|EAP|CPT® 64480||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Inj Anesthetic/steroid Epidural W/ Img Guid Cervical Or Thoracic Ea Add Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|836.85|FSC: 400601; BFG: 52||Not reimbursed separately|836.85|FSC: 400601; BFG: 52||External grouping not supported
49000845|EAP|CPT® 64490||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Paravertebral Facet Joint W/ Img Guid Cervical Or Thoracic Single Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000846|EAP|CPT® 64491||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Paravertebral Facet Joint W/ Img Guid Cervical Or Thoracic Second Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|523.95|FSC: 400601; BFG: 52||Not reimbursed separately|523.95|FSC: 400601; BFG: 52||External grouping not supported
49000847|EAP|CPT® 64492||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Paravertebral Facet Joint W/ Img Guid Cervical Or Thoracic Third + Levels For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|523.95|FSC: 400601; BFG: 52||Not reimbursed separately|523.95|FSC: 400601; BFG: 52||External grouping not supported
30100551|EAP|CPT® 84305||0301 - LABORATORY - CHEMISTRY|Hc So Somatomedin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.35|FSC: 400601; BFG: 52||Not reimbursed separately|70.35|FSC: 400601; BFG: 52||External grouping not supported
49000848|EAP|CPT® 64493||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Paravertebral Facet Joint W/ Img Guid Lumbar Or Sacral Single Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,228.10|FSC: 400601; BFG: 52||Not reimbursed separately|2,228.10|FSC: 400601; BFG: 52||External grouping not supported
49000849|EAP|CPT® 64494||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Paravertebral Facet Joint W/ Img Guid Lumbar Or Sacral Second Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,380.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,380.75|FSC: 400601; BFG: 52||External grouping not supported
49000850|EAP|CPT® 64495||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Paravertebral Facet Joint W/ Img Guid Lumbar Or Sacral Third + Levels For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|523.95|FSC: 400601; BFG: 52||Not reimbursed separately|523.95|FSC: 400601; BFG: 52||External grouping not supported
51000605|EAP|CPT® 20526||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Injection Therapeutic Carpal Tunnel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
27204405|EAP|Custom 27204405||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cannula Trach 6 Moore Inner|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.50|FSC: 400601; BFG: 52||Not reimbursed separately|19.50|FSC: 400601; BFG: 52||External grouping not supported
27204406|EAP|Custom 27204406||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cannula Trach 8 Moore Inner|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.50|FSC: 400601; BFG: 52||Not reimbursed separately|19.50|FSC: 400601; BFG: 52||External grouping not supported
30100552|EAP|CPT® 84112||0301 - LABORATORY - CHEMISTRY|Hc Cch Placenta Alpha Micro Ig C/v|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|257.25|FSC: 400601; BFG: 52||Not reimbursed separately|257.25|FSC: 400601; BFG: 52||External grouping not supported
92900001|EAP|Custom 92900001||0929 - OTHER DIAGNOSTIC SERVICES - OTHER DIAGNOSTIC SERVICE|Hc Sane Collection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
92900002|EAP|Custom 92900002||0929 - OTHER DIAGNOSTIC SERVICES - OTHER DIAGNOSTIC SERVICE|Hc Sane Supply|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
27207667|EAP|Custom 27207667||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag Resuscitation Adult Manual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.65|FSC: 400601; BFG: 52||Not reimbursed separately|82.65|FSC: 400601; BFG: 52||External grouping not supported
27207681|EAP|Custom 27207681||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cannula Disposable Inner Any Size|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.20|FSC: 400601; BFG: 52||Not reimbursed separately|34.20|FSC: 400601; BFG: 52||External grouping not supported
27207693|EAP|Custom 27207693||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Circuit Ventilator Bipap|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.95|FSC: 400601; BFG: 52||Not reimbursed separately|30.95|FSC: 400601; BFG: 52||External grouping not supported
27204424|EAP|Custom 27204424||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Circuit W/ Vent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.20|FSC: 400601; BFG: 52||Not reimbursed separately|52.20|FSC: 400601; BFG: 52||External grouping not supported
27204427|EAP|Custom 27204427||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sling & Swathe Sm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.45|FSC: 400601; BFG: 52||Not reimbursed separately|45.45|FSC: 400601; BFG: 52||External grouping not supported
27207699|EAP|Custom 27207699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Container 1000ml Empty Evacuated Glass|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.95|FSC: 400601; BFG: 52||Not reimbursed separately|23.95|FSC: 400601; BFG: 52||External grouping not supported
52287|EAP|CPT® 52287|||CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|465.00|FSC: 46100; BFG: 52||Not reimbursed separately|465.00|FSC: 46100; BFG: 52||External grouping not supported
49000688|EAP|CPT® 63650||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Implant Neurostimulator Electrodes Percutaneous Epidural|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,214.10|FSC: 400601; BFG: 52||Not reimbursed separately|16,214.10|FSC: 400601; BFG: 52||External grouping not supported
27207716|EAP|Custom 27207716||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Optifoam Dressing 4x4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.55|FSC: 400601; BFG: 52||Not reimbursed separately|14.55|FSC: 400601; BFG: 52||External grouping not supported
27207720|EAP|Custom 27207720||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Holder Tube Endotracheal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.40|FSC: 400601; BFG: 52||Not reimbursed separately|28.40|FSC: 400601; BFG: 52||External grouping not supported
30000074|EAP|CPT® 86906||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Cch Bld Typing Serologic Rh Phnt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
27207728|EAP|Custom 27207728||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle 19ga X 1in Powerloc W/y-site|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.15|FSC: 400601; BFG: 52||Not reimbursed separately|41.15|FSC: 400601; BFG: 52||External grouping not supported
30100811|EAP|CPT® 82943||0301 - LABORATORY - CHEMISTRY|Hc So Glucagon|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|113.40|FSC: 400601; BFG: 52||Not reimbursed separately|113.40|FSC: 400601; BFG: 52||External grouping not supported
30100812|EAP|CPT® 84586||0301 - LABORATORY - CHEMISTRY|Hc So Vip Vasoactive Intestinal Peptide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|261.45|FSC: 400601; BFG: 52||Not reimbursed separately|261.45|FSC: 400601; BFG: 52||External grouping not supported
27205814|EAP|Custom 27205814||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Corrugated Comfort Flo Circuit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|114.00|FSC: 400601; BFG: 52||Not reimbursed separately|114.00|FSC: 400601; BFG: 52||External grouping not supported
27205815|EAP|Custom 27205815||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Comfort Flo Plus Cannula W/ Chin Strap Large|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.58|FSC: 400601; BFG: 52||Not reimbursed separately|53.58|FSC: 400601; BFG: 52||External grouping not supported
27205816|EAP|Custom 27205816||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Comfort Flo Plus Cannula W/ Chin Strap Medium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.58|FSC: 400601; BFG: 52||Not reimbursed separately|53.58|FSC: 400601; BFG: 52||External grouping not supported
27207738|EAP|Custom 27207738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Bipap Performa W/ Headgear Med|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|194.45|FSC: 400601; BFG: 52||Not reimbursed separately|194.45|FSC: 400601; BFG: 52||External grouping not supported
27207739|EAP|Custom 27207739||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Bipap Performa W/ Headgear Lg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|194.45|FSC: 400601; BFG: 52||Not reimbursed separately|194.45|FSC: 400601; BFG: 52||External grouping not supported
27204699|EAP|Custom 27204699||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Airway Laryngeal Mask Sz 1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|79.30|FSC: 400601; BFG: 52||Not reimbursed separately|79.30|FSC: 400601; BFG: 52||External grouping not supported
27204707|EAP|Custom 27204707||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Knee Brace Medium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|177.20|FSC: 400601; BFG: 52||Not reimbursed separately|177.20|FSC: 400601; BFG: 52||External grouping not supported
27204708|EAP|Custom 27204708||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Knee Brace Large|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|203.85|FSC: 400601; BFG: 52||Not reimbursed separately|203.85|FSC: 400601; BFG: 52||External grouping not supported
49000690|EAP|CPT® 41010||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Incision Of Lingual Frenum (frenotomy)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,408.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,408.05|FSC: 400601; BFG: 52||External grouping not supported
49000691|EAP|CPT® 40806||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Incision Of Labial Frenum (frenotomy)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|686.70|FSC: 400601; BFG: 52||Not reimbursed separately|686.70|FSC: 400601; BFG: 52||External grouping not supported
27207752|EAP|Custom 27207752||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Set Y-type Tur-bladder Irrigation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.15|FSC: 400601; BFG: 52||Not reimbursed separately|22.15|FSC: 400601; BFG: 52||External grouping not supported
27207754|EAP|Custom 27207754||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Optifoam Dressing 6x6|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.45|FSC: 400601; BFG: 52||Not reimbursed separately|24.45|FSC: 400601; BFG: 52||External grouping not supported
73502|EAP|CPT® 73502|||RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.00|FSC: 46100; BFG: 52||Not reimbursed separately|115.00|FSC: 46100; BFG: 52||External grouping not supported
73522|EAP|CPT® 73522|||RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.78|FSC: 46100; BFG: 52||Not reimbursed separately|69.78|FSC: 46100; BFG: 52||External grouping not supported
30200219|EAP|CPT® 86005||0302 - LABORATORY - IMMUNOLOGY|Hc So Allergen Specific Ige|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.75|FSC: 400601; BFG: 52||Not reimbursed separately|36.75|FSC: 400601; BFG: 52||External grouping not supported
27206067|EAP|Custom 27206067||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Acticoat 7|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.60|FSC: 400601; BFG: 52||Not reimbursed separately|120.60|FSC: 400601; BFG: 52||External grouping not supported
27206068|EAP|Custom 27206068||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Acticoat Absorb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.50|FSC: 400601; BFG: 52||Not reimbursed separately|56.50|FSC: 400601; BFG: 52||External grouping not supported
27206076|EAP|Custom 27206076||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Aero Chamber|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.45|FSC: 400601; BFG: 52||Not reimbursed separately|42.45|FSC: 400601; BFG: 52||External grouping not supported
49000692|EAP|CPT® 64400||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Trigeminal Each Branch For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
49000694|EAP|CPT® 64405||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Greater Occipital For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
49000697|EAP|CPT® 64416||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Brachial Plexus Cont Infusion By Cath For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,918.26|FSC: 400601; BFG: 52||Not reimbursed separately|1,918.26|FSC: 400601; BFG: 52||External grouping not supported
49000698|EAP|CPT® 64418||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Suprascapular For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
49000699|EAP|CPT® 64420||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Intercostal Single Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
49000700|EAP|CPT® 64421||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Intercostal Ea Addtl Level For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000702|EAP|CPT® 64449||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Lumbar Plexus Posterior Approach Cont Infusion By Cath For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,918.26|FSC: 400601; BFG: 52||Not reimbursed separately|1,918.26|FSC: 400601; BFG: 52||External grouping not supported
27206085|EAP|Custom 27206085||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Amnihook|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.60|FSC: 400601; BFG: 52||Not reimbursed separately|13.60|FSC: 400601; BFG: 52||External grouping not supported
49000704|EAP|CPT® 64448||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Femoral Cont Infusion By Cath For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,918.26|FSC: 400601; BFG: 52||Not reimbursed separately|1,918.26|FSC: 400601; BFG: 52||External grouping not supported
30200220|EAP|CPT® 86039||0302 - LABORATORY - IMMUNOLOGY|Hc So Antinuclear Ab (ana) Titer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.75|FSC: 400601; BFG: 52||Not reimbursed separately|36.75|FSC: 400601; BFG: 52||External grouping not supported
75000126|EAP|CPT® 44391||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Through Stoma W/ Control Of Bleeding|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
19083|EAP|CPT® 19083|||BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|959.00|FSC: 46100; BFG: 52||Not reimbursed separately|959.00|FSC: 46100; BFG: 52||External grouping not supported
64643|EAP|CPT® 64643|||CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|145.00|FSC: 46100; BFG: 52||Not reimbursed separately|145.00|FSC: 46100; BFG: 52||External grouping not supported
64646|EAP|CPT® 64646|||CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|222.00|FSC: 46100; BFG: 52||Not reimbursed separately|222.00|FSC: 46100; BFG: 52||External grouping not supported
27206107|EAP|Custom 27206107||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Athletic Supporter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.15|FSC: 400601; BFG: 52||Not reimbursed separately|30.15|FSC: 400601; BFG: 52||External grouping not supported
27206112|EAP|Custom 27206112||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Back Brace-industria|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.80|FSC: 400601; BFG: 52||Not reimbursed separately|196.80|FSC: 400601; BFG: 52||External grouping not supported
49000658|EAP|CPT® 32554||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Thoracentesis W/o Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,640.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,640.10|FSC: 400601; BFG: 52||External grouping not supported
49000659|EAP|CPT® 32555||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Thoracentesis W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,640.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,640.10|FSC: 400601; BFG: 52||External grouping not supported
34100084|EAP|CPT® 78012||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Thyroid Uptake Single Or Multiple W/quantitative Measurements|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100085|EAP|CPT® 78013||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Thyroid Imaging W/ Or W/o Vascular Flow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100086|EAP|CPT® 78014||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Thyroid Uptake Single Or Multiple W/quantitative Measurements W Or W/o Vascular Flow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100087|EAP|CPT® 78071||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Parathyroid Planar W/ Or W/o Subtraction W/ Spect|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
30600158|EAP|CPT® 87631||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Resp Virus 3-5 Targets|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|254.10|FSC: 400601; BFG: 52||Not reimbursed separately|254.10|FSC: 400601; BFG: 52||External grouping not supported
49000674|EAP|CPT® 32557||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Insertion Indwelling Catheter Percutaneous For Pleural Drainage W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,632.35|FSC: 400601; BFG: 52||Not reimbursed separately|2,632.35|FSC: 400601; BFG: 52||External grouping not supported
27206152|EAP|Custom 27206152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Blood Collection Set|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.45|FSC: 400601; BFG: 52||Not reimbursed separately|15.45|FSC: 400601; BFG: 52||External grouping not supported
75000173|EAP|CPT® 45393||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonsocopy Flexible W Decompression Inc Placement Of Decompression Tube When Performed|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
27206168|EAP|Custom 27206168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Breast Pump|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|178.35|FSC: 400601; BFG: 52||Not reimbursed separately|178.35|FSC: 400601; BFG: 52||External grouping not supported
27206171|EAP|Custom 27206171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Breast Shields|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.35|FSC: 400601; BFG: 52||Not reimbursed separately|26.35|FSC: 400601; BFG: 52||External grouping not supported
27206194|EAP|Custom 27206194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cast Shoe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.95|FSC: 400601; BFG: 52||Not reimbursed separately|31.95|FSC: 400601; BFG: 52||External grouping not supported
27206200|EAP|Custom 27206200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cath Coude Tip 16fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|62.05|FSC: 400601; BFG: 52||Not reimbursed separately|62.05|FSC: 400601; BFG: 52||External grouping not supported
27206201|EAP|Custom 27206201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cath Coude Tip 18fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.75|FSC: 400601; BFG: 52||Not reimbursed separately|58.75|FSC: 400601; BFG: 52||External grouping not supported
27206211|EAP|Custom 27206211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Thoracic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.25|FSC: 400601; BFG: 52||Not reimbursed separately|26.25|FSC: 400601; BFG: 52||External grouping not supported
27206212|EAP|Custom 27206212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Tray Foley|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.75|FSC: 400601; BFG: 52||Not reimbursed separately|98.75|FSC: 400601; BFG: 52||External grouping not supported
27206217|EAP|Custom 27206217||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Silicone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.40|FSC: 400601; BFG: 52||Not reimbursed separately|21.40|FSC: 400601; BFG: 52||External grouping not supported
27206231|EAP|Custom 27206231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Clipper Blade Disp.|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|94.00|FSC: 400601; BFG: 52||Not reimbursed separately|94.00|FSC: 400601; BFG: 52||External grouping not supported
27206236|EAP|Custom 27206236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Coban 4"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.30|FSC: 400601; BFG: 52||Not reimbursed separately|13.30|FSC: 400601; BFG: 52||External grouping not supported
27206298|EAP|Custom 27206298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Disposable Vent Circuit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|91.10|FSC: 400601; BFG: 52||Not reimbursed separately|91.10|FSC: 400601; BFG: 52||External grouping not supported
27206317|EAP|Custom 27206317||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Dressing Promogran|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.30|FSC: 400601; BFG: 52||Not reimbursed separately|36.30|FSC: 400601; BFG: 52||External grouping not supported
27206338|EAP|Custom 27206338||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Elastoplast Roll 2"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.05|FSC: 400601; BFG: 52||Not reimbursed separately|20.05|FSC: 400601; BFG: 52||External grouping not supported
27206339|EAP|Custom 27206339||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Elastoplast Roll 4"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.90|FSC: 400601; BFG: 52||Not reimbursed separately|24.90|FSC: 400601; BFG: 52||External grouping not supported
27206386|EAP|Custom 27206386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Cath 6 Fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.90|FSC: 400601; BFG: 52||Not reimbursed separately|32.90|FSC: 400601; BFG: 52||External grouping not supported
27206392|EAP|Custom 27206392||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Gait Belt 60"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.35|FSC: 400601; BFG: 52||Not reimbursed separately|32.35|FSC: 400601; BFG: 52||External grouping not supported
49000675|EAP|CPT® 64415||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Brachial Plexus For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000676|EAP|CPT® 64447||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Femoral For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
49000677|EAP|CPT® 64445||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Nerve Sciatic For Pain Mgmt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
51000495|EAP|CPT® 10030||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Catheter Drainage Soft Tissue Percutaneous W/ Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000717|EAP|CPT® 19285||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Pre-op Placement Breast Localization Device First Lesion W/ Us Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
75000142|EAP|CPT® 43254||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Endoscopic Mucosal Resection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,822.00|FSC: 400601; BFG: 52||Not reimbursed separately|3,822.00|FSC: 400601; BFG: 52||External grouping not supported
49000729|EAP|CPT® 49405||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Drainage Catheter Visceral Percutaneous W/ Image Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000730|EAP|CPT® 49406||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Drainage Catheter Percutaneous Peritoneal/retroperitoneal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
27206443|EAP|Custom 27206443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Intraosseous Needle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|651.70|FSC: 400601; BFG: 52||Not reimbursed separately|651.70|FSC: 400601; BFG: 52||External grouping not supported
51000496|EAP|CPT® 64616||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Chemodenervation Muscle Neck Excl Larynx Unilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
51000498|EAP|CPT® 64642||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Chemodenervation Extremity 1-4 Muscles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
51000502|EAP|CPT® 64646||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Chemodenervation Trunk 1-5 Muscles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
30100568|EAP|CPT® 80159||0301 - LABORATORY - CHEMISTRY|Hc So Drug Screen Quant Clozapine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
30100571|EAP|CPT® 80169||0301 - LABORATORY - CHEMISTRY|Hc So Drug Screen Quant Everolimus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100572|EAP|CPT® 80171||0301 - LABORATORY - CHEMISTRY|Hc So Gabapentin Whole Blood/serum/plasma|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|138.60|FSC: 400601; BFG: 52||Not reimbursed separately|138.60|FSC: 400601; BFG: 52||External grouping not supported
30100574|EAP|CPT® 80175||0301 - LABORATORY - CHEMISTRY|Hc So Drug Screen Quan Lamotrigine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30100576|EAP|CPT® 80177||0301 - LABORATORY - CHEMISTRY|Hc So Drug Scrn Quan Levetiracetam - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30100580|EAP|CPT® 80183||0301 - LABORATORY - CHEMISTRY|Hc So Drug Scrn Quant Oxcarbazepin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30600177|EAP|CPT® 87661||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Trichomonas Vaginalis Amplif - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
44400011|EAP|CPT® 92521||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Speech Evaluation Fluency|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|138.60|FSC: 400601; BFG: 52||Not reimbursed separately|138.60|FSC: 400601; BFG: 52||External grouping not supported
44400012|EAP|CPT® 92522||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Speech Evaluation Sound Production|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|113.40|FSC: 400601; BFG: 52||Not reimbursed separately|113.40|FSC: 400601; BFG: 52||External grouping not supported
44400014|EAP|CPT® 92524||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Behavioral And Qualitative Analysis Of Voice And Resonance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|117.60|FSC: 400601; BFG: 52||Not reimbursed separately|117.60|FSC: 400601; BFG: 52||External grouping not supported
27206455|EAP|Custom 27206455||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Irrigiation Solution Water 3000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.70|FSC: 400601; BFG: 52||Not reimbursed separately|31.70|FSC: 400601; BFG: 52||External grouping not supported
27206457|EAP|Custom 27206457||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Irrigiation Saline 3000cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.50|FSC: 400601; BFG: 52||Not reimbursed separately|30.50|FSC: 400601; BFG: 52||External grouping not supported
49000734|EAP|CPT® 62324||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Placement Epidural Cervical/thoracic For Cont Infusion For Pain Mgmt W/o Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000707|EAP|CPT® 19081||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|HC BREAST BX W/ LOC DEVICE & IMG OF SPEC FIRST LESION W/ STEREOTACTIC GUIDE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000708|EAP|CPT® 19082||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Breast Bx W/ Localization Device & Imaging Of Specimen Ea Addl Lesion W/ Stereotactic Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,666.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,666.35|FSC: 400601; BFG: 52||External grouping not supported
49000709|EAP|CPT® 19083||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Breast Bx W/ Localization Device & Imaging Of Specimen First Lesion W/ Us Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000710|EAP|CPT® 19084||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Breast Bx W/ Localization Device & Imaging Of Specimen Ea Addl Lesion W/ Us Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,338.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,338.75|FSC: 400601; BFG: 52||External grouping not supported
49000713|EAP|CPT® 19281||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Pre-op Placement Breast Localization Device First Lesion W/ Mammographic Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000714|EAP|CPT® 19282||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Pre-op Placement Breast Localization Device Ea Addl Lesion W/ Mammographic Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|397.95|FSC: 400601; BFG: 52||Not reimbursed separately|397.95|FSC: 400601; BFG: 52||External grouping not supported
49000715|EAP|CPT® 19283||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Pre-op Placement Breast Localization Device First Lesion W/ Stereostatic Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000716|EAP|CPT® 19284||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Pre-op Placement Breast Localization Device Ea Addl Lesion W/ Stereotactic Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|550.20|FSC: 400601; BFG: 52||Not reimbursed separately|550.20|FSC: 400601; BFG: 52||External grouping not supported
49000718|EAP|CPT® 19286||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Pre-op Placement Breast Localization Device Ea Addl Lesion W/ Us Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|439.95|FSC: 400601; BFG: 52||Not reimbursed separately|439.95|FSC: 400601; BFG: 52||External grouping not supported
27206469|EAP|Custom 27206469||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Isolation Thermometer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.75|FSC: 400601; BFG: 52||Not reimbursed separately|24.75|FSC: 400601; BFG: 52||External grouping not supported
49000731|EAP|CPT® 49407||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Drainage Catheter Peritoneal/retroperitoneal W/ Transvaginal/transrectal Image Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
44400013|EAP|CPT® 92523||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Speech Evaluation Sound Production W/ Language Comprehension And Expression|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|234.15|FSC: 400601; BFG: 52||Not reimbursed separately|234.15|FSC: 400601; BFG: 52||External grouping not supported
27206480|EAP|Custom 27206480||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kaltostat 2gm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.55|FSC: 400601; BFG: 52||Not reimbursed separately|13.55|FSC: 400601; BFG: 52||External grouping not supported
27206498|EAP|Custom 27206498||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Knee Brace Neo Hinge|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|394.25|FSC: 400601; BFG: 52||Not reimbursed separately|394.25|FSC: 400601; BFG: 52||External grouping not supported
27206512|EAP|Custom 27206512||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Limb Restraint Disp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.55|FSC: 400601; BFG: 52||Not reimbursed separately|19.55|FSC: 400601; BFG: 52||External grouping not supported
27206517|EAP|Custom 27206517||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Lumbar Brace Warm&fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|101.60|FSC: 400601; BFG: 52||Not reimbursed separately|101.60|FSC: 400601; BFG: 52||External grouping not supported
27000092|EAP|Custom 27000092||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Cch Mouth Care System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.95|FSC: 400601; BFG: 52||Not reimbursed separately|103.95|FSC: 400601; BFG: 52||External grouping not supported
27400276|EAP|Custom 27400276||0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES|Hc Cch Shoe Post Op|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.15|FSC: 400601; BFG: 52||Not reimbursed separately|87.15|FSC: 400601; BFG: 52||External grouping not supported
27204219|EAP|Custom 27204219||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Stapler Skin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.95|FSC: 400601; BFG: 52||Not reimbursed separately|59.95|FSC: 400601; BFG: 52||External grouping not supported
76100122|EAP|CPT® 54160||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Cch Circumcision Neonate <= 28 Days|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,285.20|FSC: 400601; BFG: 52||Not reimbursed separately|1,285.20|FSC: 400601; BFG: 52||External grouping not supported
30100538|EAP|CPT® 83550||0301 - LABORATORY - CHEMISTRY|Hc Cch Iron Binding Capacity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
34100089|EAP|CPT® 78708||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Cch Nuc Med Kidney Image Morphology W/ Vasc Flow Function & Pharmocologic Intervention Sgl Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
32000226|EAP|CPT® 76010||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cch Radiology Exam Nose To Rectum For Fb Single View Child|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000227|EAP|CPT® 77076||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cch Radiology Exam Osseous Survey Infant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000225|EAP|CPT® 74247||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cch Radiology Exam Upper Gi W/ Air Contrast W/ Kub|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000224|EAP|CPT® 74241||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cch Radiology Exam Upper Gi W/ Kub|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|676.20|FSC: 400601; BFG: 52||Not reimbursed separately|676.20|FSC: 400601; BFG: 52||External grouping not supported
32000220|EAP|CPT® 73092||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology X-ray Arm Infant 2+ Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
30600167|EAP|CPT® 87880||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Strep A Assay W/ Optic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30600281|EAP|CPT® 0100U||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Respiratory Pathogens 20 Targets|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|847.35|FSC: 400601; BFG: 52||Not reimbursed separately|847.35|FSC: 400601; BFG: 52||External grouping not supported
30600282|EAP|CPT® 87507||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Gi Pathogen 22 Targets|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|994.35|FSC: 400601; BFG: 52||Not reimbursed separately|994.35|FSC: 400601; BFG: 52||External grouping not supported
27206569|EAP|Custom 27206569||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Nebulizer Set Up Continous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.30|FSC: 400601; BFG: 52||Not reimbursed separately|86.30|FSC: 400601; BFG: 52||External grouping not supported
27206594|EAP|Custom 27206594||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Oxygen Humidifier Disp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.45|FSC: 400601; BFG: 52||Not reimbursed separately|19.45|FSC: 400601; BFG: 52||External grouping not supported
30600170|EAP|CPT® 87493||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So C Diff Amplified Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
27802778|EAP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hc Cath Umbilical 5.0fr Dual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
27802779|EAP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hc Cath Umbilical 3.5fr Dual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
27206605|EAP|Custom 27206605||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ointment Lanolin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.70|FSC: 400601; BFG: 52||Not reimbursed separately|22.70|FSC: 400601; BFG: 52||External grouping not supported
27204224|EAP|Custom 27204224||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Mattress Infant Transwarmer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|132.45|FSC: 400601; BFG: 52||Not reimbursed separately|132.45|FSC: 400601; BFG: 52||External grouping not supported
27204227|EAP|Custom 27204227||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Transducer Trifurcated W Vamp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.70|FSC: 400601; BFG: 52||Not reimbursed separately|110.70|FSC: 400601; BFG: 52||External grouping not supported
27206614|EAP|Custom 27206614||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ostomy Skin Br-4"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.75|FSC: 400601; BFG: 52||Not reimbursed separately|24.75|FSC: 400601; BFG: 52||External grouping not supported
49000679|EAP|CPT® 41115||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Excision Of Lingual Frenum (frenectomy)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,723.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,723.05|FSC: 400601; BFG: 52||External grouping not supported
49000678|EAP|CPT® 40819||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Excision Of Frenum Labial Or Buccal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,060.10|FSC: 400601; BFG: 52||Not reimbursed separately|2,060.10|FSC: 400601; BFG: 52||External grouping not supported
27206636|EAP|Custom 27206636||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Paste Stomahes 2 Oz|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.90|FSC: 400601; BFG: 52||Not reimbursed separately|51.90|FSC: 400601; BFG: 52||External grouping not supported
27206638|EAP|Custom 27206638||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Peak Flow Meter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.20|FSC: 400601; BFG: 52||Not reimbursed separately|59.20|FSC: 400601; BFG: 52||External grouping not supported
27206642|EAP|Custom 27206642||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Perc.suprapubic Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|434.30|FSC: 400601; BFG: 52||Not reimbursed separately|434.30|FSC: 400601; BFG: 52||External grouping not supported
27206653|EAP|Custom 27206653||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Pneumothorax Kit-dis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|952.40|FSC: 400601; BFG: 52||Not reimbursed separately|952.40|FSC: 400601; BFG: 52||External grouping not supported
27206663|EAP|Custom 27206663||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Pouch Ostomy Drain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.70|FSC: 400601; BFG: 52||Not reimbursed separately|59.70|FSC: 400601; BFG: 52||External grouping not supported
27206673|EAP|Custom 27206673||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Prisma Dressing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.85|FSC: 400601; BFG: 52||Not reimbursed separately|99.85|FSC: 400601; BFG: 52||External grouping not supported
27206686|EAP|Custom 27206686||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Radial Artery Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.40|FSC: 400601; BFG: 52||Not reimbursed separately|53.40|FSC: 400601; BFG: 52||External grouping not supported
27206721|EAP|Custom 27206721||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sitz Bath Disposable|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|112.10|FSC: 400601; BFG: 52||Not reimbursed separately|112.10|FSC: 400601; BFG: 52||External grouping not supported
27206726|EAP|Custom 27206726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sling Arm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.75|FSC: 400601; BFG: 52||Not reimbursed separately|16.75|FSC: 400601; BFG: 52||External grouping not supported
27206736|EAP|Custom 27206736||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Spandage/foot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.60|FSC: 400601; BFG: 52||Not reimbursed separately|13.60|FSC: 400601; BFG: 52||External grouping not supported
27206738|EAP|Custom 27206738||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Spirometer Disposable|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.60|FSC: 400601; BFG: 52||Not reimbursed separately|23.60|FSC: 400601; BFG: 52||External grouping not supported
30600179|EAP|CPT® 87205||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Smear - Gram Or Giemsa|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.65|FSC: 400601; BFG: 52||Not reimbursed separately|13.65|FSC: 400601; BFG: 52||External grouping not supported
44000037|EAP|CPT® 96125||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Cognitive Test Per Hour By St|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.90|FSC: 400601; BFG: 52||Not reimbursed separately|102.90|FSC: 400601; BFG: 52||External grouping not supported
27206783|EAP|Custom 27206783||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Surgicel 4x8|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|286.25|FSC: 400601; BFG: 52||Not reimbursed separately|286.25|FSC: 400601; BFG: 52||External grouping not supported
49000784|EAP|CPT® 47531||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Cholangiography Percutaneous Incl Imaging Guidance Existing Access|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|6,189.75|FSC: 400601; BFG: 52||Not reimbursed separately|6,189.75|FSC: 400601; BFG: 52||External grouping not supported
49000800|EAP|CPT® 50431||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Antegrade Nephrostogram/ureterogram W/ Image Guidance Existing Access|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,514.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,514.10|FSC: 400601; BFG: 52||External grouping not supported
49000801|EAP|CPT® 50432||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Placement Nephrostomy Catheter Percutaneous W/ Image Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,540.20|FSC: 400601; BFG: 52||Not reimbursed separately|4,540.20|FSC: 400601; BFG: 52||External grouping not supported
27206799|EAP|Custom 27206799||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tape Elastoplast 3in|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.10|FSC: 400601; BFG: 52||Not reimbursed separately|19.10|FSC: 400601; BFG: 52||External grouping not supported
49000804|EAP|CPT® 50435||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Exchange Nephrostomy Catheter Percutaneous W/ Image Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,540.20|FSC: 400601; BFG: 52||Not reimbursed separately|4,540.20|FSC: 400601; BFG: 52||External grouping not supported
49000806|EAP|CPT® 50693||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Placement Ureteral Stent Percutaneous W/ Image Guidance Via Pre-existing Nephrostomy Tract|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,653.48|FSC: 400601; BFG: 52||Not reimbursed separately|3,653.48|FSC: 400601; BFG: 52||External grouping not supported
32000232|EAP|CPT® 72081||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Spine Entire Thoracic And Lumbar 1 View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000233|EAP|CPT® 72082||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Spine Entire Thoracic And Lumbar 2 Or 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000234|EAP|CPT® 72083||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Spine Entire Thoracic And Lumbar 4 Or 5 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000236|EAP|CPT® 73501||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Hip W/ Pelvis When Performed Unilateral 1 View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000237|EAP|CPT® 73502||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Hip W/ Pelvis When Performed Unilateral 2 -3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000240|EAP|CPT® 73522||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Hip W/ Pelvis When Performed Bilateral 3-4 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000241|EAP|CPT® 73523||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Hip W/ Pelvis When Performed Bilateral Minimum 5 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000242|EAP|CPT® 73551||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Femur 1 View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
32000243|EAP|CPT® 73552||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Femur Minimum 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
27206824|EAP|Custom 27206824||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Towels Sterile Nodis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.45|FSC: 400601; BFG: 52||Not reimbursed separately|15.45|FSC: 400601; BFG: 52||External grouping not supported
27206829|EAP|Custom 27206829||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tracheostomy Tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|240.85|FSC: 400601; BFG: 52||Not reimbursed separately|240.85|FSC: 400601; BFG: 52||External grouping not supported
42000087|EAP|CPT® 97139||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Pt Visit/procedure|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
43000084|EAP|CPT® 97139||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Ot Visit/procedure|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
27206852|EAP|Custom 27206852||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Unna Boot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.55|FSC: 400601; BFG: 52||Not reimbursed separately|47.55|FSC: 400601; BFG: 52||External grouping not supported
27206863|EAP|Custom 27206863||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Urine Drainage Bag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.30|FSC: 400601; BFG: 52||Not reimbursed separately|23.30|FSC: 400601; BFG: 52||External grouping not supported
27206876|EAP|Custom 27206876||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Vacuum Delivery Kit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.30|FSC: 400601; BFG: 52||Not reimbursed separately|196.30|FSC: 400601; BFG: 52||External grouping not supported
27206880|EAP|Custom 27206880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Valve Reflex Salem|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|113.85|FSC: 400601; BFG: 52||Not reimbursed separately|113.85|FSC: 400601; BFG: 52||External grouping not supported
27206900|EAP|Custom 27206900||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Water Drainage Seal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|171.80|FSC: 400601; BFG: 52||Not reimbursed separately|171.80|FSC: 400601; BFG: 52||External grouping not supported
30600283|EAP|CPT® 87541||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Legionella Pneumphilia Amplified Probe Technique|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.80|FSC: 400601; BFG: 52||Not reimbursed separately|205.80|FSC: 400601; BFG: 52||External grouping not supported
30100752|EAP|CPT® 83986||0301 - LABORATORY - CHEMISTRY|Hc So Assay Ph Body Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
30100756|EAP|CPT® 84560||0301 - LABORATORY - CHEMISTRY|Hc So Uric Acid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
62100002|EAP|Custom 62100002||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Barium Thick|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.05|FSC: 400601; BFG: 52||Not reimbursed separately|22.05|FSC: 400601; BFG: 52||External grouping not supported
62100004|EAP|Custom 62100004||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Barium Readi Cat|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.25|FSC: 400601; BFG: 52||Not reimbursed separately|26.25|FSC: 400601; BFG: 52||External grouping not supported
62100006|EAP|Custom 62100006||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Biopsy Gun|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|271.95|FSC: 400601; BFG: 52||Not reimbursed separately|271.95|FSC: 400601; BFG: 52||External grouping not supported
62100016|EAP|Custom 62100016||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Chiba Needle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
62100018|EAP|Custom 62100018||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Connecting Tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
62100024|EAP|Custom 62100024||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Ez A.c. Barium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|139.65|FSC: 400601; BFG: 52||Not reimbursed separately|139.65|FSC: 400601; BFG: 52||External grouping not supported
62100026|EAP|Custom 62100026||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Ez Gas|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.90|FSC: 400601; BFG: 52||Not reimbursed separately|18.90|FSC: 400601; BFG: 52||External grouping not supported
31200029|EAP|CPT® 88307||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Surg Path Level V|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
27204911|EAP|Custom 27204911||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Valve Chest Drain Pneumostat|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.30|FSC: 400601; BFG: 52||Not reimbursed separately|196.30|FSC: 400601; BFG: 52||External grouping not supported
27204915|EAP|Custom 27204915||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Lens Morgan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.15|FSC: 400601; BFG: 52||Not reimbursed separately|29.15|FSC: 400601; BFG: 52||External grouping not supported
30500070|EAP|CPT® 85420||0305 - LABORATORY - HEMATOLOGY|Hc So Functional Plasminogen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.75|FSC: 400601; BFG: 52||Not reimbursed separately|120.75|FSC: 400601; BFG: 52||External grouping not supported
94200026|EAP|CPT® 97802||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Medical Nutrition Therapy Individual Initial Assessment & Intervention Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54.60|FSC: 400601; BFG: 52||Not reimbursed separately|54.60|FSC: 400601; BFG: 52||External grouping not supported
94200027|EAP|CPT® 97803||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Medical Nutrition Therapy Individual Re-assessment & Intervention Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54.60|FSC: 400601; BFG: 52||Not reimbursed separately|54.60|FSC: 400601; BFG: 52||External grouping not supported
94200028|EAP|CPT® 97804||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Medical Nutrition Therapy Group >2 Individuals Each 30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.10|FSC: 400601; BFG: 52||Not reimbursed separately|23.10|FSC: 400601; BFG: 52||External grouping not supported
30000072|EAP|CPT® 86885||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Coombs Test Indirect Qual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.45|FSC: 400601; BFG: 52||Not reimbursed separately|345.45|FSC: 400601; BFG: 52||External grouping not supported
35200025|EAP|CPT® 71271||0352 - CT SCAN - BODY SCAN|HC LOW DOSE CT LLUNG SCREENING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|163.80|FSC: 400601; BFG: 52||Not reimbursed separately|163.80|FSC: 400601; BFG: 52||External grouping not supported
77000004|EAP|HCPCS G0296||0770 - PREVENTIVE CARE SERVICES - GENERAL CLASSIFICATION|Hc Visit For Determination Low Dose Ct Scan Elig|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|166.95|FSC: 400601; BFG: 52||Not reimbursed separately|166.95|FSC: 400601; BFG: 52||External grouping not supported
62100057|EAP|Custom 62100057||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Thoracentesis Set|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
51400001|EAP|CPT® 59000||0514 - CLINIC - OB-GYN CLINIC|Hc Amniocentesis Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,541.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,541.40|FSC: 400601; BFG: 52||External grouping not supported
39100001|EAP|CPT® 36430||0391 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - ADMINISTRATION (EG, TRANSFUSIONS)|Hc Transfusion Blood Or Blood Components|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|682.50|FSC: 400601; BFG: 52||Not reimbursed separately|682.50|FSC: 400601; BFG: 52||External grouping not supported
44400004|EAP|CPT® 92610||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Swallowing Evaluation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|232.05|FSC: 400601; BFG: 52||Not reimbursed separately|232.05|FSC: 400601; BFG: 52||External grouping not supported
44400005|EAP|CPT® 92611||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Motion Fluoroscopic Swallowing Evaluation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|278.25|FSC: 400601; BFG: 52||Not reimbursed separately|278.25|FSC: 400601; BFG: 52||External grouping not supported
44400006|EAP|CPT® 96105||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Aphasia Assessment Per Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|238.35|FSC: 400601; BFG: 52||Not reimbursed separately|238.35|FSC: 400601; BFG: 52||External grouping not supported
77100001|EAP|CPT® 90471||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hc Vaccine Administration Initial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|155.40|FSC: 400601; BFG: 52||Not reimbursed separately|155.40|FSC: 400601; BFG: 52||External grouping not supported
77100002|EAP|CPT® 90472||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hc Vaccine Administration Each Additional|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
77100003|EAP|HCPCS G0008||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hc Influenza Vaccine Administration|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
77100004|EAP|HCPCS G0009||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|Hc Pneumococcal Vaccine Administration|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
92100001|EAP|CPT® 93880||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Extracranial Arteries Complete Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|835.80|FSC: 400601; BFG: 52||Not reimbursed separately|835.80|FSC: 400601; BFG: 52||External grouping not supported
92100002|EAP|CPT® 93882||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Extracranial Arteries Unilateral Or Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|605.85|FSC: 400601; BFG: 52||Not reimbursed separately|605.85|FSC: 400601; BFG: 52||External grouping not supported
92100005|EAP|CPT® 93924||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Complete Le Study At Rest And Stress Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
92100006|EAP|CPT® 93925||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Le Arteries Or Bypass Grafts Complete Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
92100007|EAP|CPT® 93926||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Le Arteries Or Bypass Grafts Unilateral Or Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|605.85|FSC: 400601; BFG: 52||Not reimbursed separately|605.85|FSC: 400601; BFG: 52||External grouping not supported
92100008|EAP|CPT® 93930||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Ue Arteries Or Bypass Grafts Complete Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
92100009|EAP|CPT® 93931||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Ue Arteries Or Bypass Grafts Unilateral Or Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|605.85|FSC: 400601; BFG: 52||Not reimbursed separately|605.85|FSC: 400601; BFG: 52||External grouping not supported
92100010|EAP|CPT® 93970||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Extremity Veins Compression Complete Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
92100011|EAP|CPT® 93971||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Extremity Veins Compression Unilateral Or Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|605.85|FSC: 400601; BFG: 52||Not reimbursed separately|605.85|FSC: 400601; BFG: 52||External grouping not supported
92100012|EAP|CPT® 93975||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Abdomen Pelvis Retroperitoneal Or Scrotum Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,043.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,043.70|FSC: 400601; BFG: 52||External grouping not supported
92100013|EAP|CPT® 93976||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Duplex Abdomen Pelvis Retroperitoneal Or Scrotum Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,043.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,043.70|FSC: 400601; BFG: 52||External grouping not supported
62100062|EAP|Custom 62100062||0621 - MEDICAL/SURGICAL SUPPLIES - SUPPLIES INCIDENT TO RADIOLOGY|Hc Cch Vessel Dilator|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.20|FSC: 400601; BFG: 52||Not reimbursed separately|46.20|FSC: 400601; BFG: 52||External grouping not supported
94000024|EAP|CPT® 99195||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Phlebotomy Therapeutic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
49000006|EAP|CPT® 10160||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Puncture Aspiration Abscess Hematoma Or Cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|832.65|FSC: 400601; BFG: 52||Not reimbursed separately|832.65|FSC: 400601; BFG: 52||External grouping not supported
30500075|EAP|CPT® 85810||0305 - LABORATORY - HEMATOLOGY|Hc So Viscosity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
49000028|EAP|CPT® 19000||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Puncture Aspiration Breast Cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000036|EAP|CPT® 20206||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Muscle Percutaneous Needle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000037|EAP|CPT® 20220||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Bone Trocar/needle Superficial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,657.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,657.95|FSC: 400601; BFG: 52||External grouping not supported
49000039|EAP|CPT® 20501||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Sinus Tract Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|241.50|FSC: 400601; BFG: 52||Not reimbursed separately|241.50|FSC: 400601; BFG: 52||External grouping not supported
49000051|EAP|CPT® 23350||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Shoulder Arthrography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|177.45|FSC: 400601; BFG: 52||Not reimbursed separately|177.45|FSC: 400601; BFG: 52||External grouping not supported
49000052|EAP|CPT® 24220||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Elbow Arthrography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|233.10|FSC: 400601; BFG: 52||Not reimbursed separately|233.10|FSC: 400601; BFG: 52||External grouping not supported
49000053|EAP|CPT® 25246||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Wrist Arthrography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.20|FSC: 400601; BFG: 52||Not reimbursed separately|256.20|FSC: 400601; BFG: 52||External grouping not supported
49000055|EAP|CPT® 27093||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Hip Arthrography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|264.60|FSC: 400601; BFG: 52||Not reimbursed separately|264.60|FSC: 400601; BFG: 52||External grouping not supported
49000056|EAP|CPT® 27369||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Knee Arthrography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|172.20|FSC: 400601; BFG: 52||Not reimbursed separately|172.20|FSC: 400601; BFG: 52||External grouping not supported
49000057|EAP|CPT® 27648||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Ankle Arthrography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|172.20|FSC: 400601; BFG: 52||Not reimbursed separately|172.20|FSC: 400601; BFG: 52||External grouping not supported
49000060|EAP|CPT® 31622||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,543.75|FSC: 400601; BFG: 52||Not reimbursed separately|3,543.75|FSC: 400601; BFG: 52||External grouping not supported
49000061|EAP|CPT® 31623||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Brushings|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,543.75|FSC: 400601; BFG: 52||Not reimbursed separately|3,543.75|FSC: 400601; BFG: 52||External grouping not supported
49000062|EAP|CPT® 31624||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Bal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,543.75|FSC: 400601; BFG: 52||Not reimbursed separately|3,543.75|FSC: 400601; BFG: 52||External grouping not supported
49000063|EAP|CPT® 31625||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Bronch Or Endobronchial Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,543.75|FSC: 400601; BFG: 52||Not reimbursed separately|3,543.75|FSC: 400601; BFG: 52||External grouping not supported
49000064|EAP|CPT® 31628||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Transbronch Lung Bx Single Lobe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5,755.05|FSC: 400601; BFG: 52||Not reimbursed separately|5,755.05|FSC: 400601; BFG: 52||External grouping not supported
49000065|EAP|CPT® 31629||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy Needle Bx Trachea Main Stem And Bronch|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,197.75|FSC: 400601; BFG: 52||Not reimbursed separately|7,197.75|FSC: 400601; BFG: 52||External grouping not supported
49000068|EAP|CPT® 31632||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Transbronch Lung Bx Each Addl Lobe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,356.20|FSC: 400601; BFG: 52||Not reimbursed separately|2,356.20|FSC: 400601; BFG: 52||External grouping not supported
49000070|EAP|CPT® 31635||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Removal Fb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,543.75|FSC: 400601; BFG: 52||Not reimbursed separately|3,543.75|FSC: 400601; BFG: 52||External grouping not supported
49000076|EAP|CPT® 31645||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bronchoscopy W/ Asp Tracheobronchial Tree Initial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,666.60|FSC: 400601; BFG: 52||Not reimbursed separately|3,666.60|FSC: 400601; BFG: 52||External grouping not supported
49000080|EAP|CPT® 32408||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|HC BX LUNG MEDIASTINUM PERCUTANEOUS NEEDLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000084|EAP|CPT® 32560||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Treat Pleurodesis With Agent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,640.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,640.10|FSC: 400601; BFG: 52||External grouping not supported
99900104|EAP|Custom 99900104||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Cch Edema Glove|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
49000153|EAP|CPT® 36005||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Extremity Venography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|168.00|FSC: 400601; BFG: 52||Not reimbursed separately|168.00|FSC: 400601; BFG: 52||External grouping not supported
49000154|EAP|CPT® 36010||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Introduction Cath Inferior Or Superior Vena Cava|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|434.70|FSC: 400601; BFG: 52||Not reimbursed separately|434.70|FSC: 400601; BFG: 52||External grouping not supported
49000155|EAP|CPT® 36011||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cath Placement Venous 1st Order|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|558.60|FSC: 400601; BFG: 52||Not reimbursed separately|558.60|FSC: 400601; BFG: 52||External grouping not supported
49000156|EAP|CPT® 36012||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cath Placement Venous 2nd Order Or More Selective Branch|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|620.55|FSC: 400601; BFG: 52||Not reimbursed separately|620.55|FSC: 400601; BFG: 52||External grouping not supported
49000164|EAP|CPT® 36200||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Introduction Needle Or Intracatheter Aorta|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|537.60|FSC: 400601; BFG: 52||Not reimbursed separately|537.60|FSC: 400601; BFG: 52||External grouping not supported
49000176|EAP|CPT® 36500||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Venous Cath For Selective Organ Blood Sampling|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|642.60|FSC: 400601; BFG: 52||Not reimbursed separately|642.60|FSC: 400601; BFG: 52||External grouping not supported
27205089|EAP|Custom 27205089||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Wound Vac Cannister 300cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|234.15|FSC: 400601; BFG: 52||Not reimbursed separately|234.15|FSC: 400601; BFG: 52||External grouping not supported
76100020|EAP|CPT® 32552||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Removal Pleural Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,640.10|FSC: 400601; BFG: 52||Not reimbursed separately|1,640.10|FSC: 400601; BFG: 52||External grouping not supported
76100094|EAP|CPT® 97605||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Negative Pressure Wound Tx W/ Dme <= 50 Sq Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|452.55|FSC: 400601; BFG: 52||Not reimbursed separately|452.55|FSC: 400601; BFG: 52||External grouping not supported
76100095|EAP|CPT® 97606||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Negative Pressure Wound Tx W/ Dme > 50 Sq Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|832.65|FSC: 400601; BFG: 52||Not reimbursed separately|832.65|FSC: 400601; BFG: 52||External grouping not supported
94000019|EAP|CPT® 96372||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Injection Im Or Sq|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|134.40|FSC: 400601; BFG: 52||Not reimbursed separately|134.40|FSC: 400601; BFG: 52||External grouping not supported
49000186|EAP|CPT® 36569||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Insertion Picc W/o Pump/port W/o Imaging > 5 Years Old|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,632.35|FSC: 400601; BFG: 52||Not reimbursed separately|2,632.35|FSC: 400601; BFG: 52||External grouping not supported
49000200|EAP|CPT® 36597||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Repositioning Cvc Under Fluoro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,632.35|FSC: 400601; BFG: 52||Not reimbursed separately|2,632.35|FSC: 400601; BFG: 52||External grouping not supported
49000201|EAP|CPT® 36598||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Contrast For Eval Of Central Vad W/ Fluoro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|511.35|FSC: 400601; BFG: 52||Not reimbursed separately|511.35|FSC: 400601; BFG: 52||External grouping not supported
27205102|EAP|Custom 27205102||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Lens Morgan Mt200|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.60|FSC: 400601; BFG: 52||Not reimbursed separately|110.60|FSC: 400601; BFG: 52||External grouping not supported
51000514|EAP|CPT® 64615||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Chemodenervation Muscles Facial/trigem/cerv Sp/access Nerves Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
49000238|EAP|CPT® 38505||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Lymph Node Needle Superficial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,657.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,657.95|FSC: 400601; BFG: 52||External grouping not supported
92000007|EAP|CPT® 59020||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hc Fetal Contraction Stress Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|430.50|FSC: 400601; BFG: 52||Not reimbursed separately|430.50|FSC: 400601; BFG: 52||External grouping not supported
92000008|EAP|CPT® 59025||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hc Fetal Non-stress Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|430.50|FSC: 400601; BFG: 52||Not reimbursed separately|430.50|FSC: 400601; BFG: 52||External grouping not supported
51000515|EAP|CPT® 20551||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Injection Tendon Origin/insertion Single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
94000034|EAP|Custom 94000034||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Dry Needling Of Trigger Point By Pt Per 15 Min|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.01|FSC: 400601; BFG: 52||Not reimbursed separately|70.01|FSC: 400601; BFG: 52||External grouping not supported
49000243|EAP|CPT® 42400||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Salivary Gland Needle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000248|EAP|CPT® 44500||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Introduction Long Gi Tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,063.25|FSC: 400601; BFG: 52||Not reimbursed separately|2,063.25|FSC: 400601; BFG: 52||External grouping not supported
49000252|EAP|CPT® 47000||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Liver Needle Percutaneous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000271|EAP|CPT® 48102||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Pancreas Percutaneous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,888.55|FSC: 400601; BFG: 52||Not reimbursed separately|2,888.55|FSC: 400601; BFG: 52||External grouping not supported
49000281|EAP|CPT® 49180||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Abdominal/retroperitonela Mass Percutaneous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
49000283|EAP|CPT® 49423||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Exchange Abscess Or Cyst Drainage Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,743.00|FSC: 400601; BFG: 52||Not reimbursed separately|1,743.00|FSC: 400601; BFG: 52||External grouping not supported
49000284|EAP|CPT® 49424||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Contrast Via Cath/tube For Eval Abscess Or Cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|689.85|FSC: 400601; BFG: 52||Not reimbursed separately|689.85|FSC: 400601; BFG: 52||External grouping not supported
49000294|EAP|CPT® 49465||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Contrast Percutaneous For Eval Gi Tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
49000299|EAP|CPT® 50200||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Renal Percutaneous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
30100793|EAP|CPT® 83986||0301 - LABORATORY - CHEMISTRY|Hc Assay Ph Body Fluid Nos|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
49000302|EAP|CPT® 50390||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Aspiration/injection Renal Cyst/pelvis Percutaneous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000316|EAP|CPT® 50690||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Visualization Ileal Conduit/ureteropyelography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|203.70|FSC: 400601; BFG: 52||Not reimbursed separately|203.70|FSC: 400601; BFG: 52||External grouping not supported
49000319|EAP|CPT® 51102||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bladder Aspiration W/ Insertion Suprapubic Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,540.20|FSC: 400601; BFG: 52||Not reimbursed separately|4,540.20|FSC: 400601; BFG: 52||External grouping not supported
27206921|EAP|Custom 27206921||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bair Hugger Blanket|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.80|FSC: 400601; BFG: 52||Not reimbursed separately|44.80|FSC: 400601; BFG: 52||External grouping not supported
49000320|EAP|CPT® 51600||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Cystography/voiding Urethrocystography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|407.40|FSC: 400601; BFG: 52||Not reimbursed separately|407.40|FSC: 400601; BFG: 52||External grouping not supported
49000321|EAP|CPT® 51610||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Retrograde Urethrocystography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|349.65|FSC: 400601; BFG: 52||Not reimbursed separately|349.65|FSC: 400601; BFG: 52||External grouping not supported
27206926|EAP|Custom 27206926||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Elbow-band It|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|177.55|FSC: 400601; BFG: 52||Not reimbursed separately|177.55|FSC: 400601; BFG: 52||External grouping not supported
49000358|EAP|CPT® 58340||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Hysterosalpingography Or Saline Infusion Sonohysterograophy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.95|FSC: 400601; BFG: 52||Not reimbursed separately|208.95|FSC: 400601; BFG: 52||External grouping not supported
27206931|EAP|Custom 27206931||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Nasopharyngl Airway|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.70|FSC: 400601; BFG: 52||Not reimbursed separately|24.70|FSC: 400601; BFG: 52||External grouping not supported
49000366|EAP|CPT® 60100||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Thyroid Percutaneous Needle Core|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000367|EAP|CPT® 60300||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Aspiration Thyroid Cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,534.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,534.05|FSC: 400601; BFG: 52||External grouping not supported
49000375|EAP|CPT® 62270||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|HC LUMBAR PUNCTURE DIAGNOSTIC W/O GUIDANCE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
49000376|EAP|CPT® 62273||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|HC INJECTION/EPICURAL BLOOD/CLOT PATCH|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
49000377|EAP|CPT® 62284||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Myelography And/or Ct Lumbar|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|380.10|FSC: 400601; BFG: 52||Not reimbursed separately|380.10|FSC: 400601; BFG: 52||External grouping not supported
49000378|EAP|CPT® 62290||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Discography Lumbar Each Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|505.05|FSC: 400601; BFG: 52||Not reimbursed separately|505.05|FSC: 400601; BFG: 52||External grouping not supported
49000389|EAP|CPT® 64640||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction Neurolytic Agent Other Peripheral Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000390|EAP|HCPCS G0260||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Sacroiliac Joint W/ Arthrography & Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
51000046|EAP|CPT® 10140||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc I&d Hematoma Seroma Or Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,683.40|FSC: 400601; BFG: 52||Not reimbursed separately|3,683.40|FSC: 400601; BFG: 52||External grouping not supported
27206950|EAP|Custom 27206950||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Splint Traction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|96.45|FSC: 400601; BFG: 52||Not reimbursed separately|96.45|FSC: 400601; BFG: 52||External grouping not supported
12000001|EAP|Custom 12000001||0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION|Hc Med/surg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|909.30|FSC: 400601; BFG: 52||Not reimbursed separately|909.30|FSC: 400601; BFG: 52||Accommodation codes not reimbursed separately
12000002|EAP|Custom 12000002||0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION|Hc Med/surg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,338.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,338.75|FSC: 400601; BFG: 52||Accommodation codes not reimbursed separately
17000001|EAP|Custom 17000001||0170 - NURSERY - GENERAL CLASSIFICATION|Hc Nursery|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,499.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,499.40|FSC: 400601; BFG: 52||Accommodation codes not reimbursed separately
20000001|EAP|Custom 20000001||0200 - INTENSIVE CARE - GENERAL CLASSIFICATION|Hc Icu|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,356.20|FSC: 400601; BFG: 52||Not reimbursed separately|2,356.20|FSC: 400601; BFG: 52||Accommodation codes not reimbursed separately
20600001|EAP|Custom 20600001||0206 - INTENSIVE CARE - INTERMEDIATE ICU|Hc Intermediate Care|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,606.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,606.50|FSC: 400601; BFG: 52||Accommodation codes not reimbursed separately
37000010|EAP|Custom 37000010||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Regional Anesthesia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|294.00|FSC: 400601; BFG: 52||Not reimbursed separately|294.00|FSC: 400601; BFG: 52||External grouping not supported
41000001|EAP|CPT® 94002||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Ventilator Initial Day|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,233.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,233.75|FSC: 400601; BFG: 52||External grouping not supported
41000002|EAP|CPT® 94003||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Ventilator Each Subsequent Day|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,233.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,233.75|FSC: 400601; BFG: 52||External grouping not supported
41000016|EAP|CPT® 94644||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Continuous Inhalation Tx 1st Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
41000017|EAP|CPT® 94645||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Continuous Inhalation Tx Each Addl Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
41000028|EAP|CPT® 94667||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Manual Chest Wall Manipulation (pep) Initial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
41000029|EAP|CPT® 94668||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Manual Chest Wall Manipulation (pep) Subsequent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
41000033|EAP|HCPCS G0239||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Pulmonary Exercise Session Group|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
42000011|EAP|CPT® 97012||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Traction Mechanical|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.75|FSC: 400601; BFG: 52||Not reimbursed separately|57.75|FSC: 400601; BFG: 52||External grouping not supported
42000013|EAP|CPT® 97018||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Paraffin Bath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
42000014|EAP|CPT® 97022||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Whirlpool|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
42000016|EAP|CPT® 97032||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Electrical Stimulation Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.25|FSC: 400601; BFG: 52||Not reimbursed separately|68.25|FSC: 400601; BFG: 52||External grouping not supported
42000017|EAP|CPT® 97033||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Iontophoresis Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|159.60|FSC: 400601; BFG: 52||Not reimbursed separately|159.60|FSC: 400601; BFG: 52||External grouping not supported
42000018|EAP|CPT® 97034||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Contrast Baths Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
42000019|EAP|CPT® 97035||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Ultrasound Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
42000021|EAP|CPT® 97110||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Therapeutic Exercises Rom & Flexibility Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
42000022|EAP|CPT® 97112||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Neuromuscular Reeducation Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
42000023|EAP|CPT® 97113||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Aquatic Therapy Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|111.30|FSC: 400601; BFG: 52||Not reimbursed separately|111.30|FSC: 400601; BFG: 52||External grouping not supported
42000024|EAP|CPT® 97116||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Gait Training Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
42000025|EAP|CPT® 97124||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Massage Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
42000026|EAP|CPT® 97140||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Manual Therapy Techniques Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|117.60|FSC: 400601; BFG: 52||Not reimbursed separately|117.60|FSC: 400601; BFG: 52||External grouping not supported
42000030|EAP|CPT® 97533||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Sensory Integrative Techniques Direct Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.15|FSC: 400601; BFG: 52||Not reimbursed separately|87.15|FSC: 400601; BFG: 52||External grouping not supported
42000034|EAP|CPT® 97545||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Work Hardening/conditioning Initial 2 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|241.50|FSC: 400601; BFG: 52||Not reimbursed separately|241.50|FSC: 400601; BFG: 52||External grouping not supported
42000035|EAP|CPT® 97546||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Work Hardening/conditioning Each Addl Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|122.85|FSC: 400601; BFG: 52||Not reimbursed separately|122.85|FSC: 400601; BFG: 52||External grouping not supported
42000045|EAP|CPT® 97750||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Physical Performance Test W/ Report Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
42000040|EAP|CPT® 97760||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Orthotic Mgmt & Training Initial Each 15 Min|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.95|FSC: 400601; BFG: 52||Not reimbursed separately|103.95|FSC: 400601; BFG: 52||External grouping not supported
42000041|EAP|CPT® 97761||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Prosthetic Training Upper/lower Extremity Initial Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|94.50|FSC: 400601; BFG: 52||Not reimbursed separately|94.50|FSC: 400601; BFG: 52||External grouping not supported
42000043|EAP|HCPCS G0283||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Electrical Stimulation Non-wound Care|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
41000045|EAP|CPT® 31500||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Intubation Endotracheal Emergent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|477.75|FSC: 400601; BFG: 52||Not reimbursed separately|477.75|FSC: 400601; BFG: 52||External grouping not supported
36000006|EAP|CPT® 32551||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|HC INSERTION CHEST TUBE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,632.35|FSC: 400601; BFG: 52||Not reimbursed separately|2,632.35|FSC: 400601; BFG: 52||External grouping not supported
36000027|EAP|Custom 36000027||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level I 0-30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,905.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,905.75|FSC: 400601; BFG: 52||External grouping not supported
36000028|EAP|Custom 36000028||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level I Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|328.65|FSC: 400601; BFG: 52||Not reimbursed separately|328.65|FSC: 400601; BFG: 52||External grouping not supported
36000029|EAP|Custom 36000029||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level Ii 0-30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,926.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,926.75|FSC: 400601; BFG: 52||External grouping not supported
36000030|EAP|Custom 36000030||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level Ii Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|369.60|FSC: 400601; BFG: 52||Not reimbursed separately|369.60|FSC: 400601; BFG: 52||External grouping not supported
36000031|EAP|Custom 36000031||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level Iii 0-30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,102.10|FSC: 400601; BFG: 52||Not reimbursed separately|2,102.10|FSC: 400601; BFG: 52||External grouping not supported
36000032|EAP|Custom 36000032||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level Iii Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|410.55|FSC: 400601; BFG: 52||Not reimbursed separately|410.55|FSC: 400601; BFG: 52||External grouping not supported
36000033|EAP|Custom 36000033||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level Iv 0-30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,452.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,452.80|FSC: 400601; BFG: 52||External grouping not supported
36000034|EAP|Custom 36000034||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level Iv Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|452.55|FSC: 400601; BFG: 52||Not reimbursed separately|452.55|FSC: 400601; BFG: 52||External grouping not supported
36000035|EAP|Custom 36000035||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level V 0-30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,803.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,803.50|FSC: 400601; BFG: 52||External grouping not supported
36000036|EAP|Custom 36000036||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Or Level V Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|487.20|FSC: 400601; BFG: 52||Not reimbursed separately|487.20|FSC: 400601; BFG: 52||External grouping not supported
63600218|EAP|HCPCS J2790||0636 - PHARMACY - DRUGS REQUIRING DETAILED CODING|Hc Rho D Immune Globulin Full Dose|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|178.50|FSC: 400601; BFG: 52||Not reimbursed separately|178.50|FSC: 400601; BFG: 52||External grouping not supported
27206959|EAP|Custom 27206959||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Nasal Cannula|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.40|FSC: 400601; BFG: 52||Not reimbursed separately|17.40|FSC: 400601; BFG: 52||External grouping not supported
44000001|EAP|CPT® 92507||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Speech Therapy Individual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|240.45|FSC: 400601; BFG: 52||Not reimbursed separately|240.45|FSC: 400601; BFG: 52||External grouping not supported
44000002|EAP|CPT® 92508||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Speech Therapy Group|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.35|FSC: 400601; BFG: 52||Not reimbursed separately|28.35|FSC: 400601; BFG: 52||External grouping not supported
44000003|EAP|CPT® 92526||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Swallowing Dysfunction Treatment|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|171.15|FSC: 400601; BFG: 52||Not reimbursed separately|171.15|FSC: 400601; BFG: 52||External grouping not supported
44400007|EAP|CPT® 92597||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Evaluation For Use/fit Of Voice Prosthetic Device|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
44400008|EAP|CPT® 92607||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Evaluation Rx For Speech Device First Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|158.55|FSC: 400601; BFG: 52||Not reimbursed separately|158.55|FSC: 400601; BFG: 52||External grouping not supported
44400009|EAP|CPT® 92608||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Evaluation Rx For Speech Device Each Addl 30 Minutes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|170.10|FSC: 400601; BFG: 52||Not reimbursed separately|170.10|FSC: 400601; BFG: 52||External grouping not supported
44000008|EAP|CPT® 92609||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Therapeutic Services For Speech Devices|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|164.85|FSC: 400601; BFG: 52||Not reimbursed separately|164.85|FSC: 400601; BFG: 52||External grouping not supported
27400393|EAP|HCPCS L1906||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Cch Ankle Brace|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
30102042|EAP|CPT® 81247||0301 - LABORATORY - CHEMISTRY|Hc Cch So Glucose-6-phosphate Dehydrogenase (g6pd) 2 Mutations|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|412.99|FSC: 400601; BFG: 52||Not reimbursed separately|412.99|FSC: 400601; BFG: 52||External grouping not supported
46000001|EAP|CPT® 94010||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Spirometry Vital Capacity W/ Or W/o Maximal Voluntary Ventilation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
46000002|EAP|CPT® 94060||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Bronchodilation Response Pre & Post Bronchodilator Admin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
46000003|EAP|CPT® 94070||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Bronchospasm Provocation Eval|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
46000021|EAP|CPT® 94760||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Pulse Oximetry For O2 Sat Single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
46000022|EAP|CPT® 94761||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Pulse Oximetry For O2 Sat Multiple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
46000023|EAP|CPT® 94762||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Pulse Oximetry For O2 Sat Continuous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
42400002|EAP|CPT® 97164||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Pt Re-evaluation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|109.20|FSC: 400601; BFG: 52||Not reimbursed separately|109.20|FSC: 400601; BFG: 52||External grouping not supported
27400408|EAP|HCPCS A4565||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Immobilizer Shoulder|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.70|FSC: 400601; BFG: 52||Not reimbursed separately|56.70|FSC: 400601; BFG: 52||External grouping not supported
43000004|EAP|CPT® 95852||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Rom Testing Hand|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|112.35|FSC: 400601; BFG: 52||Not reimbursed separately|112.35|FSC: 400601; BFG: 52||External grouping not supported
30100815|EAP|CPT® 80201||0301 - LABORATORY - CHEMISTRY|Hc So Topiramate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200231|EAP|CPT® 86671||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Fungus Nes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30200234|EAP|CPT® 86793||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Yersinia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
40100006|EAP|HCPCS G0279||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hc Diagnostic Mammo Tomo Unilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|337.05|FSC: 400601; BFG: 52||Not reimbursed separately|337.05|FSC: 400601; BFG: 52||External grouping not supported
30100816|EAP|CPT® 80074||0301 - LABORATORY - CHEMISTRY|Hc Cch So Acute Hepatitis Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|157.50|FSC: 400601; BFG: 52||Not reimbursed separately|157.50|FSC: 400601; BFG: 52||External grouping not supported
30100817|EAP|CPT® 80178||0301 - LABORATORY - CHEMISTRY|Hc Cch So Lithium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.05|FSC: 400601; BFG: 52||Not reimbursed separately|22.05|FSC: 400601; BFG: 52||External grouping not supported
30100819|EAP|CPT® 80186||0301 - LABORATORY - CHEMISTRY|Hc Cch So Phenytoin Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100820|EAP|CPT® 80197||0301 - LABORATORY - CHEMISTRY|Hc Cch So Tacrolimus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30200228|EAP|CPT® 86708||0302 - LABORATORY - IMMUNOLOGY|Hc So Hepatitis A Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30200229|EAP|CPT® 86709||0302 - LABORATORY - IMMUNOLOGY|Hc So Hepatitis A Igm Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.75|FSC: 400601; BFG: 52||Not reimbursed separately|36.75|FSC: 400601; BFG: 52||External grouping not supported
30100822|EAP|CPT® 82024||0301 - LABORATORY - CHEMISTRY|Hc Cch So Acth|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.10|FSC: 400601; BFG: 52||Not reimbursed separately|128.10|FSC: 400601; BFG: 52||External grouping not supported
30100823|EAP|CPT® 82308||0301 - LABORATORY - CHEMISTRY|Hc So Calcitonin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
30100825|EAP|CPT® 82378||0301 - LABORATORY - CHEMISTRY|Hc Cch So Carcinoembryonic Antigen (cea)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
30100828|EAP|CPT® 82542||0301 - LABORATORY - CHEMISTRY|Hc Cch So Hplc 6-mtgn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
30100830|EAP|CPT® 82607||0301 - LABORATORY - CHEMISTRY|Hc Cch So Vitamin B-12 Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30100831|EAP|CPT® 82627||0301 - LABORATORY - CHEMISTRY|Hc Cch So Dhea-s|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|FSC: 400601; BFG: 52||Not reimbursed separately|73.50|FSC: 400601; BFG: 52||External grouping not supported
30100832|EAP|CPT® 82705||0301 - LABORATORY - CHEMISTRY|Hc Cch So Fat Or Lipids Feces Qual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100833|EAP|CPT® 82728||0301 - LABORATORY - CHEMISTRY|Hc Cch So Ferritin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
51000100|EAP|CPT® 29580||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Unna Boot Strapping|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|362.25|FSC: 400601; BFG: 52||Not reimbursed separately|362.25|FSC: 400601; BFG: 52||External grouping not supported
51000101|EAP|CPT® 29581||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Application Multi-layer Wound Compression Below Knee|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|362.25|FSC: 400601; BFG: 52||Not reimbursed separately|362.25|FSC: 400601; BFG: 52||External grouping not supported
30100834|EAP|CPT® 82746||0301 - LABORATORY - CHEMISTRY|Hc Cch So Folic Acid Serum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30100835|EAP|CPT® 82747||0301 - LABORATORY - CHEMISTRY|Hc Cch So Folic Acid Rbc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30100836|EAP|CPT® 82941||0301 - LABORATORY - CHEMISTRY|Hc Cch So Gastrin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
51000110|EAP|CPT® 31575||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Laryngoscopy Flexible Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|444.15|FSC: 400601; BFG: 52||Not reimbursed separately|444.15|FSC: 400601; BFG: 52||External grouping not supported
51000111|EAP|CPT® 31579||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Laryngoscopy W/ Stroboscopy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,004.85|FSC: 400601; BFG: 52||Not reimbursed separately|1,004.85|FSC: 400601; BFG: 52||External grouping not supported
30100837|EAP|CPT® 83001||0301 - LABORATORY - CHEMISTRY|Hc Cch So Gonadotropin Fsh|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
30100838|EAP|CPT® 83002||0301 - LABORATORY - CHEMISTRY|Hc Cch So Gonadotropin Luteinizing Hormone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
30100839|EAP|CPT® 83070||0301 - LABORATORY - CHEMISTRY|Hc Cch So Hemosiderin Qualitative|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
51000143|EAP|CPT® 64450||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|HC INJECTION PERIPHERAL NERVE OR BRANCH|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
51000144|EAP|CPT® 64483||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Injection(s) Transforaminal Lumbar Sacral Single Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,047.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,047.50|FSC: 400601; BFG: 52||External grouping not supported
51000145|EAP|CPT® 64484||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Injection(s) Transforaminal Lumbar Sacral Each Addl Level|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|836.85|FSC: 400601; BFG: 52||Not reimbursed separately|836.85|FSC: 400601; BFG: 52||External grouping not supported
30100843|EAP|CPT® 83586||0301 - LABORATORY - CHEMISTRY|Hc Cch So Ketosteroids 17 Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|151.20|FSC: 400601; BFG: 52||Not reimbursed separately|151.20|FSC: 400601; BFG: 52||External grouping not supported
51000152|EAP|CPT® 92520||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Laryngeal Function Studies|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
51000002|EAP|CPT® 99202||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit New Pt Level 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|221.55|FSC: 400601; BFG: 52||Not reimbursed separately|221.55|FSC: 400601; BFG: 52||External grouping not supported
51000003|EAP|CPT® 99203||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit New Pt Level 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|279.30|FSC: 400601; BFG: 52||Not reimbursed separately|279.30|FSC: 400601; BFG: 52||External grouping not supported
51000004|EAP|CPT® 99204||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit New Pt Level 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|318.15|FSC: 400601; BFG: 52||Not reimbursed separately|318.15|FSC: 400601; BFG: 52||External grouping not supported
51000005|EAP|CPT® 99205||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit New Pt Level 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|341.25|FSC: 400601; BFG: 52||Not reimbursed separately|341.25|FSC: 400601; BFG: 52||External grouping not supported
51000006|EAP|CPT® 99211||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit Established Pt Level 1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.15|FSC: 400601; BFG: 52||Not reimbursed separately|87.15|FSC: 400601; BFG: 52||External grouping not supported
30100846|EAP|CPT® 83918||0301 - LABORATORY - CHEMISTRY|Hc Cch So Organic Acids Total Quantitative Each Specimen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|112.35|FSC: 400601; BFG: 52||Not reimbursed separately|112.35|FSC: 400601; BFG: 52||External grouping not supported
51000007|EAP|CPT® 99212||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit Established Pt Level 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|178.50|FSC: 400601; BFG: 52||Not reimbursed separately|178.50|FSC: 400601; BFG: 52||External grouping not supported
51000008|EAP|CPT® 99213||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit Established Pt Level 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|203.70|FSC: 400601; BFG: 52||Not reimbursed separately|203.70|FSC: 400601; BFG: 52||External grouping not supported
30100847|EAP|CPT® 83930||0301 - LABORATORY - CHEMISTRY|Hc Cch So Blood Osmolality|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.05|FSC: 400601; BFG: 52||Not reimbursed separately|22.05|FSC: 400601; BFG: 52||External grouping not supported
51000009|EAP|CPT® 99214||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit Established Pt Level 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|252.00|FSC: 400601; BFG: 52||Not reimbursed separately|252.00|FSC: 400601; BFG: 52||External grouping not supported
51000010|EAP|CPT® 99215||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Clinic Visit Established Pt Level 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.10|FSC: 400601; BFG: 52||Not reimbursed separately|275.10|FSC: 400601; BFG: 52||External grouping not supported
30100848|EAP|CPT® 83935||0301 - LABORATORY - CHEMISTRY|Hc Cch So Osmolality Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.05|FSC: 400601; BFG: 52||Not reimbursed separately|22.05|FSC: 400601; BFG: 52||External grouping not supported
30100850|EAP|CPT® 84134||0301 - LABORATORY - CHEMISTRY|Hc Cch So Prealbumin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30100851|EAP|CPT® 84144||0301 - LABORATORY - CHEMISTRY|Hc Cch So Progesterone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
30100852|EAP|CPT® 84146||0301 - LABORATORY - CHEMISTRY|Hc Cch So Prolactin Assay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
30100856|EAP|CPT® 84165||0301 - LABORATORY - CHEMISTRY|Hc Cch So Protein Ep Fract & Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.70|FSC: 400601; BFG: 52||Not reimbursed separately|35.70|FSC: 400601; BFG: 52||External grouping not supported
30100860|EAP|CPT® 84466||0301 - LABORATORY - CHEMISTRY|Hc Cch So Transferrin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.00|FSC: 400601; BFG: 52||Not reimbursed separately|42.00|FSC: 400601; BFG: 52||External grouping not supported
30100861|EAP|CPT® 84479||0301 - LABORATORY - CHEMISTRY|Hc Cch So T3 Or T4 Or Thyroid Hormone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.75|FSC: 400601; BFG: 52||Not reimbursed separately|57.75|FSC: 400601; BFG: 52||External grouping not supported
30100862|EAP|CPT® 84681||0301 - LABORATORY - CHEMISTRY|Hc Cch So C-peptide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
30200240|EAP|CPT® 86157||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Cold Agglutinin Titer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.85|FSC: 400601; BFG: 52||Not reimbursed separately|80.85|FSC: 400601; BFG: 52||External grouping not supported
30200241|EAP|CPT® 86200||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Ccp Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200242|EAP|CPT® 86304||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Ia-quant Ca 125|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
30200245|EAP|CPT® 86361||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So T Cells Absolute Cd4 Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
30200246|EAP|CPT® 86376||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Microsomal Ab Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
94300002|EAP|CPT® 93798||0943 - OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION|Hc Cardiac Rehab W/ Ekg Per Session|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|210.00|FSC: 400601; BFG: 52||Not reimbursed separately|210.00|FSC: 400601; BFG: 52||External grouping not supported
30200250|EAP|CPT® 86707||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Ab Hbeab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30500077|EAP|CPT® 85004||0305 - LABORATORY - HEMATOLOGY|Hc Auto Diff Wbc Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
30500082|EAP|CPT® 85097||0305 - LABORATORY - HEMATOLOGY|Hc Cch Bone Marrow Smear|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,648.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,648.50|FSC: 400601; BFG: 52||External grouping not supported
30500085|EAP|CPT® 85245||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Clotting Factor Viii Ristocetin Cofact|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.60|FSC: 400601; BFG: 52||Not reimbursed separately|75.60|FSC: 400601; BFG: 52||External grouping not supported
30500086|EAP|CPT® 85260||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Clotting Factor X|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.80|FSC: 400601; BFG: 52||Not reimbursed separately|58.80|FSC: 400601; BFG: 52||External grouping not supported
30500087|EAP|CPT® 85300||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Clotting Inhib/anticoag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
30500089|EAP|CPT® 85460||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Fetal Screen Rbc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
30500091|EAP|CPT® 85613||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Russell Viper Venom Time Diluted|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
30500092|EAP|CPT® 85730||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Ptt Plasma Or Whole Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30600207|EAP|CPT® 87102||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Fungus Culture Not Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
30600209|EAP|CPT® 87116||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Culture Acid-fast Bacilli Isol & Id|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.70|FSC: 400601; BFG: 52||Not reimbursed separately|35.70|FSC: 400601; BFG: 52||External grouping not supported
30600211|EAP|CPT® 87206||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Smear Fluorescent Or Afb Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.85|FSC: 400601; BFG: 52||Not reimbursed separately|17.85|FSC: 400601; BFG: 52||External grouping not supported
30600212|EAP|CPT® 87220||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Koh For Fungi/parasites/mites|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.65|FSC: 400601; BFG: 52||Not reimbursed separately|13.65|FSC: 400601; BFG: 52||External grouping not supported
30600215|EAP|CPT® 87337||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Entamoeb Hist Group Ag Ia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30600216|EAP|CPT® 87350||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Hepatitis Be Ag Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30600217|EAP|CPT® 87389||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Hiv-1 Ag W/hiv-1 & Hiv-2 Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|79.80|FSC: 400601; BFG: 52||Not reimbursed separately|79.80|FSC: 400601; BFG: 52||External grouping not supported
30600218|EAP|CPT® 87400||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Influenza A Or B Antigen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30600223|EAP|CPT® 87480||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Candida Na Direct Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30600225|EAP|CPT® 87510||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Gardnerella Dir Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30600228|EAP|CPT® 87641||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Mr-staph Dna Amp Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30600229|EAP|CPT® 87660||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Trichomonas Vagin Dir Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30900010|EAP|CPT® 89055||0309 - LABORATORY - OTHER LABORATORY|Hc Cch Leukocyte Assessment Fecal Qualitative/semiquantitative|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.65|FSC: 400601; BFG: 52||Not reimbursed separately|13.65|FSC: 400601; BFG: 52||External grouping not supported
30900011|EAP|CPT® 89160||0309 - LABORATORY - OTHER LABORATORY|Hc Cch So Meat Fibers Feces|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30900012|EAP|CPT® 89190||0309 - LABORATORY - OTHER LABORATORY|Hc Cch Nasal Smear For Eosinophils|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
31000071|EAP|CPT® 81256||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Mer Hemochromatosis Muta|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|216.30|FSC: 400601; BFG: 52||Not reimbursed separately|216.30|FSC: 400601; BFG: 52||External grouping not supported
31100040|EAP|CPT® 88142||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Cp Cerv/vag Atl Manual Scrn (diagnostic)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.55|FSC: 400601; BFG: 52||Not reimbursed separately|95.55|FSC: 400601; BFG: 52||External grouping not supported
31100041|EAP|HCPCS G0123||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Cp Cerv/vag Atl Manual Scrn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
31100043|EAP|CPT® 88175||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Cytopath C/v Auto Fluid Redo (diagnostic)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.15|FSC: 400601; BFG: 52||Not reimbursed separately|87.15|FSC: 400601; BFG: 52||External grouping not supported
30000076|EAP|CPT® 86901||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Blood Typing Rh D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
30000078|EAP|CPT® 86965||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Pool Platelets Or Bld Product|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|122.85|FSC: 400601; BFG: 52||Not reimbursed separately|122.85|FSC: 400601; BFG: 52||External grouping not supported
30000079|EAP|CPT® 86970||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Pretreat Rbc Chem Or Drugs|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
30200252|EAP|CPT® 86146||0302 - LABORATORY - IMMUNOLOGY|Hc Beta 2 Glycoprotein I Ab- Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30900001|EAP|CPT® 89060||0309 - LABORATORY - OTHER LABORATORY|Hc Exam Synovial Fluid Crystals|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.15|FSC: 400601; BFG: 52||Not reimbursed separately|24.15|FSC: 400601; BFG: 52||External grouping not supported
30900004|EAP|CPT® 89051||0309 - LABORATORY - OTHER LABORATORY|Hc Cell Count W/ Diff Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.85|FSC: 400601; BFG: 52||Not reimbursed separately|17.85|FSC: 400601; BFG: 52||External grouping not supported
30000095|EAP|CPT® 86920||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Compatibilty Test Spin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.45|FSC: 400601; BFG: 52||Not reimbursed separately|345.45|FSC: 400601; BFG: 52||External grouping not supported
30000001|EAP|CPT® 36415||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Venipuncture|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
30000002|EAP|CPT® 36591||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Collect Blood From Implantable Venous Device|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.73|FSC: 400601; BFG: 52||Not reimbursed separately|275.73|FSC: 400601; BFG: 52||External grouping not supported
30000003|EAP|CPT® 36592||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Collect Blood From Cvc/picc/midline|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.73|FSC: 400601; BFG: 52||Not reimbursed separately|275.73|FSC: 400601; BFG: 52||External grouping not supported
27207865|EAP|Custom 27207865||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Picc Line Statlock Stabilization Device Foam|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.15|FSC: 400601; BFG: 52||Not reimbursed separately|36.15|FSC: 400601; BFG: 52||External grouping not supported
30000014|EAP|CPT® 86850||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Rbc Ab Scrn Ea Techiq|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
30000036|EAP|CPT® 86880||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Direct Coombs|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
30000021|EAP|CPT® 86927||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Cch Ffp Thawing- Ea Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.20|FSC: 400601; BFG: 52||Not reimbursed separately|46.20|FSC: 400601; BFG: 52||External grouping not supported
30000022|EAP|CPT® 86945||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Debit Irradiate Bld Product Ea Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
30100001|EAP|CPT® 80061||0301 - LABORATORY - CHEMISTRY|Hc Lipid Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|145.95|FSC: 400601; BFG: 52||Not reimbursed separately|145.95|FSC: 400601; BFG: 52||External grouping not supported
30100005|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO AMITRIPTYLINE 1 OR 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30100006|EAP|CPT® 80156||0301 - LABORATORY - CHEMISTRY|Hc Carbamazepine Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30100008|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO DESIPRAMINE 1 OR 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30100009|EAP|CPT® 80162||0301 - LABORATORY - CHEMISTRY|Hc Digoxin Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30100010|EAP|CPT® 80164||0301 - LABORATORY - CHEMISTRY|Hc Valproic Acid (dipropylacetic Acid) Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100011|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO DOXEPIN 1 OR 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30100216|EAP|CPT® 80168||0301 - LABORATORY - CHEMISTRY|Hc So Ethosuximide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.55|FSC: 400601; BFG: 52||Not reimbursed separately|95.55|FSC: 400601; BFG: 52||External grouping not supported
30100013|EAP|CPT® 80170||0301 - LABORATORY - CHEMISTRY|Hc Gentamicin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54.60|FSC: 400601; BFG: 52||Not reimbursed separately|54.60|FSC: 400601; BFG: 52||External grouping not supported
30100016|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO IMIPRAMINE 1 OR 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30100019|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO NORTRIPTYLINE 1 OR 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
30100020|EAP|CPT® 80184||0301 - LABORATORY - CHEMISTRY|Hc Phenobarbital|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30100021|EAP|CPT® 80185||0301 - LABORATORY - CHEMISTRY|Hc Phenytoin Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30100023|EAP|CPT® 80188||0301 - LABORATORY - CHEMISTRY|Hc So Primidone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
30100024|EAP|CPT® 80192||0301 - LABORATORY - CHEMISTRY|Hc So Procainamide W Metabolites|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|106.05|FSC: 400601; BFG: 52||Not reimbursed separately|106.05|FSC: 400601; BFG: 52||External grouping not supported
30100025|EAP|CPT® 80194||0301 - LABORATORY - CHEMISTRY|Hc So Quinidine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.10|FSC: 400601; BFG: 52||Not reimbursed separately|86.10|FSC: 400601; BFG: 52||External grouping not supported
30100026|EAP|CPT® 80195||0301 - LABORATORY - CHEMISTRY|Hc So Sirolimus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100029|EAP|CPT® 80198||0301 - LABORATORY - CHEMISTRY|Hc Theophylline|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30100031|EAP|CPT® 80202||0301 - LABORATORY - CHEMISTRY|Hc Vancomycin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100166|EAP|CPT® 80299||0301 - LABORATORY - CHEMISTRY|Hc So Drug Quant Nes - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
30100034|EAP|CPT® 82009||0301 - LABORATORY - CHEMISTRY|Hc Qual Serum Acetone/ketones|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30100040|EAP|CPT® 82040||0301 - LABORATORY - CHEMISTRY|Hc Assay Of Serum Albumin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100042|EAP|CPT® 82043||0301 - LABORATORY - CHEMISTRY|Hc Microalbumin Urine Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.90|FSC: 400601; BFG: 52||Not reimbursed separately|18.90|FSC: 400601; BFG: 52||External grouping not supported
30100044|EAP|CPT® 82085||0301 - LABORATORY - CHEMISTRY|Hc So Aldolase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.55|FSC: 400601; BFG: 52||Not reimbursed separately|32.55|FSC: 400601; BFG: 52||External grouping not supported
30100296|EAP|CPT® 82088||0301 - LABORATORY - CHEMISTRY|Hc So Aldosterone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|134.40|FSC: 400601; BFG: 52||Not reimbursed separately|134.40|FSC: 400601; BFG: 52||External grouping not supported
30100301|EAP|CPT® 82103||0301 - LABORATORY - CHEMISTRY|Hc So Alpha-1-antitrypsin Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30100051|EAP|CPT® 82108||0301 - LABORATORY - CHEMISTRY|Hc So Aluminum Assay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|123.90|FSC: 400601; BFG: 52||Not reimbursed separately|123.90|FSC: 400601; BFG: 52||External grouping not supported
30100052|EAP|CPT® 82131||0301 - LABORATORY - CHEMISTRY|Hc So Amino Acids Sgl Quan Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|91.35|FSC: 400601; BFG: 52||Not reimbursed separately|91.35|FSC: 400601; BFG: 52||External grouping not supported
30100053|EAP|CPT® 82135||0301 - LABORATORY - CHEMISTRY|Hc So Delta Ala|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|FSC: 400601; BFG: 52||Not reimbursed separately|73.50|FSC: 400601; BFG: 52||External grouping not supported
30100055|EAP|CPT® 82139||0301 - LABORATORY - CHEMISTRY|Hc So Amino Acids 6/> Quan Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|381.15|FSC: 400601; BFG: 52||Not reimbursed separately|381.15|FSC: 400601; BFG: 52||External grouping not supported
30100056|EAP|CPT® 82140||0301 - LABORATORY - CHEMISTRY|Hc Ammonia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30100297|EAP|CPT® 82150||0301 - LABORATORY - CHEMISTRY|Hc Amylase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
30100298|EAP|CPT® 82150||0301 - LABORATORY - CHEMISTRY|Hc So Amylase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
30100058|EAP|CPT® 82157||0301 - LABORATORY - CHEMISTRY|Hc So Androstenedione|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|141.75|FSC: 400601; BFG: 52||Not reimbursed separately|141.75|FSC: 400601; BFG: 52||External grouping not supported
30100059|EAP|CPT® 82164||0301 - LABORATORY - CHEMISTRY|Hc So Angiotensin I Convering Enzyme|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30100294|EAP|CPT® 82175||0301 - LABORATORY - CHEMISTRY|Hc So Arsenic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
30100061|EAP|CPT® 82180||0301 - LABORATORY - CHEMISTRY|Hc So Ascorbic Acid- Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.10|FSC: 400601; BFG: 52||Not reimbursed separately|86.10|FSC: 400601; BFG: 52||External grouping not supported
63600222|EAP|CPT® 90662||0636 - PHARMACY - DRUGS REQUIRING DETAILED CODING|Hc Influenza Vaccine Quadrivalent Split Virus Prsrv Free High Dose Im|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.00|FSC: 400601; BFG: 52||Not reimbursed separately|86.00|FSC: 400601; BFG: 52||External grouping not supported
30100302|EAP|CPT® 82232||0301 - LABORATORY - CHEMISTRY|Hc So Beta-2 Microglobulin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
30100289|EAP|CPT® 82239||0301 - LABORATORY - CHEMISTRY|Hc So Bile Acids Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.70|FSC: 400601; BFG: 52||Not reimbursed separately|56.70|FSC: 400601; BFG: 52||External grouping not supported
30100064|EAP|CPT® 82247||0301 - LABORATORY - CHEMISTRY|Hc Bilirubin Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100065|EAP|CPT® 82248||0301 - LABORATORY - CHEMISTRY|Hc Bilirubin Direct|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100319|EAP|CPT® 82270||0301 - LABORATORY - CHEMISTRY|Hc Occult Blood Feces|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100067|EAP|CPT® 82271||0301 - LABORATORY - CHEMISTRY|Hc Occult Blood Other Sources|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30100068|EAP|CPT® 82272||0301 - LABORATORY - CHEMISTRY|Hc Occult Blood 1-3 Tests|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
30100321|EAP|CPT® 82306||0301 - LABORATORY - CHEMISTRY|Hc So Vitamin D 25 Hydroxy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
30100071|EAP|CPT® 82310||0301 - LABORATORY - CHEMISTRY|Hc Calcium Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100072|EAP|CPT® 82330||0301 - LABORATORY - CHEMISTRY|Hc Calcium Ionized|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100073|EAP|CPT® 82340||0301 - LABORATORY - CHEMISTRY|Hc Calcium Urine Quan Timed|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
30100074|EAP|CPT® 82365||0301 - LABORATORY - CHEMISTRY|Hc So Stone Infrared Spectroscopy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30100076|EAP|CPT® 82374||0301 - LABORATORY - CHEMISTRY|Hc Carbon Dioxide (co2)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30100077|EAP|CPT® 82375||0301 - LABORATORY - CHEMISTRY|Hc Assay Carboxyhb Quant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30100080|EAP|CPT® 82380||0301 - LABORATORY - CHEMISTRY|Hc So Carotene|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
30100295|EAP|CPT® 82384||0301 - LABORATORY - CHEMISTRY|Hc So Catecholamines Fractionated|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30100299|EAP|CPT® 82397||0301 - LABORATORY - CHEMISTRY|Hc So Chemiluminescent Assay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|183.75|FSC: 400601; BFG: 52||Not reimbursed separately|183.75|FSC: 400601; BFG: 52||External grouping not supported
30100082|EAP|CPT® 82435||0301 - LABORATORY - CHEMISTRY|Hc Chloride Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30100085|EAP|CPT® 82441||0301 - LABORATORY - CHEMISTRY|Hc So Chlorinated Hc Screen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.20|FSC: 400601; BFG: 52||Not reimbursed separately|130.20|FSC: 400601; BFG: 52||External grouping not supported
30100086|EAP|CPT® 82465||0301 - LABORATORY - CHEMISTRY|Hc Serum/wb Tot Cholest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30100322|EAP|CPT® 82465||0301 - LABORATORY - CHEMISTRY|Hc So Serum/wb Tot Cholest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
12000003|EAP|Custom 12000003||0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION|Hc Cch Ob|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,499.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,499.40|FSC: 400601; BFG: 52||Accommodation codes not reimbursed separately
30100092|EAP|CPT® 82507||0301 - LABORATORY - CHEMISTRY|Hc So Citrate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|134.40|FSC: 400601; BFG: 52||Not reimbursed separately|134.40|FSC: 400601; BFG: 52||External grouping not supported
30100093|EAP|CPT® 82523||0301 - LABORATORY - CHEMISTRY|Hc So Collagen Cross Links - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.95|FSC: 400601; BFG: 52||Not reimbursed separately|82.95|FSC: 400601; BFG: 52||External grouping not supported
30100094|EAP|CPT® 82525||0301 - LABORATORY - CHEMISTRY|Hc So Copper|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30100095|EAP|CPT® 82530||0301 - LABORATORY - CHEMISTRY|Hc So Cortisol Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30100099|EAP|CPT® 82550||0301 - LABORATORY - CHEMISTRY|Hc Cpk Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.05|FSC: 400601; BFG: 52||Not reimbursed separately|22.05|FSC: 400601; BFG: 52||External grouping not supported
30100100|EAP|CPT® 82552||0301 - LABORATORY - CHEMISTRY|Hc So Cpk Isoenzymes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30100864|EAP|CPT® 88720||0301 - LABORATORY - CHEMISTRY|Hc Cch Bilirubin Total Transcutaneous|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100102|EAP|CPT® 82565||0301 - LABORATORY - CHEMISTRY|Hc Creatinine Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30100305|EAP|CPT® 82570||0301 - LABORATORY - CHEMISTRY|Hc Creatinine Not Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
32000247|EAP|CPT® 77054||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Cch Radiology Mammary Ductogram Or Galactogram Multiple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|621.60|FSC: 400601; BFG: 52||Not reimbursed separately|621.60|FSC: 400601; BFG: 52||External grouping not supported
30100103|EAP|CPT® 82575||0301 - LABORATORY - CHEMISTRY|Hc Creatinine Clearance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
30100316|EAP|CPT® 82595||0301 - LABORATORY - CHEMISTRY|Hc So Cryoglobulin - Qual/semi Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
30100106|EAP|CPT® 82600||0301 - LABORATORY - CHEMISTRY|Hc So Cyanide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
30100109|EAP|CPT® 82626||0301 - LABORATORY - CHEMISTRY|Hc So Dhea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30100114|EAP|CPT® 82652||0301 - LABORATORY - CHEMISTRY|Hc So Vit D 1- 25-dihydroxy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.05|FSC: 400601; BFG: 52||Not reimbursed separately|127.05|FSC: 400601; BFG: 52||External grouping not supported
40200066|EAP|CPT® 76999||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Cch Ultrasound Unlisted|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
30100310|EAP|CPT® 82672||0301 - LABORATORY - CHEMISTRY|Hc So Estrogens Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.40|FSC: 400601; BFG: 52||Not reimbursed separately|71.40|FSC: 400601; BFG: 52||External grouping not supported
30100311|EAP|CPT® 82677||0301 - LABORATORY - CHEMISTRY|Hc So Estriol|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|123.90|FSC: 400601; BFG: 52||Not reimbursed separately|123.90|FSC: 400601; BFG: 52||External grouping not supported
30100118|EAP|CPT® 82679||0301 - LABORATORY - CHEMISTRY|Hc So Estrone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.75|FSC: 400601; BFG: 52||Not reimbursed separately|120.75|FSC: 400601; BFG: 52||External grouping not supported
41000048|EAP|CPT® 31720||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Cch Nasotracheal Catheter Aspiration|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|498.75|FSC: 400601; BFG: 52||Not reimbursed separately|498.75|FSC: 400601; BFG: 52||External grouping not supported
30100312|EAP|CPT® 82710||0301 - LABORATORY - CHEMISTRY|Hc So Fat/lipids- Feces Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
30100318|EAP|CPT® 82784||0301 - LABORATORY - CHEMISTRY|Hc So Assay Iga/igd/igm Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.45|FSC: 400601; BFG: 52||Not reimbursed separately|30.45|FSC: 400601; BFG: 52||External grouping not supported
30100129|EAP|CPT® 82787||0301 - LABORATORY - CHEMISTRY|Hc So Igg 1/2/3/or 4 Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.25|FSC: 400601; BFG: 52||Not reimbursed separately|26.25|FSC: 400601; BFG: 52||External grouping not supported
30100130|EAP|CPT® 82800||0301 - LABORATORY - CHEMISTRY|Hc Blood Gas Ph Only|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
30100131|EAP|CPT® 82803||0301 - LABORATORY - CHEMISTRY|Hc Blood Gas Mixed Wo O2 Sat|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
42000073|EAP|CPT® 97597||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Debridement Wound Selective 1st 20 Sq Cm By Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|470.40|FSC: 400601; BFG: 52||Not reimbursed separately|470.40|FSC: 400601; BFG: 52||External grouping not supported
42000074|EAP|CPT® 97602||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Debridement Wound Nonselective By Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|470.40|FSC: 400601; BFG: 52||Not reimbursed separately|470.40|FSC: 400601; BFG: 52||External grouping not supported
30100138|EAP|CPT® 82945||0301 - LABORATORY - CHEMISTRY|Hc Glucose Body Fluid Other Than Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.60|FSC: 400601; BFG: 52||Not reimbursed separately|12.60|FSC: 400601; BFG: 52||External grouping not supported
30100314|EAP|CPT® 82947||0301 - LABORATORY - CHEMISTRY|Hc Glucose Quan Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30100139|EAP|CPT® 82948||0301 - LABORATORY - CHEMISTRY|Hc Glucose Blood Reagent Strip|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
30100140|EAP|CPT® 82950||0301 - LABORATORY - CHEMISTRY|Hc Glucose Post Glucose Dose|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30100141|EAP|CPT® 82951||0301 - LABORATORY - CHEMISTRY|Hc Glucose Tolerance Test Incl 3 Specimens|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30100142|EAP|CPT® 82952||0301 - LABORATORY - CHEMISTRY|Hc Glucose Tolerance Test Ea Add'l Specimen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30100145|EAP|CPT® 82977||0301 - LABORATORY - CHEMISTRY|Hc Glutamyltransferase Gamma|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.15|FSC: 400601; BFG: 52||Not reimbursed separately|24.15|FSC: 400601; BFG: 52||External grouping not supported
30100146|EAP|CPT® 82985||0301 - LABORATORY - CHEMISTRY|Hc So Glycated Protein - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30100152|EAP|CPT® 83033||0301 - LABORATORY - CHEMISTRY|Hc So Hgb Fetal Qual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.65|FSC: 400601; BFG: 52||Not reimbursed separately|34.65|FSC: 400601; BFG: 52||External grouping not supported
30100331|EAP|CPT® 83036||0301 - LABORATORY - CHEMISTRY|Hc So Hgb Glycosylated (a1c)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|101.85|FSC: 400601; BFG: 52||Not reimbursed separately|101.85|FSC: 400601; BFG: 52||External grouping not supported
30100329|EAP|CPT® 83088||0301 - LABORATORY - CHEMISTRY|Hc So Histamine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|492.45|FSC: 400601; BFG: 52||Not reimbursed separately|492.45|FSC: 400601; BFG: 52||External grouping not supported
30100335|EAP|CPT® 83090||0301 - LABORATORY - CHEMISTRY|Hc So Assay Of Homocystine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30100159|EAP|CPT® 83491||0301 - LABORATORY - CHEMISTRY|Hc So 17-ohcs|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|138.60|FSC: 400601; BFG: 52||Not reimbursed separately|138.60|FSC: 400601; BFG: 52||External grouping not supported
30100160|EAP|CPT® 83497||0301 - LABORATORY - CHEMISTRY|Hc So 5-hiaa|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|91.35|FSC: 400601; BFG: 52||Not reimbursed separately|91.35|FSC: 400601; BFG: 52||External grouping not supported
43000070|EAP|CPT® 97597||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Debridement Wound Selective 1st 20 Sq Cm By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|470.40|FSC: 400601; BFG: 52||Not reimbursed separately|470.40|FSC: 400601; BFG: 52||External grouping not supported
30100161|EAP|CPT® 83498||0301 - LABORATORY - CHEMISTRY|Hc So Hydroxyprogesterone 17-d|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
30100162|EAP|CPT® 83500||0301 - LABORATORY - CHEMISTRY|Hc So Hydroxyproline Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|136.50|FSC: 400601; BFG: 52||Not reimbursed separately|136.50|FSC: 400601; BFG: 52||External grouping not supported
43000071|EAP|CPT® 97602||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Debridement Wound Nonselective By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|470.40|FSC: 400601; BFG: 52||Not reimbursed separately|470.40|FSC: 400601; BFG: 52||External grouping not supported
30100163|EAP|CPT® 83505||0301 - LABORATORY - CHEMISTRY|Hc So Hydroxyproline Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|116.55|FSC: 400601; BFG: 52||Not reimbursed separately|116.55|FSC: 400601; BFG: 52||External grouping not supported
30100337|EAP|CPT® 83516||0301 - LABORATORY - CHEMISTRY|Hc So Immunoassay- Nonantibody - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30100333|EAP|CPT® 83519||0301 - LABORATORY - CHEMISTRY|Hc So Ria Nonantibody - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30100334|EAP|CPT® 83520||0301 - LABORATORY - CHEMISTRY|Hc So Immunoassay Quant Nos Nonab - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.20|FSC: 400601; BFG: 52||Not reimbursed separately|46.20|FSC: 400601; BFG: 52||External grouping not supported
30100338|EAP|CPT® 83525||0301 - LABORATORY - CHEMISTRY|Hc So Insulin Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30100165|EAP|CPT® 83540||0301 - LABORATORY - CHEMISTRY|Hc Iron|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
30100167|EAP|CPT® 83593||0301 - LABORATORY - CHEMISTRY|Hc So Ketosteroids 17 Fractionation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|151.20|FSC: 400601; BFG: 52||Not reimbursed separately|151.20|FSC: 400601; BFG: 52||External grouping not supported
30100168|EAP|CPT® 83605||0301 - LABORATORY - CHEMISTRY|Hc Lactate (lactic Acid)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|123.90|FSC: 400601; BFG: 52||Not reimbursed separately|123.90|FSC: 400601; BFG: 52||External grouping not supported
30100169|EAP|CPT® 83615||0301 - LABORATORY - CHEMISTRY|Hc Lactate Dehydrogenase (ld) (ldh)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
30100341|EAP|CPT® 83655||0301 - LABORATORY - CHEMISTRY|Hc So Lead - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30100174|EAP|CPT® 83690||0301 - LABORATORY - CHEMISTRY|Hc Lipase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
30100175|EAP|CPT® 83695||0301 - LABORATORY - CHEMISTRY|Hc So Assay Of Lipoprotein (a)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30100342|EAP|CPT® 83701||0301 - LABORATORY - CHEMISTRY|Hc So Lipoprotein Bld- Hr Fraction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|156.45|FSC: 400601; BFG: 52||Not reimbursed separately|156.45|FSC: 400601; BFG: 52||External grouping not supported
30100178|EAP|CPT® 83718||0301 - LABORATORY - CHEMISTRY|Hc Lipoprotein Hdl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
30100400|EAP|CPT® 83721||0301 - LABORATORY - CHEMISTRY|Hc So Assay Of Blood Lipoprotein|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
30100180|EAP|CPT® 83735||0301 - LABORATORY - CHEMISTRY|Hc Magnesium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
44400015|EAP|CPT® 92626||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Cch Eval Of Auditory Func For Candidacy Or Postop Status First Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
30100345|EAP|CPT® 83789||0301 - LABORATORY - CHEMISTRY|Hc So Quan Mass Spect  Ea Specimen - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|280.35|FSC: 400601; BFG: 52||Not reimbursed separately|280.35|FSC: 400601; BFG: 52||External grouping not supported
30100346|EAP|CPT® 83825||0301 - LABORATORY - CHEMISTRY|Hc So Mercury Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
44400016|EAP|CPT® 92627||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Cch Eval Of Auditory Func For Candidacy Or Postop Status Ea Addtl 15 Min|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.90|FSC: 400601; BFG: 52||Not reimbursed separately|102.90|FSC: 400601; BFG: 52||External grouping not supported
30100181|EAP|CPT® 83835||0301 - LABORATORY - CHEMISTRY|Hc So Metanephrines|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30100183|EAP|CPT® 83873||0301 - LABORATORY - CHEMISTRY|Hc So Myelin Basic Protein- Csf|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.70|FSC: 400601; BFG: 52||Not reimbursed separately|56.70|FSC: 400601; BFG: 52||External grouping not supported
45000011|EAP|CPT® 92977||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Cch Iv Infusion Coronary Thrombolysis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|390.60|FSC: 400601; BFG: 52||Not reimbursed separately|390.60|FSC: 400601; BFG: 52||External grouping not supported
30100347|EAP|CPT® 83874||0301 - LABORATORY - CHEMISTRY|Hc So Myoglobin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|114.45|FSC: 400601; BFG: 52||Not reimbursed separately|114.45|FSC: 400601; BFG: 52||External grouping not supported
30100186|EAP|CPT® 83880||0301 - LABORATORY - CHEMISTRY|Hc Natriueretic Peptide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|298.20|FSC: 400601; BFG: 52||Not reimbursed separately|298.20|FSC: 400601; BFG: 52||External grouping not supported
30100348|EAP|CPT® 83880||0301 - LABORATORY - CHEMISTRY|Hc So Natriueretic Peptide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|298.20|FSC: 400601; BFG: 52||Not reimbursed separately|298.20|FSC: 400601; BFG: 52||External grouping not supported
30100402|EAP|CPT® 83883||0301 - LABORATORY - CHEMISTRY|Hc So Nephelometry Ea Analyte Nes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
45000014|EAP|Custom 45000014||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Cch Emergency Room Procedure Level 1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.75|FSC: 400601; BFG: 52||Not reimbursed separately|120.75|FSC: 400601; BFG: 52||External grouping not supported
30100403|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO NICOTINE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.30|FSC: 400601; BFG: 52||Not reimbursed separately|300.30|FSC: 400601; BFG: 52||External grouping not supported
45000015|EAP|Custom 45000015||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Cch Emergency Room Procedure Level 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|225.75|FSC: 400601; BFG: 52||Not reimbursed separately|225.75|FSC: 400601; BFG: 52||External grouping not supported
45000016|EAP|Custom 45000016||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Cch Emergency Room Procedure Level 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|630.00|FSC: 400601; BFG: 52||Not reimbursed separately|630.00|FSC: 400601; BFG: 52||External grouping not supported
45000017|EAP|Custom 45000017||0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION|Hc Cch Emergency Room Procedure Level 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|882.00|FSC: 400601; BFG: 52||Not reimbursed separately|882.00|FSC: 400601; BFG: 52||External grouping not supported
49000852|EAP|CPT® 19030||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Mammary Ductogram Or Galactogram|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|268.80|FSC: 400601; BFG: 52||Not reimbursed separately|268.80|FSC: 400601; BFG: 52||External grouping not supported
49000857|EAP|CPT® 64417||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Axillary Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000858|EAP|CPT® 64505||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Anesthetic Agent Sphenopalatine Ganglion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
30100203|EAP|CPT® 83915||0301 - LABORATORY - CHEMISTRY|Hc So Assay Of Nucleotidase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
30100206|EAP|CPT® 83921||0301 - LABORATORY - CHEMISTRY|Hc So Organic Acid- Single  Quant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.70|FSC: 400601; BFG: 52||Not reimbursed separately|56.70|FSC: 400601; BFG: 52||External grouping not supported
30100210|EAP|CPT® 83937||0301 - LABORATORY - CHEMISTRY|Hc So Osteocalcin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|144.90|FSC: 400601; BFG: 52||Not reimbursed separately|144.90|FSC: 400601; BFG: 52||External grouping not supported
30100211|EAP|CPT® 83945||0301 - LABORATORY - CHEMISTRY|Hc So Oxalate - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30100213|EAP|CPT® 84060||0301 - LABORATORY - CHEMISTRY|Hc So Total Acid Phosphatase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
30100214|EAP|CPT® 84066||0301 - LABORATORY - CHEMISTRY|Hc So Prostatic Acid  Phosphatase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|FSC: 400601; BFG: 52||Not reimbursed separately|73.50|FSC: 400601; BFG: 52||External grouping not supported
30100215|EAP|CPT® 84075||0301 - LABORATORY - CHEMISTRY|Hc Alkaline Phosphatase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100373|EAP|CPT® 84080||0301 - LABORATORY - CHEMISTRY|Hc So Alkaline Phosphatase Isoenzym|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30100217|EAP|CPT® 84100||0301 - LABORATORY - CHEMISTRY|Hc Phosphate Inorganic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30100218|EAP|CPT® 84105||0301 - LABORATORY - CHEMISTRY|Hc Urine Phosphate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30100220|EAP|CPT® 84110||0301 - LABORATORY - CHEMISTRY|Hc So Porphobilinogen- Urine Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30100221|EAP|CPT® 84120||0301 - LABORATORY - CHEMISTRY|Hc So Quan Urine Porphyrins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
30100222|EAP|CPT® 84126||0301 - LABORATORY - CHEMISTRY|Hc So Quan Fecal Porphyrins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|316.05|FSC: 400601; BFG: 52||Not reimbursed separately|316.05|FSC: 400601; BFG: 52||External grouping not supported
30100223|EAP|CPT® 84132||0301 - LABORATORY - CHEMISTRY|Hc Assay Of Serum Potassium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30100224|EAP|CPT® 84133||0301 - LABORATORY - CHEMISTRY|Hc Potassium Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
73100005|EAP|CPT® 93271||0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR|Hc Cch Event Monitoring And Analysis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|308.70|FSC: 400601; BFG: 52||Not reimbursed separately|308.70|FSC: 400601; BFG: 52||External grouping not supported
30100226|EAP|CPT® 84143||0301 - LABORATORY - CHEMISTRY|Hc So 17-hydroxypregnenolone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
30100392|EAP|CPT® 84153||0301 - LABORATORY - CHEMISTRY|Hc So Psa Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
92000042|EAP|HCPCS G0399||0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Home Sleep Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
30100230|EAP|CPT® 84154||0301 - LABORATORY - CHEMISTRY|Hc So Psa Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
30100231|EAP|CPT® 84155||0301 - LABORATORY - CHEMISTRY|Hc Assay Of Protein Serum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.60|FSC: 400601; BFG: 52||Not reimbursed separately|12.60|FSC: 400601; BFG: 52||External grouping not supported
94000036|EAP|CPT® 92953||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Temporary Transcutaneous Pacing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,372.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,372.35|FSC: 400601; BFG: 52||External grouping not supported
30100233|EAP|CPT® 84156||0301 - LABORATORY - CHEMISTRY|Hc Urine Total Protein|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.60|FSC: 400601; BFG: 52||Not reimbursed separately|12.60|FSC: 400601; BFG: 52||External grouping not supported
30100234|EAP|CPT® 84157||0301 - LABORATORY - CHEMISTRY|Hc Total Protein Other Specimen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.60|FSC: 400601; BFG: 52||Not reimbursed separately|12.60|FSC: 400601; BFG: 52||External grouping not supported
94200029|EAP|HCPCS G0270||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Medical Nutrition Therapy Reevaluation Ind Per 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30100238|EAP|CPT® 84202||0301 - LABORATORY - CHEMISTRY|Hc So Protoporphyrin- Rbc Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
94200030|EAP|HCPCS G0271||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Medical Nutrition Therapy Reevaluation Group Per 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
30100240|EAP|CPT® 84207||0301 - LABORATORY - CHEMISTRY|Hc So Vitamin B6|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
30100242|EAP|CPT® 84220||0301 - LABORATORY - CHEMISTRY|Hc So Pyruvate Kinase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.20|FSC: 400601; BFG: 52||Not reimbursed separately|130.20|FSC: 400601; BFG: 52||External grouping not supported
30100375|EAP|CPT® 84238||0301 - LABORATORY - CHEMISTRY|Hc So Assay- Nonendocrine Receptor - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.75|FSC: 400601; BFG: 52||Not reimbursed separately|120.75|FSC: 400601; BFG: 52||External grouping not supported
30100393|EAP|CPT® 84244||0301 - LABORATORY - CHEMISTRY|Hc So Renin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.45|FSC: 400601; BFG: 52||Not reimbursed separately|72.45|FSC: 400601; BFG: 52||External grouping not supported
30100244|EAP|CPT® 84252||0301 - LABORATORY - CHEMISTRY|Hc So Riboflavin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.20|FSC: 400601; BFG: 52||Not reimbursed separately|67.20|FSC: 400601; BFG: 52||External grouping not supported
30100245|EAP|CPT® 84255||0301 - LABORATORY - CHEMISTRY|Hc So Selenium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30100247|EAP|CPT® 84270||0301 - LABORATORY - CHEMISTRY|Hc So Sex Hormone Binding Globulin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.25|FSC: 400601; BFG: 52||Not reimbursed separately|110.25|FSC: 400601; BFG: 52||External grouping not supported
30100249|EAP|CPT® 84295||0301 - LABORATORY - CHEMISTRY|Hc Assay Of Serum Sodium|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30100250|EAP|CPT® 84300||0301 - LABORATORY - CHEMISTRY|Hc Sodium Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30100377|EAP|CPT® 84311||0301 - LABORATORY - CHEMISTRY|Hc So Spectrophotometry- Analyte Nes - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|351.75|FSC: 400601; BFG: 52||Not reimbursed separately|351.75|FSC: 400601; BFG: 52||External grouping not supported
30100253|EAP|CPT® 84315||0301 - LABORATORY - CHEMISTRY|Hc Non-urine Specific Gravity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|8.40|FSC: 400601; BFG: 52||Not reimbursed separately|8.40|FSC: 400601; BFG: 52||External grouping not supported
30100254|EAP|CPT® 84376||0301 - LABORATORY - CHEMISTRY|Hc So Sugars Single Qual- Ea Specimen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.85|FSC: 400601; BFG: 52||Not reimbursed separately|17.85|FSC: 400601; BFG: 52||External grouping not supported
30100394|EAP|CPT® 84402||0301 - LABORATORY - CHEMISTRY|Hc So Testosterone Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30100378|EAP|CPT® 84403||0301 - LABORATORY - CHEMISTRY|Hc So Testosterone Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
30100379|EAP|CPT® 84425||0301 - LABORATORY - CHEMISTRY|Hc So Thiamine (vitamin B-1)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.35|FSC: 400601; BFG: 52||Not reimbursed separately|70.35|FSC: 400601; BFG: 52||External grouping not supported
30100381|EAP|CPT® 84432||0301 - LABORATORY - CHEMISTRY|Hc So Thyroglobulin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
30100395|EAP|CPT® 84436||0301 - LABORATORY - CHEMISTRY|Hc So Thyroxine Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.10|FSC: 400601; BFG: 52||Not reimbursed separately|23.10|FSC: 400601; BFG: 52||External grouping not supported
30100262|EAP|CPT® 84439||0301 - LABORATORY - CHEMISTRY|Hc Free Thyroxine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.15|FSC: 400601; BFG: 52||Not reimbursed separately|87.15|FSC: 400601; BFG: 52||External grouping not supported
30100263|EAP|CPT® 84442||0301 - LABORATORY - CHEMISTRY|Hc So Thyroxine Binding Globulin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|156.45|FSC: 400601; BFG: 52||Not reimbursed separately|156.45|FSC: 400601; BFG: 52||External grouping not supported
30100264|EAP|CPT® 84443||0301 - LABORATORY - CHEMISTRY|Hc Thyroid Stimulating Hormone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|142.80|FSC: 400601; BFG: 52||Not reimbursed separately|142.80|FSC: 400601; BFG: 52||External grouping not supported
30100265|EAP|CPT® 84445||0301 - LABORATORY - CHEMISTRY|Hc So Thyroid Stimulating Immunoglobulins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|168.00|FSC: 400601; BFG: 52||Not reimbursed separately|168.00|FSC: 400601; BFG: 52||External grouping not supported
30100266|EAP|CPT® 84446||0301 - LABORATORY - CHEMISTRY|Hc So Tocopherol Alpha (vit E)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30100267|EAP|CPT® 84450||0301 - LABORATORY - CHEMISTRY|Hc Ast Or Sgot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100268|EAP|CPT® 84460||0301 - LABORATORY - CHEMISTRY|Hc Transferase Alanine Amino|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.85|FSC: 400601; BFG: 52||Not reimbursed separately|17.85|FSC: 400601; BFG: 52||External grouping not supported
30100270|EAP|CPT® 84478||0301 - LABORATORY - CHEMISTRY|Hc Triglycerides|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.90|FSC: 400601; BFG: 52||Not reimbursed separately|18.90|FSC: 400601; BFG: 52||External grouping not supported
30100382|EAP|CPT® 84478||0301 - LABORATORY - CHEMISTRY|Hc So Tryiglycerides|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.90|FSC: 400601; BFG: 52||Not reimbursed separately|18.90|FSC: 400601; BFG: 52||External grouping not supported
30100398|EAP|CPT® 84481||0301 - LABORATORY - CHEMISTRY|Hc So T3 Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30100274|EAP|CPT® 84482||0301 - LABORATORY - CHEMISTRY|Hc So T3 Reverse|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
30100275|EAP|CPT® 84484||0301 - LABORATORY - CHEMISTRY|Hc Troponin Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30100276|EAP|CPT® 84520||0301 - LABORATORY - CHEMISTRY|Hc Urea Nitrogen Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
30100277|EAP|CPT® 84540||0301 - LABORATORY - CHEMISTRY|Hc Urea Nitrogen Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.55|FSC: 400601; BFG: 52||Not reimbursed separately|32.55|FSC: 400601; BFG: 52||External grouping not supported
30100278|EAP|CPT® 84550||0301 - LABORATORY - CHEMISTRY|Hc Uric Acid Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30100279|EAP|CPT® 84560||0301 - LABORATORY - CHEMISTRY|Hc Uric Acid Not Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30100281|EAP|CPT® 84585||0301 - LABORATORY - CHEMISTRY|Hc So Vma- Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|FSC: 400601; BFG: 52||Not reimbursed separately|51.45|FSC: 400601; BFG: 52||External grouping not supported
30100282|EAP|CPT® 84588||0301 - LABORATORY - CHEMISTRY|Hc So Vasopressin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|164.85|FSC: 400601; BFG: 52||Not reimbursed separately|164.85|FSC: 400601; BFG: 52||External grouping not supported
30100283|EAP|CPT® 84590||0301 - LABORATORY - CHEMISTRY|Hc So Vitamin A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
30100384|EAP|CPT® 84591||0301 - LABORATORY - CHEMISTRY|Hc So Vitamin Nos - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.20|FSC: 400601; BFG: 52||Not reimbursed separately|46.20|FSC: 400601; BFG: 52||External grouping not supported
30100284|EAP|CPT® 84597||0301 - LABORATORY - CHEMISTRY|Hc So Vitamin K|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100285|EAP|CPT® 84620||0301 - LABORATORY - CHEMISTRY|Hc So Xylose Absorption- Blood &/or Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30100286|EAP|CPT® 84630||0301 - LABORATORY - CHEMISTRY|Hc So Zinc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.80|FSC: 400601; BFG: 52||Not reimbursed separately|37.80|FSC: 400601; BFG: 52||External grouping not supported
30100386|EAP|CPT® 84702||0301 - LABORATORY - CHEMISTRY|Hc Hcg Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30100387|EAP|CPT® 84703||0301 - LABORATORY - CHEMISTRY|Hc Hcg Qual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
30100389|EAP|CPT® 84999||0301 - LABORATORY - CHEMISTRY|Hc So Unlisted Chemistry Test - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.95|FSC: 400601; BFG: 52||Not reimbursed separately|250.95|FSC: 400601; BFG: 52||External grouping not supported
30200001|EAP|CPT® 86000||0302 - LABORATORY - IMMUNOLOGY|Hc So Agglutinins- Febrile|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30200108|EAP|CPT® 86003||0302 - LABORATORY - IMMUNOLOGY|Hc So Allergen Specific Ige- Ea - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30200109|EAP|CPT® 86021||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Id Leukocyte Ab - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|FSC: 400601; BFG: 52||Not reimbursed separately|73.50|FSC: 400601; BFG: 52||External grouping not supported
30200111|EAP|CPT® 86022||0302 - LABORATORY - IMMUNOLOGY|Hc So Hep Plt Aggregating Factor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|191.10|FSC: 400601; BFG: 52||Not reimbursed separately|191.10|FSC: 400601; BFG: 52||External grouping not supported
30200005|EAP|CPT® 86060||0302 - LABORATORY - IMMUNOLOGY|Hc So Aso Titer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.15|FSC: 400601; BFG: 52||Not reimbursed separately|24.15|FSC: 400601; BFG: 52||External grouping not supported
30200007|EAP|CPT® 86140||0302 - LABORATORY - IMMUNOLOGY|Hc C-reactive Protein|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.70|FSC: 400601; BFG: 52||Not reimbursed separately|140.70|FSC: 400601; BFG: 52||External grouping not supported
30200008|EAP|CPT® 86141||0302 - LABORATORY - IMMUNOLOGY|Hc So C-reactive Protein Hs|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200168|EAP|CPT® 86147||0302 - LABORATORY - IMMUNOLOGY|Hc So Cardiolipin Ab- Ea Ig Class|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30200011|EAP|CPT® 86148||0302 - LABORATORY - IMMUNOLOGY|Hc So Anti-phosphatidylserine Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|77.70|FSC: 400601; BFG: 52||Not reimbursed separately|77.70|FSC: 400601; BFG: 52||External grouping not supported
30200113|EAP|CPT® 86160||0302 - LABORATORY - IMMUNOLOGY|Hc So Complement- Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200114|EAP|CPT® 86161||0302 - LABORATORY - IMMUNOLOGY|Hc So Complement Fcn Activity- Ea - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200019|EAP|CPT® 86226||0302 - LABORATORY - IMMUNOLOGY|Hc So Dna Ab Ss|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.00|FSC: 400601; BFG: 52||Not reimbursed separately|126.00|FSC: 400601; BFG: 52||External grouping not supported
30200026|EAP|CPT® 86235||0302 - LABORATORY - IMMUNOLOGY|Hc So Ena- Any Method - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.80|FSC: 400601; BFG: 52||Not reimbursed separately|58.80|FSC: 400601; BFG: 52||External grouping not supported
30200116|EAP|CPT® 86255||0302 - LABORATORY - IMMUNOLOGY|Hc So Fluorescent Noninf Agent Ab- Ea - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200169|EAP|CPT® 86256||0302 - LABORATORY - IMMUNOLOGY|Hc So Fluorescent Ab Titer- Ea Ab - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200118|EAP|CPT® 86300||0302 - LABORATORY - IMMUNOLOGY|Hc So Ca 15-3 (27.29)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
30200023|EAP|CPT® 86308||0302 - LABORATORY - IMMUNOLOGY|Hc Qual Heterophile Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30200119|EAP|CPT® 86316||0302 - LABORATORY - IMMUNOLOGY|Hc So Tumor Marker- Immunoassay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.30|FSC: 400601; BFG: 52||Not reimbursed separately|69.30|FSC: 400601; BFG: 52||External grouping not supported
30200120|EAP|CPT® 86317||0302 - LABORATORY - IMMUNOLOGY|Hc So Immunoassay Infectious Agent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30200122|EAP|CPT® 86331||0302 - LABORATORY - IMMUNOLOGY|Hc So Gel- Diffusion/qual/nos|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200123|EAP|CPT® 86332||0302 - LABORATORY - IMMUNOLOGY|Hc So Immune Complex Assay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.85|FSC: 400601; BFG: 52||Not reimbursed separately|80.85|FSC: 400601; BFG: 52||External grouping not supported
30200125|EAP|CPT® 86335||0302 - LABORATORY - IMMUNOLOGY|Hc So Immunofixation- Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|96.60|FSC: 400601; BFG: 52||Not reimbursed separately|96.60|FSC: 400601; BFG: 52||External grouping not supported
30200126|EAP|CPT® 86336||0302 - LABORATORY - IMMUNOLOGY|Hc So Inhibin A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|FSC: 400601; BFG: 52||Not reimbursed separately|51.45|FSC: 400601; BFG: 52||External grouping not supported
30200029|EAP|CPT® 86337||0302 - LABORATORY - IMMUNOLOGY|Hc So Insulin Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.95|FSC: 400601; BFG: 52||Not reimbursed separately|103.95|FSC: 400601; BFG: 52||External grouping not supported
30200030|EAP|CPT® 86340||0302 - LABORATORY - IMMUNOLOGY|Hc So Intrinsic Factor Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
30200127|EAP|CPT® 86341||0302 - LABORATORY - IMMUNOLOGY|Hc So Islet Cell Antibody - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.10|FSC: 400601; BFG: 52||Not reimbursed separately|65.10|FSC: 400601; BFG: 52||External grouping not supported
30200031|EAP|CPT® 86353||0302 - LABORATORY - IMMUNOLOGY|Hc So Lymph Transform- Mitogen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|233.10|FSC: 400601; BFG: 52||Not reimbursed separately|233.10|FSC: 400601; BFG: 52||External grouping not supported
30200129|EAP|CPT® 86480||0302 - LABORATORY - IMMUNOLOGY|Hc So Tb Test- Cell Immun Measure|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|200.55|FSC: 400601; BFG: 52||Not reimbursed separately|200.55|FSC: 400601; BFG: 52||External grouping not supported
30200132|EAP|CPT® 86592||0302 - LABORATORY - IMMUNOLOGY|Hc So Syphilis Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.65|FSC: 400601; BFG: 52||Not reimbursed separately|13.65|FSC: 400601; BFG: 52||External grouping not supported
30200045|EAP|CPT® 86603||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Adenovirus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
30200134|EAP|CPT® 86606||0302 - LABORATORY - IMMUNOLOGY|Hc So Aspergillus Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30200047|EAP|CPT® 86611||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Bartonella|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30200048|EAP|CPT® 86615||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Bordetella|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30200049|EAP|CPT® 86617||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Lyme's (wb) Confirm - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.70|FSC: 400601; BFG: 52||Not reimbursed separately|140.70|FSC: 400601; BFG: 52||External grouping not supported
30200171|EAP|CPT® 86618||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Lyme's Disease|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.70|FSC: 400601; BFG: 52||Not reimbursed separately|56.70|FSC: 400601; BFG: 52||External grouping not supported
30200051|EAP|CPT® 86622||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Brucella|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200053|EAP|CPT® 86628||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Candida|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.55|FSC: 400601; BFG: 52||Not reimbursed separately|95.55|FSC: 400601; BFG: 52||External grouping not supported
30200136|EAP|CPT® 86631||0302 - LABORATORY - IMMUNOLOGY|Hc So Chlamydia Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
30200138|EAP|CPT® 86644||0302 - LABORATORY - IMMUNOLOGY|Hc So Cytomegalovirus Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30200139|EAP|CPT® 86645||0302 - LABORATORY - IMMUNOLOGY|Hc So Cytomegalovirus Igm Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30200060|EAP|CPT® 86651||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Encephalitis- Calif|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
30200061|EAP|CPT® 86652||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Encephalitis- E Equine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30200062|EAP|CPT® 86653||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Encephalitis- St. Louis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30200063|EAP|CPT® 86654||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Encephalitis- W/ Equine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30200140|EAP|CPT® 86658||0302 - LABORATORY - IMMUNOLOGY|Hc So Enterovirus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30200064|EAP|CPT® 86663||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Eb- Early Ag Virus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200065|EAP|CPT® 86664||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Ebna|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
30200067|EAP|CPT® 86668||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Francisella Tularensis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
30200068|EAP|CPT® 86677||0302 - LABORATORY - IMMUNOLOGY|Hc Ab Helicobacter Pylori|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30200142|EAP|CPT® 86677||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Helicobacter Pylori|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30200069|EAP|CPT® 86684||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Hemophilus Influenza|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.65|FSC: 400601; BFG: 52||Not reimbursed separately|76.65|FSC: 400601; BFG: 52||External grouping not supported
30200147|EAP|CPT® 86689||0302 - LABORATORY - IMMUNOLOGY|Hc So Western Blot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|155.40|FSC: 400601; BFG: 52||Not reimbursed separately|155.40|FSC: 400601; BFG: 52||External grouping not supported
30200071|EAP|CPT® 86692||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Hepatitis D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|186.90|FSC: 400601; BFG: 52||Not reimbursed separately|186.90|FSC: 400601; BFG: 52||External grouping not supported
30200072|EAP|CPT® 86694||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Hsv- Non-specific|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30200149|EAP|CPT® 86695||0302 - LABORATORY - IMMUNOLOGY|Hc So Herpes Simplex- Type I|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30200172|EAP|CPT® 86696||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Hsv Ii|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
30200151|EAP|CPT® 86698||0302 - LABORATORY - IMMUNOLOGY|Hc So Histoplasma Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.65|FSC: 400601; BFG: 52||Not reimbursed separately|76.65|FSC: 400601; BFG: 52||External grouping not supported
30200152|EAP|CPT® 86703||0302 - LABORATORY - IMMUNOLOGY|Hc So Anti Hiv 1\hiv 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|118.65|FSC: 400601; BFG: 52||Not reimbursed separately|118.65|FSC: 400601; BFG: 52||External grouping not supported
30200153|EAP|CPT® 86704||0302 - LABORATORY - IMMUNOLOGY|Hc So Hepatitis B Core Ab- Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200154|EAP|CPT® 86706||0302 - LABORATORY - IMMUNOLOGY|Hc So Hepatitis B Surf Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.70|FSC: 400601; BFG: 52||Not reimbursed separately|35.70|FSC: 400601; BFG: 52||External grouping not supported
30200155|EAP|CPT® 86710||0302 - LABORATORY - IMMUNOLOGY|Hc So Influenza Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.35|FSC: 400601; BFG: 52||Not reimbursed separately|70.35|FSC: 400601; BFG: 52||External grouping not supported
30200084|EAP|CPT® 86720||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Leptospira|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
30200156|EAP|CPT® 86735||0302 - LABORATORY - IMMUNOLOGY|Hc So Mumps Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200173|EAP|CPT® 86738||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Mycoplasma|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.95|FSC: 400601; BFG: 52||Not reimbursed separately|82.95|FSC: 400601; BFG: 52||External grouping not supported
30200088|EAP|CPT® 86747||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Parvovirus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.45|FSC: 400601; BFG: 52||Not reimbursed separately|72.45|FSC: 400601; BFG: 52||External grouping not supported
30200090|EAP|CPT® 86756||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Rsv|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.85|FSC: 400601; BFG: 52||Not reimbursed separately|80.85|FSC: 400601; BFG: 52||External grouping not supported
30200160|EAP|CPT® 86762||0302 - LABORATORY - IMMUNOLOGY|Hc So Rubella Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30200174|EAP|CPT® 86765||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Rubeola|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200092|EAP|CPT® 86768||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Salmonella|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
30200096|EAP|CPT® 86780||0302 - LABORATORY - IMMUNOLOGY|Hc So Treponema Pallidum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.10|FSC: 400601; BFG: 52||Not reimbursed separately|44.10|FSC: 400601; BFG: 52||External grouping not supported
30200161|EAP|CPT® 86787||0302 - LABORATORY - IMMUNOLOGY|Hc So Varicella Zoster Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30200162|EAP|CPT® 86790||0302 - LABORATORY - IMMUNOLOGY|Hc So Viral Antibody Nos - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|131.25|FSC: 400601; BFG: 52||Not reimbursed separately|131.25|FSC: 400601; BFG: 52||External grouping not supported
30200163|EAP|CPT® 86803||0302 - LABORATORY - IMMUNOLOGY|Hc So Hepatitis C Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30200101|EAP|CPT® 86804||0302 - LABORATORY - IMMUNOLOGY|Hc So Hepatitis C Confirmation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.80|FSC: 400601; BFG: 52||Not reimbursed separately|205.80|FSC: 400601; BFG: 52||External grouping not supported
30200165|EAP|CPT® 86812||0302 - LABORATORY - IMMUNOLOGY|Hc So Hla Typing- Ea Antigen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
30200166|EAP|CPT® 86813||0302 - LABORATORY - IMMUNOLOGY|Hc So Hla Type A/ B/ C/ Multi Ag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|276.15|FSC: 400601; BFG: 52||Not reimbursed separately|276.15|FSC: 400601; BFG: 52||External grouping not supported
30500001|EAP|CPT® 85007||0305 - LABORATORY - HEMATOLOGY|Hc Bl Smear W/ Diff Wbc Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30500002|EAP|CPT® 85014||0305 - LABORATORY - HEMATOLOGY|Hc Hematocrit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7.35|FSC: 400601; BFG: 52||Not reimbursed separately|7.35|FSC: 400601; BFG: 52||External grouping not supported
30500003|EAP|CPT® 85018||0305 - LABORATORY - HEMATOLOGY|Hc Hemoglobin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
30500004|EAP|CPT® 85025||0305 - LABORATORY - HEMATOLOGY|Hc Cbc Ediff & Platelet|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
30500051|EAP|CPT® 85027||0305 - LABORATORY - HEMATOLOGY|Hc Cbc & Platelet|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30500052|EAP|CPT® 85048||0305 - LABORATORY - HEMATOLOGY|Hc Wbc Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|8.40|FSC: 400601; BFG: 52||Not reimbursed separately|8.40|FSC: 400601; BFG: 52||External grouping not supported
30500006|EAP|CPT® 85049||0305 - LABORATORY - HEMATOLOGY|Hc Platelet Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|FSC: 400601; BFG: 52||Not reimbursed separately|14.70|FSC: 400601; BFG: 52||External grouping not supported
30500013|EAP|CPT® 85246||0305 - LABORATORY - HEMATOLOGY|Hc So Clotting: Factor Viii- Vw Factor Ag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.60|FSC: 400601; BFG: 52||Not reimbursed separately|75.60|FSC: 400601; BFG: 52||External grouping not supported
30500018|EAP|CPT® 85280||0305 - LABORATORY - HEMATOLOGY|Hc So Clotting Factor Xii|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|213.15|FSC: 400601; BFG: 52||Not reimbursed separately|213.15|FSC: 400601; BFG: 52||External grouping not supported
30500022|EAP|CPT® 85302||0305 - LABORATORY - HEMATOLOGY|Hc So Clotting Inhibitor Protein C Ag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30500024|EAP|CPT® 85305||0305 - LABORATORY - HEMATOLOGY|Hc So Clotting Inhibitor Protein S- Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
30500026|EAP|CPT® 85307||0305 - LABORATORY - HEMATOLOGY|Hc So Activated Protein C Resistance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
30500029|EAP|CPT® 85379||0305 - LABORATORY - HEMATOLOGY|Hc D-dimer - Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30500030|EAP|CPT® 85384||0305 - LABORATORY - HEMATOLOGY|Hc Fibrinogen Activity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.35|FSC: 400601; BFG: 52||Not reimbursed separately|28.35|FSC: 400601; BFG: 52||External grouping not supported
30200253|EAP|CPT® 86355||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So B Cells Total Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.80|FSC: 400601; BFG: 52||Not reimbursed separately|121.80|FSC: 400601; BFG: 52||External grouping not supported
30500056|EAP|CPT® 85415||0305 - LABORATORY - HEMATOLOGY|Hc So Plasminogen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|199.50|FSC: 400601; BFG: 52||Not reimbursed separately|199.50|FSC: 400601; BFG: 52||External grouping not supported
30200254|EAP|CPT® 86357||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Nk Cells Total Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.80|FSC: 400601; BFG: 52||Not reimbursed separately|121.80|FSC: 400601; BFG: 52||External grouping not supported
30200255|EAP|CPT® 86359||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So T Cells Total Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.80|FSC: 400601; BFG: 52||Not reimbursed separately|121.80|FSC: 400601; BFG: 52||External grouping not supported
30200256|EAP|CPT® 86360||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So T Cells Absol Cd4 And Cd8|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|152.25|FSC: 400601; BFG: 52||Not reimbursed separately|152.25|FSC: 400601; BFG: 52||External grouping not supported
30500036|EAP|CPT® 85540||0305 - LABORATORY - HEMATOLOGY|Hc So Leukocyte Alk Phos W/ Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30500037|EAP|CPT® 85549||0305 - LABORATORY - HEMATOLOGY|Hc So Muramidase|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.95|FSC: 400601; BFG: 52||Not reimbursed separately|61.95|FSC: 400601; BFG: 52||External grouping not supported
30500093|EAP|CPT® 85670||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Thrombin Time Plasma|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.20|FSC: 400601; BFG: 52||Not reimbursed separately|130.20|FSC: 400601; BFG: 52||External grouping not supported
30500040|EAP|CPT® 85610||0305 - LABORATORY - HEMATOLOGY|Hc Prothombin Time|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.30|FSC: 400601; BFG: 52||Not reimbursed separately|27.30|FSC: 400601; BFG: 52||External grouping not supported
30500043|EAP|CPT® 85651||0305 - LABORATORY - HEMATOLOGY|Hc Nonauto Erythrocyte Sed Rate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
30500047|EAP|CPT® 85730||0305 - LABORATORY - HEMATOLOGY|Hc Ptt Plasma Or Whole Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30700001|EAP|CPT® 81000||0307 - LABORATORY - UROLOGY|Hc Urinalysis Total Non-automated W/ Micro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
30700002|EAP|CPT® 81001||0307 - LABORATORY - UROLOGY|Hc Urinalysis Total Automated W/ Micro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
30700003|EAP|CPT® 81002||0307 - LABORATORY - UROLOGY|Hc Urinalysis Total Non-automated W/o Micro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
30700004|EAP|CPT® 81003||0307 - LABORATORY - UROLOGY|Hc Urinalysis Total Automated W/o Micro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
30700005|EAP|CPT® 81015||0307 - LABORATORY - UROLOGY|Hc Urinalysis Microscopic Only|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.50|FSC: 400601; BFG: 52||Not reimbursed separately|10.50|FSC: 400601; BFG: 52||External grouping not supported
30700007|EAP|CPT® 81025||0307 - LABORATORY - UROLOGY|Hc Urine Pregnancy Visual Color|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.10|FSC: 400601; BFG: 52||Not reimbursed separately|23.10|FSC: 400601; BFG: 52||External grouping not supported
30700008|EAP|CPT® 81050||0307 - LABORATORY - UROLOGY|Hc Timed Urine Vol Measure Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30600090|EAP|CPT® 87015||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Concentration For Infect Agent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.75|FSC: 400601; BFG: 52||Not reimbursed separately|57.75|FSC: 400601; BFG: 52||External grouping not supported
30600017|EAP|CPT® 87109||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Culture- Mycoplasma - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.40|FSC: 400601; BFG: 52||Not reimbursed separately|50.40|FSC: 400601; BFG: 52||External grouping not supported
30600093|EAP|CPT® 87186||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Microbe Susceptible- Mic - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.00|FSC: 400601; BFG: 52||Not reimbursed separately|42.00|FSC: 400601; BFG: 52||External grouping not supported
30600041|EAP|CPT® 87207||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Smear- Special Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.55|FSC: 400601; BFG: 52||Not reimbursed separately|95.55|FSC: 400601; BFG: 52||External grouping not supported
30600036|EAP|CPT® 87209||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Smear Complex Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30600037|EAP|CPT® 87210||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Smear - Infectious Wet Mount|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
30600096|EAP|CPT® 87253||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Virus Isolate Add'l Or Id|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
30600097|EAP|CPT® 87254||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Virus Isol- Shell Vial Techn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|FSC: 400601; BFG: 52||Not reimbursed separately|51.45|FSC: 400601; BFG: 52||External grouping not supported
30600098|EAP|CPT® 87329||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Giardia Ag- Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30600051|EAP|CPT® 87338||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Hpylori Stool- Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30600099|EAP|CPT® 87340||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Hepatitis B Surface Ag- Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.65|FSC: 400601; BFG: 52||Not reimbursed separately|34.65|FSC: 400601; BFG: 52||External grouping not supported
30600102|EAP|CPT® 87385||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Histoplasma Capsule Ag- Eia - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|187.95|FSC: 400601; BFG: 52||Not reimbursed separately|187.95|FSC: 400601; BFG: 52||External grouping not supported
30600058|EAP|CPT® 87420||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Resp Syncytial Ag Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30000093|EAP|CPT® 99000||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Cch Specimen Handling|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.00|FSC: 400601; BFG: 52||Not reimbursed separately|42.00|FSC: 400601; BFG: 52||External grouping not supported
30600101|EAP|CPT® 87449||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Infectious Agent Antigen - Multi Step|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30600063|EAP|CPT® 87480||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Candida Na Direct Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
30600103|EAP|CPT® 87491||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Chlamydia Trachomatis Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30600066|EAP|CPT® 87496||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Cytomegalov Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30600070|EAP|CPT® 87510||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Gardnerella Dir Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
30600071|EAP|CPT® 87517||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Hep-b Na Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|141.75|FSC: 400601; BFG: 52||Not reimbursed separately|141.75|FSC: 400601; BFG: 52||External grouping not supported
30600105|EAP|CPT® 87521||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HC SO HEP-C, AMPLIF NA PROBE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|355.95|FSC: 400601; BFG: 52||Not reimbursed separately|355.95|FSC: 400601; BFG: 52||External grouping not supported
30600106|EAP|CPT® 87522||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HC SO HEP-C, NA QUAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|141.75|FSC: 400601; BFG: 52||Not reimbursed separately|141.75|FSC: 400601; BFG: 52||External grouping not supported
30600074|EAP|CPT® 87529||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Herpes S- Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30600119|EAP|CPT® 87902||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Hepatitis C - Dna Or Rna|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|850.50|FSC: 400601; BFG: 52||Not reimbursed separately|850.50|FSC: 400601; BFG: 52||External grouping not supported
30600108|EAP|CPT® 87536||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|HC SO HIV-1, NA QUAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
71000003|EAP|Custom 71000003||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hc Phase Ii Recovery First 30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|147.00|FSC: 400601; BFG: 52||Not reimbursed separately|147.00|FSC: 400601; BFG: 52||External grouping not supported
30600111|EAP|CPT® 87591||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Neisseria Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
71000004|EAP|Custom 71000004||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hc Phase Ii Recovery Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.15|FSC: 400601; BFG: 52||Not reimbursed separately|24.15|FSC: 400601; BFG: 52||External grouping not supported
30600083|EAP|CPT® 87660||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Trichomonas Vagin Dir Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
30600113|EAP|CPT® 87798||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Amplif Na Probe Nos Agent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30600115|EAP|CPT® 87799||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Na Quan Nos Agent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|141.75|FSC: 400601; BFG: 52||Not reimbursed separately|141.75|FSC: 400601; BFG: 52||External grouping not supported
30600116|EAP|CPT® 87801||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Dna/rna Multi Org  - Amp Pr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|232.05|FSC: 400601; BFG: 52||Not reimbursed separately|232.05|FSC: 400601; BFG: 52||External grouping not supported
30600118|EAP|CPT® 87899||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Agent Nos Assay W/optic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
31200023|EAP|CPT® 88305||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Surg Path Level Iv Except Prostate Needle Biopsy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
31200013|EAP|CPT® 88313||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Special Stains Group 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
31200019|EAP|CPT® 88348||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Electron Microscopy Diagnostic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,059.45|FSC: 400601; BFG: 52||Not reimbursed separately|1,059.45|FSC: 400601; BFG: 52||External grouping not supported
31100019|EAP|CPT® 88184||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc So Flow Cytometry Tc 1st Marker|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
31100020|EAP|CPT® 88185||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc So Flow Cytometry Ea Addl Marker|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|138.60|FSC: 400601; BFG: 52||Not reimbursed separately|138.60|FSC: 400601; BFG: 52||External grouping not supported
76200001|EAP|HCPCS G0378||0762 - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM|Hc Observation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.20|FSC: 400601; BFG: 52||Not reimbursed separately|67.20|FSC: 400601; BFG: 52||External grouping not supported
76200002|EAP|HCPCS G0378||0762 - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM|Hc Observation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.65|FSC: 400601; BFG: 52||Not reimbursed separately|76.65|FSC: 400601; BFG: 52||External grouping not supported
27207030|EAP|Custom 27207030||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Forcep Biopsy Egd|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.05|FSC: 400601; BFG: 52||Not reimbursed separately|51.05|FSC: 400601; BFG: 52||External grouping not supported
27207037|EAP|Custom 27207037||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Retriever Rothnet Fb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|563.35|FSC: 400601; BFG: 52||Not reimbursed separately|563.35|FSC: 400601; BFG: 52||External grouping not supported
28291|EAP|CPT® 28291|||HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,083.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,083.00|FSC: 46100; BFG: 52||External grouping not supported
62321|EAP|CPT® 62321|||NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|358.00|FSC: 46100; BFG: 52||Not reimbursed separately|358.00|FSC: 46100; BFG: 52||External grouping not supported
62323|EAP|CPT® 62323|||NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|353.00|FSC: 46100; BFG: 52||Not reimbursed separately|353.00|FSC: 46100; BFG: 52||External grouping not supported
11045|EAP|CPT® 11045|||Pr Debridement, Skin, Sub-q Tissue,each Add 20 Sq Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
99224|EAP|CPT® 99224|||SBSQ OBSERVATION CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.00|FSC: 46100; BFG: 52||Not reimbursed separately|65.00|FSC: 46100; BFG: 52||External grouping not supported
99225|EAP|CPT® 99225|||SBSQ OBSERVATION CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
99226|EAP|CPT® 99226|||SBSQ OBSERVATION CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.00|FSC: 46100; BFG: 52||Not reimbursed separately|160.00|FSC: 46100; BFG: 52||External grouping not supported
49000873|EAP|CPT® 62321||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Epidural Or Subarachnoid Cervical Or Thoracic For Pain Mgmt W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,483.65|FSC: 400601; BFG: 52||Not reimbursed separately|1,483.65|FSC: 400601; BFG: 52||External grouping not supported
49000875|EAP|CPT® 62323||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Epidural Or Subarachnoid Lumbar Or Sacral (caudal) For Pain Mgmt W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,483.65|FSC: 400601; BFG: 52||Not reimbursed separately|1,483.65|FSC: 400601; BFG: 52||External grouping not supported
49000879|EAP|CPT® 62327||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Placement Epidural Lumbar/sacral Cont Infusion For Pain Mgmt W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,835.40|FSC: 400601; BFG: 52||Not reimbursed separately|1,835.40|FSC: 400601; BFG: 52||External grouping not supported
42400005|EAP|CPT® 97161||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Pt Evaluation Low Complexity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|217.35|FSC: 400601; BFG: 52||Not reimbursed separately|217.35|FSC: 400601; BFG: 52||External grouping not supported
42400006|EAP|CPT® 97162||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Pt Evaluation Moderate Complexity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|282.45|FSC: 400601; BFG: 52||Not reimbursed separately|282.45|FSC: 400601; BFG: 52||External grouping not supported
42400007|EAP|CPT® 97163||0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Pt Evaluation High Complexity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|217.35|FSC: 400601; BFG: 52||Not reimbursed separately|217.35|FSC: 400601; BFG: 52||External grouping not supported
43400007|EAP|CPT® 97165||0434 - OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Ot Evaluation Low Complexity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|204.75|FSC: 400601; BFG: 52||Not reimbursed separately|204.75|FSC: 400601; BFG: 52||External grouping not supported
43400008|EAP|CPT® 97166||0434 - OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Ot Evaluation Moderate Complexity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|206.85|FSC: 400601; BFG: 52||Not reimbursed separately|206.85|FSC: 400601; BFG: 52||External grouping not supported
43400009|EAP|CPT® 97167||0434 - OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Ot Evaluation High Complexity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.95|FSC: 400601; BFG: 52||Not reimbursed separately|208.95|FSC: 400601; BFG: 52||External grouping not supported
37000018|EAP|CPT® 99151||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Cch Mod Sedation < 5 Yrs Initial 15 Mins Same Md|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|156.45|FSC: 400601; BFG: 52||Not reimbursed separately|156.45|FSC: 400601; BFG: 52||External grouping not supported
37000020|EAP|CPT® 99152||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Mod Sedation > 5 Yrs Initial 15 Mins Same Md|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|151.20|FSC: 400601; BFG: 52||Not reimbursed separately|151.20|FSC: 400601; BFG: 52||External grouping not supported
37000019|EAP|CPT® 99153||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Mod Sedation Ea Addl 15 Mins Same Md|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.10|FSC: 400601; BFG: 52||Not reimbursed separately|65.10|FSC: 400601; BFG: 52||External grouping not supported
27207072|EAP|Custom 27207072||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Valve Bronch Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.55|FSC: 400601; BFG: 52||Not reimbursed separately|19.55|FSC: 400601; BFG: 52||External grouping not supported
30500094|EAP|CPT® 85362||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Fibrin Degradation Products|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
25800003|EAP|Custom 25800003||0258 - PHARMACY - IV SOLUTIONS|Hc Cch Dex 10% 1000ml|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.85|FSC: 400601; BFG: 52||Not reimbursed separately|82.85|FSC: 400601; BFG: 52||External grouping not supported
49000893|EAP|CPT® 63661||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Removal Spinal Neurostimulator Electrode Perc Array Includes Fluoro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
49000894|EAP|CPT® 63663||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Revision Includes Replacement Of Spinal Neurostimulator Electrode Perc Array Includes Fluoro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16,214.10|FSC: 400601; BFG: 52||Not reimbursed separately|16,214.10|FSC: 400601; BFG: 52||External grouping not supported
49000895|EAP|CPT® 63685||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Insert/replace Spinal Neurostimulator Pulse Generator/receiver Direct/inductive Coupling|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58,165.49|FSC: 400601; BFG: 52||Not reimbursed separately|58,165.49|FSC: 400601; BFG: 52||External grouping not supported
49000896|EAP|CPT® 63688||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Revision/removal Implanted Spinal Neurostimulator Pulse Generator/receiver|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,709.10|FSC: 400601; BFG: 52||Not reimbursed separately|7,709.10|FSC: 400601; BFG: 52||External grouping not supported
27207101|EAP|Custom 27207101||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Set Pneumothorax Wayne 14fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|992.50|FSC: 400601; BFG: 52||Not reimbursed separately|992.50|FSC: 400601; BFG: 52||External grouping not supported
27207106|EAP|Custom 27207106||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sensor Spo2 Neonatal Lncs Masimo|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|94.00|FSC: 400601; BFG: 52||Not reimbursed separately|94.00|FSC: 400601; BFG: 52||External grouping not supported
27207115|EAP|Custom 27207115||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Detector Co2 End Tidial Temp Controlled Below 75|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.35|FSC: 400601; BFG: 52||Not reimbursed separately|72.35|FSC: 400601; BFG: 52||External grouping not supported
27207150|EAP|Custom 27207150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cautery Fine Tip High-temp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.25|FSC: 400601; BFG: 52||Not reimbursed separately|43.25|FSC: 400601; BFG: 52||External grouping not supported
27207198|EAP|Custom 27207198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sleeve Scd Express Thigh Med|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|298.00|FSC: 400601; BFG: 52||Not reimbursed separately|298.00|FSC: 400601; BFG: 52||External grouping not supported
27207199|EAP|Custom 27207199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sleeve Scd Express Thigh Sm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.10|FSC: 400601; BFG: 52||Not reimbursed separately|256.10|FSC: 400601; BFG: 52||External grouping not supported
27207200|EAP|Custom 27207200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sleeve Scd Express Thigh Lg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|327.75|FSC: 400601; BFG: 52||Not reimbursed separately|327.75|FSC: 400601; BFG: 52||External grouping not supported
27207236|EAP|Custom 27207236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Ethilon Ps-2 4-0 18in|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.70|FSC: 400601; BFG: 52||Not reimbursed separately|15.70|FSC: 400601; BFG: 52||External grouping not supported
27207240|EAP|Custom 27207240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Prolene 5-0 Pc3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.60|FSC: 400601; BFG: 52||Not reimbursed separately|24.60|FSC: 400601; BFG: 52||External grouping not supported
27207244|EAP|Custom 27207244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Prolene 4-0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.60|FSC: 400601; BFG: 52||Not reimbursed separately|24.60|FSC: 400601; BFG: 52||External grouping not supported
27207261|EAP|Custom 27207261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Prolene 6-0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.90|FSC: 400601; BFG: 52||Not reimbursed separately|19.90|FSC: 400601; BFG: 52||External grouping not supported
27207266|EAP|Custom 27207266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Forcep Disp Bx Hot 000852|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.65|FSC: 400601; BFG: 52||Not reimbursed separately|128.65|FSC: 400601; BFG: 52||External grouping not supported
63600501|EAP|CPT® 91301||0636 - PHARMACY - DRUGS REQUIRING DETAILED CODING|HC SARS-COV-2 (COVID-19) VACCINE 0.5ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
27207300|EAP|Custom 27207300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Delivery Room Pack|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|83.70|FSC: 400601; BFG: 52||Not reimbursed separately|83.70|FSC: 400601; BFG: 52||External grouping not supported
27207349|EAP|Custom 27207349||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Collar Stifneck Baby No Neck|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 400601; BFG: 52||Not reimbursed separately|75.00|FSC: 400601; BFG: 52||External grouping not supported
27207350|EAP|Custom 27207350||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Collar Cervical Stifneck Adult|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.40|FSC: 400601; BFG: 52||Not reimbursed separately|71.40|FSC: 400601; BFG: 52||External grouping not supported
27207351|EAP|Custom 27207351||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Abdominal Binder/any Size|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|153.25|FSC: 400601; BFG: 52||Not reimbursed separately|153.25|FSC: 400601; BFG: 52||External grouping not supported
27207352|EAP|Custom 27207352||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bucks Traction/any Size|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.80|FSC: 400601; BFG: 52||Not reimbursed separately|85.80|FSC: 400601; BFG: 52||External grouping not supported
27207366|EAP|Custom 27207366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Dressing Medium Granufoam Vac|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|277.80|FSC: 400601; BFG: 52||Not reimbursed separately|277.80|FSC: 400601; BFG: 52||External grouping not supported
27207367|EAP|Custom 27207367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Cath Radial Artery Ak04020|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.65|FSC: 400601; BFG: 52||Not reimbursed separately|119.65|FSC: 400601; BFG: 52||External grouping not supported
27207371|EAP|Custom 27207371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Insulated Stimuplex W/ext Set 21ga X4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.10|FSC: 400601; BFG: 52||Not reimbursed separately|66.10|FSC: 400601; BFG: 52||External grouping not supported
27207381|EAP|Custom 27207381||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Optho-burr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.85|FSC: 400601; BFG: 52||Not reimbursed separately|52.85|FSC: 400601; BFG: 52||External grouping not supported
27207386|EAP|Custom 27207386||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sheath Pinnacle 5fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|179.80|FSC: 400601; BFG: 52||Not reimbursed separately|179.80|FSC: 400601; BFG: 52||External grouping not supported
27400439|EAP|HCPCS L3807||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Cch Splint Wrist/ Forearm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.90|FSC: 400601; BFG: 52||Not reimbursed separately|102.90|FSC: 400601; BFG: 52||External grouping not supported
30100884|EAP|CPT® 80047||0301 - LABORATORY - CHEMISTRY|Hc Cch Basic Metabolic Panel Ionized Ca|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.65|FSC: 400601; BFG: 52||Not reimbursed separately|76.65|FSC: 400601; BFG: 52||External grouping not supported
30100885|EAP|CPT® 80305||0301 - LABORATORY - CHEMISTRY|Hc Cch Drug Test Presumptive Direct Optical Observation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|404.25|FSC: 400601; BFG: 52||Not reimbursed separately|404.25|FSC: 400601; BFG: 52||External grouping not supported
30100897|EAP|CPT® 82436||0301 - LABORATORY - CHEMISTRY|Hc Cch So Chloride Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30500097|EAP|CPT® 85732||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Ptt Substitution Plasma Fractions Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
30600235|EAP|CPT® 87172||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Pinworm Exam|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
30600236|EAP|CPT® 87265||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So B Pertussis/parapertussis Ag By Dfa|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|91.35|FSC: 400601; BFG: 52||Not reimbursed separately|91.35|FSC: 400601; BFG: 52||External grouping not supported
30600237|EAP|CPT® 87327||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Cryptococcus Neoform Ag Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
31200051|EAP|CPT® 88312||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Special Stains Group 1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.99|FSC: 400601; BFG: 52||Not reimbursed separately|196.99|FSC: 400601; BFG: 52||External grouping not supported
30100599|EAP|CPT® 83916||0301 - LABORATORY - CHEMISTRY|Hc So Oligoclonal Bands|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
49000742|EAP|CPT® 49422||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Removal Tunneled Intraperitoneal Catheter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,670.15|FSC: 400601; BFG: 52||Not reimbursed separately|2,670.15|FSC: 400601; BFG: 52||External grouping not supported
30100601|EAP|CPT® 82040||0301 - LABORATORY - CHEMISTRY|Hc So Assay Of Serum Albumin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
30100602|EAP|CPT® 82042||0301 - LABORATORY - CHEMISTRY|Hc So Albumin Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.75|FSC: 400601; BFG: 52||Not reimbursed separately|78.75|FSC: 400601; BFG: 52||External grouping not supported
31000136|EAP|CPT® 88332||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Sp Consult Ea Addl Tb W/ Fs|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
27803470|EAP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hc Cch Triple Lumen Picc Line|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,233.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,233.75|FSC: 400601; BFG: 52||External grouping not supported
31000165|EAP|CPT® 88331||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Sp Consult 1st Tb W/ Fs Sgl Sp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.45|FSC: 400601; BFG: 52||Not reimbursed separately|345.45|FSC: 400601; BFG: 52||External grouping not supported
94200032|EAP|CPT® 98960||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Cch Self Mgmt Educ/train 1 Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
94200033|EAP|CPT® 98961||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Cch Self Mgmt Educ/train 2-4 Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
94200034|EAP|CPT® 98962||0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING|Hc Cch Self Mgmt Educ/train 5-8 Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
30100607|EAP|CPT® 84270||0301 - LABORATORY - CHEMISTRY|Hc Sex Hormone Binding Globulin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.25|FSC: 400601; BFG: 52||Not reimbursed separately|110.25|FSC: 400601; BFG: 52||External grouping not supported
43000083|EAP|CPT® 97598||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Debridement Wound Selective Ea Addl 20 Sq Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.20|FSC: 400601; BFG: 52||Not reimbursed separately|130.20|FSC: 400601; BFG: 52||External grouping not supported
71000008|EAP|Custom 71000008||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hc Cch Extended Recovery/hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|147.00|FSC: 400601; BFG: 52||Not reimbursed separately|147.00|FSC: 400601; BFG: 52||External grouping not supported
30900015|EAP|CPT® 89321||0309 - LABORATORY - OTHER LABORATORY|Hc Cch Semen Analysis Sperm Detection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.44|FSC: 400601; BFG: 52||Not reimbursed separately|51.44|FSC: 400601; BFG: 52||External grouping not supported
49000899|EAP|CPT® 64680||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent; Celiac Plexus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
71000001|EAP|Custom 71000001||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hc Phase I Recovery First 30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|280.35|FSC: 400601; BFG: 52||Not reimbursed separately|280.35|FSC: 400601; BFG: 52||External grouping not supported
71000002|EAP|Custom 71000002||0710 - RECOVERY ROOM - GENERAL CLASSIFICATION|Hc Phase I Recovery Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|117.60|FSC: 400601; BFG: 52||Not reimbursed separately|117.60|FSC: 400601; BFG: 52||External grouping not supported
37000008|EAP|Custom 37000008||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc General Anesthesia First 30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|321.30|FSC: 400601; BFG: 52||Not reimbursed separately|321.30|FSC: 400601; BFG: 52||External grouping not supported
37000009|EAP|Custom 37000009||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc General Anesthesia Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|107.10|FSC: 400601; BFG: 52||Not reimbursed separately|107.10|FSC: 400601; BFG: 52||External grouping not supported
75000165|EAP|CPT® 45398||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonscopy Flexible W/ Band Ligation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,717.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,717.40|FSC: 400601; BFG: 52||External grouping not supported
39000003|EAP|HCPCS P9012||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Cryoprecipitate Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|117.60|FSC: 400601; BFG: 52||Not reimbursed separately|117.60|FSC: 400601; BFG: 52||External grouping not supported
39000004|EAP|HCPCS P9016||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Leukocyte Poor Blood Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|492.45|FSC: 400601; BFG: 52||Not reimbursed separately|492.45|FSC: 400601; BFG: 52||External grouping not supported
39000005|EAP|HCPCS P9017||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Ffp Single Donor Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|194.25|FSC: 400601; BFG: 52||Not reimbursed separately|194.25|FSC: 400601; BFG: 52||External grouping not supported
39000007|EAP|HCPCS P9021||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Rbc Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|382.20|FSC: 400601; BFG: 52||Not reimbursed separately|382.20|FSC: 400601; BFG: 52||External grouping not supported
39000011|EAP|HCPCS P9039||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Rbc Deglycerolized Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,126.65|FSC: 400601; BFG: 52||Not reimbursed separately|1,126.65|FSC: 400601; BFG: 52||External grouping not supported
39000019|EAP|HCPCS P9035||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Platelets Pheresis Leuko Reduced Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,276.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,276.80|FSC: 400601; BFG: 52||External grouping not supported
39000021|EAP|HCPCS P9037||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Platelets Pheresis Leuko Reduced Irradiated Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,672.65|FSC: 400601; BFG: 52||Not reimbursed separately|1,672.65|FSC: 400601; BFG: 52||External grouping not supported
39000023|EAP|HCPCS P9040||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Rbc Leuko Reduced Irradiated Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|697.20|FSC: 400601; BFG: 52||Not reimbursed separately|697.20|FSC: 400601; BFG: 52||External grouping not supported
39000026|EAP|HCPCS P9055||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Platelets Leuko Reduced Cmv Negative Apheresis/pheresis Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,756.65|FSC: 400601; BFG: 52||Not reimbursed separately|1,756.65|FSC: 400601; BFG: 52||External grouping not supported
39000029|EAP|HCPCS P9058||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Processing Rbc Leuko Reduced Cmv Negative Irradiated Each Unit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|637.35|FSC: 400601; BFG: 52||Not reimbursed separately|637.35|FSC: 400601; BFG: 52||External grouping not supported
27207457|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Guidewire Angled 150cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|231.75|FSC: 400601; BFG: 52||Not reimbursed separately|231.75|FSC: 400601; BFG: 52||External grouping not supported
27207459|EAP|Custom 27207459||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag Infuser Pressure 1000ml|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|124.55|FSC: 400601; BFG: 52||Not reimbursed separately|124.55|FSC: 400601; BFG: 52||External grouping not supported
30100609|EAP|CPT® 83010||0301 - LABORATORY - CHEMISTRY|Hc So Haptoglobin Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.00|FSC: 400601; BFG: 52||Not reimbursed separately|42.00|FSC: 400601; BFG: 52||External grouping not supported
32000228|EAP|CPT® 73592||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Lower Extremity Infant 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
27205301|EAP|HCPCS C1894||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Introducer Sheath 20fr X 28cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|670.75|FSC: 400601; BFG: 52||Not reimbursed separately|670.75|FSC: 400601; BFG: 52||External grouping not supported
30100406|EAP|CPT® 82553||0301 - LABORATORY - CHEMISTRY|Hc So Ckmb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.45|FSC: 400601; BFG: 52||Not reimbursed separately|72.45|FSC: 400601; BFG: 52||External grouping not supported
27000003|EAP|Custom 27000003||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Cch Oxygen Service Per Day|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
49000746|EAP|CPT® 64620||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Intercostal Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000747|EAP|CPT® 64630||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Pudendal Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
20604|EAP|CPT® 20604||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.32|FSC: 46100; BFG: 52||Not reimbursed separately|70.32|FSC: 46100; BFG: 52||External grouping not supported
20606|EAP|CPT® 20606|||ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|200.10|FSC: 46100; BFG: 52||Not reimbursed separately|200.10|FSC: 46100; BFG: 52||External grouping not supported
20611|EAP|CPT® 20611|||ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|133.00|FSC: 46100; BFG: 52||Not reimbursed separately|133.00|FSC: 46100; BFG: 52||External grouping not supported
45350|EAP|CPT® 45350|||SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|753.00|FSC: 46100; BFG: 52||Not reimbursed separately|753.00|FSC: 46100; BFG: 52||External grouping not supported
45398|EAP|CPT® 45398|||COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,056.60|FSC: 46100; BFG: 52||Not reimbursed separately|1,056.60|FSC: 46100; BFG: 52||External grouping not supported
64488|EAP|CPT® 64488|||TAP BLOCK BILATERAL BY INJECTION(S)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|203.00|FSC: 46100; BFG: 52||Not reimbursed separately|203.00|FSC: 46100; BFG: 52||External grouping not supported
48100065|EAP|CPT® 37221||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hc Insertion Stent Iliac Artery Initial Vessel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20,307.00|FSC: 400601; BFG: 52||Not reimbursed separately|20,307.00|FSC: 400601; BFG: 52||External grouping not supported
48100067|EAP|CPT® 37223||0481 - CARDIOLOGY - CARDIAC CATH LAB|Hc Insertion Stent Iliac Artery Each Addl Vessel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,831.45|FSC: 400601; BFG: 52||Not reimbursed separately|3,831.45|FSC: 400601; BFG: 52||External grouping not supported
40200051|EAP|CPT® 76942||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Guidance For Needle Placement|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|619.50|FSC: 400601; BFG: 52||Not reimbursed separately|619.50|FSC: 400601; BFG: 52||External grouping not supported
40200053|EAP|CPT® 76946||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Guidance For Amniocentesis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|353.85|FSC: 400601; BFG: 52||Not reimbursed separately|353.85|FSC: 400601; BFG: 52||External grouping not supported
36000037|EAP|Custom 36000037||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Cancelled Procedure In Or|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|432.60|FSC: 400601; BFG: 52||Not reimbursed separately|432.60|FSC: 400601; BFG: 52||External grouping not supported
51000175|EAP|CPT® 99215||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Cancelled Procedure In Preop|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.10|FSC: 400601; BFG: 52||Not reimbursed separately|275.10|FSC: 400601; BFG: 52||External grouping not supported
27207510|EAP|Custom 27207510||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Bipap Performa W/ Headgear Sm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|194.45|FSC: 400601; BFG: 52||Not reimbursed separately|194.45|FSC: 400601; BFG: 52||External grouping not supported
96127|EAP|CPT® 96127||0900 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - GENERAL CLASSIFICATION|BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.00|FSC: 46100; BFG: 52||Not reimbursed separately|27.00|FSC: 46100; BFG: 52||External grouping not supported
41000018|EAP|CPT® 94660||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Cpap Or Bipap|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|498.75|FSC: 400601; BFG: 52||Not reimbursed separately|498.75|FSC: 400601; BFG: 52||External grouping not supported
41000027|EAP|CPT® 94664||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Demo & Eval Of Aerosol Mdi Neb Or Ippb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|498.75|FSC: 400601; BFG: 52||Not reimbursed separately|498.75|FSC: 400601; BFG: 52||External grouping not supported
43000006|EAP|CPT® 97018||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Paraffin Bath By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
43000007|EAP|CPT® 97022||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Whirlpool By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
43000008|EAP|CPT® 97032||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Electrical Stimulation Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.25|FSC: 400601; BFG: 52||Not reimbursed separately|68.25|FSC: 400601; BFG: 52||External grouping not supported
43000009|EAP|CPT® 97033||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Iontophoresis Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|159.60|FSC: 400601; BFG: 52||Not reimbursed separately|159.60|FSC: 400601; BFG: 52||External grouping not supported
43000010|EAP|CPT® 97035||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Ultrasound Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
43000011|EAP|CPT® 97110||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Therapeutic Exercises Rom & Flexibility Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.75|FSC: 400601; BFG: 52||Not reimbursed separately|99.75|FSC: 400601; BFG: 52||External grouping not supported
43000012|EAP|CPT® 97112||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Neuromuscular Reeducation Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
43000030|EAP|CPT® 97124||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Massage Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
43000014|EAP|CPT® 97140||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Manual Therapy Techniques Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|117.60|FSC: 400601; BFG: 52||Not reimbursed separately|117.60|FSC: 400601; BFG: 52||External grouping not supported
43000015|EAP|CPT® 97533||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Sensory Integrative Techniques Direct Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.15|FSC: 400601; BFG: 52||Not reimbursed separately|87.15|FSC: 400601; BFG: 52||External grouping not supported
43000016|EAP|CPT® 97542||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Wheelchair Mgmt Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|93.45|FSC: 400601; BFG: 52||Not reimbursed separately|93.45|FSC: 400601; BFG: 52||External grouping not supported
43000018|EAP|CPT® 97755||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Assistive Technology Assess Direct Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.95|FSC: 400601; BFG: 52||Not reimbursed separately|103.95|FSC: 400601; BFG: 52||External grouping not supported
43000019|EAP|CPT® 97760||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Orthotic Mgmt & Training Initial Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.95|FSC: 400601; BFG: 52||Not reimbursed separately|103.95|FSC: 400601; BFG: 52||External grouping not supported
43000020|EAP|CPT® 97761||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Prosthetic Training Upper/lower Extremity Initial Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|94.50|FSC: 400601; BFG: 52||Not reimbursed separately|94.50|FSC: 400601; BFG: 52||External grouping not supported
43000022|EAP|CPT® G0283||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Electrical Stimulation Non-wound Care By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
43000025|EAP|CPT® 97750||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Physical Performance Test W/ Report Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
43000017|EAP|CPT® 97150||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Group Therapy Procedure By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
43000023|EAP|CPT® 97530||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Therapeutic Activities Direct- Each 15 Minutes By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
43000026|EAP|CPT® 97535||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Self Care/home Mgmt Direct Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.80|FSC: 400601; BFG: 52||Not reimbursed separately|100.80|FSC: 400601; BFG: 52||External grouping not supported
43000027|EAP|CPT® 97537||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Community/work Reintegration Direct Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
46000012|EAP|CPT® 94618||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Pulmonary Stress Test (6 Min Walk)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
61000027|EAP|CPT® 73219||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Upper Extremity Other Than Joint W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,327.85|FSC: 400601; BFG: 52||Not reimbursed separately|2,327.85|FSC: 400601; BFG: 52||External grouping not supported
61000028|EAP|CPT® 73222||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Upper Extremity Joint W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,607.55|FSC: 400601; BFG: 52||Not reimbursed separately|1,607.55|FSC: 400601; BFG: 52||External grouping not supported
61000029|EAP|CPT® 73223||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Upper Extremity Joint W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,327.85|FSC: 400601; BFG: 52||Not reimbursed separately|2,327.85|FSC: 400601; BFG: 52||External grouping not supported
61000030|EAP|CPT® 73718||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Lower Extremity Other Than Joint W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,713.60|FSC: 400601; BFG: 52||Not reimbursed separately|1,713.60|FSC: 400601; BFG: 52||External grouping not supported
61000031|EAP|CPT® 73719||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Lower Extremity Other Than Joint W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,327.85|FSC: 400601; BFG: 52||Not reimbursed separately|2,327.85|FSC: 400601; BFG: 52||External grouping not supported
61000032|EAP|CPT® 73722||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Lower Extremity Joint W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,607.55|FSC: 400601; BFG: 52||Not reimbursed separately|1,607.55|FSC: 400601; BFG: 52||External grouping not supported
61000033|EAP|CPT® 73723||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Lower Extremity Joint W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,698.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,698.50|FSC: 400601; BFG: 52||External grouping not supported
61000035|EAP|CPT® 74183||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Abdomen W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,942.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,942.50|FSC: 400601; BFG: 52||External grouping not supported
61000026|EAP|CPT® 73218||0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION|Hc Mri Upper Extremity Other Than Joint W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,072.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,072.70|FSC: 400601; BFG: 52||External grouping not supported
37000011|EAP|Custom 37000011||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Monitored Anesthesia Care/mac First 30 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|266.70|FSC: 400601; BFG: 52||Not reimbursed separately|266.70|FSC: 400601; BFG: 52||External grouping not supported
37000012|EAP|Custom 37000012||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Monitored Anesthesia Care/mac Each Addl 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|107.10|FSC: 400601; BFG: 52||Not reimbursed separately|107.10|FSC: 400601; BFG: 52||External grouping not supported
41000007|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Metered Dose Inhaler Treatment|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|391.65|FSC: 400601; BFG: 52||Not reimbursed separately|391.65|FSC: 400601; BFG: 52||External grouping not supported
41000010|EAP|CPT® 94640||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Aerosol Or Nebulizer Treatment|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
41000030|EAP|CPT® 94799||0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION|Hc Incentive Spirometry Demo & Instruction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
42000027|EAP|CPT® 97150||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Therapeutic Procedure Group|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
42000028|EAP|CPT® 97530||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Therapeutic Activities Direct Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.65|FSC: 400601; BFG: 52||Not reimbursed separately|97.65|FSC: 400601; BFG: 52||External grouping not supported
42000031|EAP|CPT® 97535||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Self Care/home Mgmt Direct Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.80|FSC: 400601; BFG: 52||Not reimbursed separately|100.80|FSC: 400601; BFG: 52||External grouping not supported
42000032|EAP|CPT® 97537||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Community/work Reintegration Training Direct Each 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
43400005|EAP|CPT® 97168||0434 - OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION|Hc Ot Re-evaluation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.00|FSC: 400601; BFG: 52||Not reimbursed separately|105.00|FSC: 400601; BFG: 52||External grouping not supported
49000038|EAP|CPT® 20225||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bx Bone Trocar/needle Deep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,608.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,608.85|FSC: 400601; BFG: 52||External grouping not supported
51000044|EAP|CPT® 10060||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc I&d Abscess Simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|452.55|FSC: 400601; BFG: 52||Not reimbursed separately|452.55|FSC: 400601; BFG: 52||External grouping not supported
51000045|EAP|CPT® 10061||0361 - OPERATING ROOM SERVICES - MINOR SURGERY|Hc I&d Abscess Complicated|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|841.05|FSC: 400601; BFG: 52||Not reimbursed separately|841.05|FSC: 400601; BFG: 52||External grouping not supported
51000078|EAP|CPT® 20552||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Trigger Point Injection 1-2 Muscles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
51000079|EAP|CPT® 20553||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Trigger Point Injection 3+ Muscles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
72000004|EAP|CPT® 92950||0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION|Hc Neonatal Resuscitation (cpr)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
74000001|EAP|CPT® 95805||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|HC MULTIPLE SLEEP LATENCY TEST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,418.15|FSC: 400601; BFG: 52||Not reimbursed separately|2,418.15|FSC: 400601; BFG: 52||External grouping not supported
74000003|EAP|CPT® 95810||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|HC POLYSOMNOGRAPHY 4+ PARAMETERS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,777.90|FSC: 400601; BFG: 52||Not reimbursed separately|3,777.90|FSC: 400601; BFG: 52||External grouping not supported
74000004|EAP|CPT® 95811||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|HC POLYSOMNOGRAPHY 4+ PARAMETERS W/ CPAP OR BI-LEVEL VENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,777.50|FSC: 400601; BFG: 52||Not reimbursed separately|4,777.50|FSC: 400601; BFG: 52||External grouping not supported
74000008|EAP|CPT® 95819||0740 - EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION|Hc Eeg Awake & Asleep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|673.05|FSC: 400601; BFG: 52||Not reimbursed separately|673.05|FSC: 400601; BFG: 52||External grouping not supported
92100003|EAP|CPT® 93922||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Limited Extremity Study Up To 2 Levels Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|605.85|FSC: 400601; BFG: 52||Not reimbursed separately|605.85|FSC: 400601; BFG: 52||External grouping not supported
92100004|EAP|CPT® 93923||0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB|Hc Complete Ext Study 3+ Levels Or Provoc Fx Maneuvers|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.40|FSC: 400601; BFG: 52||Not reimbursed separately|365.40|FSC: 400601; BFG: 52||External grouping not supported
51000177|EAP|CPT® 20550||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Injection Tendon Sheath Ligament Aponeurosis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
51000178|EAP|CPT® 20600||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Arthrocentesis Joint/bursa Small W/o Ultrasound Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
51000179|EAP|CPT® 20605||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Arthrocentesis Joint/bursa Intermediate W/o Ultrasound Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
51000180|EAP|CPT® 20610||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Arthrocentesis Joint/bursa Major W/o Ultrasound Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
51000182|EAP|CPT® 36593||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Declotting Vad Or Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|796.95|FSC: 400601; BFG: 52||Not reimbursed separately|796.95|FSC: 400601; BFG: 52||External grouping not supported
51000183|EAP|CPT® 51701||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Insertion Straight Cath (non-indwelling)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
51000184|EAP|CPT® 51702||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Insertion Foley Cath Simple (indwelling)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
51000193|EAP|CPT® 96523||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Irrigation Vad (port Flush)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
27207533|EAP|Custom 27207533||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Glidescope Blade|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.30|FSC: 400601; BFG: 52||Not reimbursed separately|120.30|FSC: 400601; BFG: 52||External grouping not supported
27207534|EAP|Custom 27207534||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Spinal Needle - Various Sizes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.75|FSC: 400601; BFG: 52||Not reimbursed separately|25.75|FSC: 400601; BFG: 52||External grouping not supported
49000418|EAP|CPT® 38220||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bone Marrow Aspiration(s)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,657.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,657.95|FSC: 400601; BFG: 52||External grouping not supported
49000419|EAP|CPT® 38221||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bone Marrow Biopsy(ies)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,657.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,657.95|FSC: 400601; BFG: 52||External grouping not supported
49000420|EAP|CPT® 38222||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Bone Marrow Aspiration(s) And Biopsy(ies)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,657.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,657.95|FSC: 400601; BFG: 52||External grouping not supported
27207598|EAP|Custom 27207598||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag Drain W/ Urine Meter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.30|FSC: 400601; BFG: 52||Not reimbursed separately|23.30|FSC: 400601; BFG: 52||External grouping not supported
43000031|EAP|CPT® 97034||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Contrast Baths Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
27207624|EAP|Custom 27207624||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Stapler Skin Ds-5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.60|FSC: 400601; BFG: 52||Not reimbursed separately|30.60|FSC: 400601; BFG: 52||External grouping not supported
27207632|EAP|Custom 27207632||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Chromic 5-0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.85|FSC: 400601; BFG: 52||Not reimbursed separately|28.85|FSC: 400601; BFG: 52||External grouping not supported
27201184|EAP|Custom 27201184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Balloon Bakri|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|857.15|FSC: 400601; BFG: 52||Not reimbursed separately|857.15|FSC: 400601; BFG: 52||External grouping not supported
27400021|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Boot Walker Large Prefabricated Off-the-shelf|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|408.45|FSC: 400601; BFG: 52||Not reimbursed separately|408.45|FSC: 400601; BFG: 52||External grouping not supported
27400023|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Boot Walker Medium Prefabricated Off-the-shelf|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|334.95|FSC: 400601; BFG: 52||Not reimbursed separately|334.95|FSC: 400601; BFG: 52||External grouping not supported
27400031|EAP|HCPCS L1902||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Boot Walker Small Prefabricated Off-the-shelf|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|290.85|FSC: 400601; BFG: 52||Not reimbursed separately|290.85|FSC: 400601; BFG: 52||External grouping not supported
27207648|EAP|Custom 27207648||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tourniquet|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.80|FSC: 400601; BFG: 52||Not reimbursed separately|15.80|FSC: 400601; BFG: 52||External grouping not supported
27200952|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cath Cricothyrotomy Set Melker|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,628.71|FSC: 400601; BFG: 52||Not reimbursed separately|1,628.71|FSC: 400601; BFG: 52||External grouping not supported
27201018|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Catheter Drain 10fr X 25cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|397.95|FSC: 400601; BFG: 52||Not reimbursed separately|397.95|FSC: 400601; BFG: 52||External grouping not supported
27201433|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Catheter Drainage 12f Multipurpose|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|397.95|FSC: 400601; BFG: 52||Not reimbursed separately|397.95|FSC: 400601; BFG: 52||External grouping not supported
27201435|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Catheter Drainage 14f Multipurpose|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|397.95|FSC: 400601; BFG: 52||Not reimbursed separately|397.95|FSC: 400601; BFG: 52||External grouping not supported
27201437|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Catheter Drainage 8.5f Multipurpose|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|314.35|FSC: 400601; BFG: 52||Not reimbursed separately|314.35|FSC: 400601; BFG: 52||External grouping not supported
27201304|EAP|Custom 27201304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Catheter Triple Lumen 7fr 14cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|491.75|FSC: 400601; BFG: 52||Not reimbursed separately|491.75|FSC: 400601; BFG: 52||External grouping not supported
77100015|EAP|CPT® 0011A||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|HC SARS-COV-2 (COVID-19) VACCINE ADMIN 0.5ML 1ST DOSE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 400601; BFG: 52||Not reimbursed separately|35.00|FSC: 400601; BFG: 52||External grouping not supported
77100016|EAP|CPT® 0012A||0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION|HC SARS-COV-2 (COVID-19) VACCINE ADMIN 0.5ML 2ND DOSE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 400601; BFG: 52||Not reimbursed separately|35.00|FSC: 400601; BFG: 52||External grouping not supported
27201583|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Guidewire .038 X 145 X-stiff|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|79.30|FSC: 400601; BFG: 52||Not reimbursed separately|79.30|FSC: 400601; BFG: 52||External grouping not supported
27201300|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Guidewire Stiff Glide 80cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.10|FSC: 400601; BFG: 52||Not reimbursed separately|130.10|FSC: 400601; BFG: 52||External grouping not supported
27300001|EAP|Custom 27300001||0273 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - TAKE HOME SUPPLIES|Hc Cch Self-care Covid Kit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|FSC: 400601; BFG: 52||Not reimbursed separately|15.75|FSC: 400601; BFG: 52||External grouping not supported
27201330|EAP|Custom 27201330||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Kit Intrauterine Pressure Catheter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|197.50|FSC: 400601; BFG: 52||Not reimbursed separately|197.50|FSC: 400601; BFG: 52||External grouping not supported
27200955|EAP|Custom 27200955||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Quick Pressure Monitor Set|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|215.93|FSC: 400601; BFG: 52||Not reimbursed separately|215.93|FSC: 400601; BFG: 52||External grouping not supported
27201233|EAP|Custom 27201233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Sensor Perianal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|227.25|FSC: 400601; BFG: 52||Not reimbursed separately|227.25|FSC: 400601; BFG: 52||External grouping not supported
27200041|EAP|Custom 27200041||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Sponge Surgicel 2 X 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|164.59|FSC: 400601; BFG: 52||Not reimbursed separately|164.59|FSC: 400601; BFG: 52||External grouping not supported
27201326|EAP|HCPCS C1751||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Tray Central Venous Catheter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|197.00|FSC: 400601; BFG: 52||Not reimbursed separately|197.00|FSC: 400601; BFG: 52||External grouping not supported
27200141|EAP|Custom 27200141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Versastep Plus 12mm Vs101512p|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.08|FSC: 400601; BFG: 52||Not reimbursed separately|10.08|FSC: 400601; BFG: 52||External grouping not supported
43000101|EAP|CPT® 97129||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cognitive Function Interventions & Compensatory Mgt By Ot First 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.16|FSC: 400601; BFG: 52||Not reimbursed separately|82.16|FSC: 400601; BFG: 52||External grouping not supported
43000102|EAP|CPT® 97130||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cognitive Function Intervention & Compensatory Mgt By Ot Ea Addtl 15 Min|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.16|FSC: 400601; BFG: 52||Not reimbursed separately|82.16|FSC: 400601; BFG: 52||External grouping not supported
44000050|EAP|CPT® 97129||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Cognitive Function Interventions & Compensatory Mgt By St First 15 Mins|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
44000051|EAP|CPT® 97130||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Cognitive Function Intervention & Compensatory Mgt By St Ea Addtl 15 Min|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30000004|EAP|CPT® 36600||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Arterial Puncture- Blood For Dx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.73|FSC: 400601; BFG: 52||Not reimbursed separately|275.73|FSC: 400601; BFG: 52||External grouping not supported
30000050|EAP|CPT® 36416||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Capillary Blood Draw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|8.40|FSC: 400601; BFG: 52||Not reimbursed separately|8.40|FSC: 400601; BFG: 52||External grouping not supported
30100407|EAP|CPT® 80048||0301 - LABORATORY - CHEMISTRY|Hc Metabolic Panel Total Ca|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|204.75|FSC: 400601; BFG: 52||Not reimbursed separately|204.75|FSC: 400601; BFG: 52||External grouping not supported
30100408|EAP|CPT® 80051||0301 - LABORATORY - CHEMISTRY|Hc Electrolyte Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
30100409|EAP|CPT® 80053||0301 - LABORATORY - CHEMISTRY|Hc Comprehen Metabolic Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|309.75|FSC: 400601; BFG: 52||Not reimbursed separately|309.75|FSC: 400601; BFG: 52||External grouping not supported
30100410|EAP|CPT® 80069||0301 - LABORATORY - CHEMISTRY|Hc Renal Function Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
30100412|EAP|CPT® 80076||0301 - LABORATORY - CHEMISTRY|Hc Hepatic Function Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|FSC: 400601; BFG: 52||Not reimbursed separately|51.45|FSC: 400601; BFG: 52||External grouping not supported
30000017|EAP|CPT® 86900||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Blood Typing Abo|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
40200063|EAP|CPT® 76641||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Breast Unilateral Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
40200064|EAP|CPT® 76642||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Breast Unilateral Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
40300005|EAP|CPT® 77063||0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY|Hc Screening Breast Tomosynthesis Digital Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.60|FSC: 400601; BFG: 52||Not reimbursed separately|33.60|FSC: 400601; BFG: 52||External grouping not supported
30600146|EAP|CPT® 87502||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Influenza Dna Amp Probe 1st 2 Types|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|169.05|FSC: 400601; BFG: 52||Not reimbursed separately|169.05|FSC: 400601; BFG: 52||External grouping not supported
30600129|EAP|CPT® 87140||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Culture If Ea Antiserum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.65|FSC: 400601; BFG: 52||Not reimbursed separately|34.65|FSC: 400601; BFG: 52||External grouping not supported
30100413|EAP|CPT® 80158||0301 - LABORATORY - CHEMISTRY|Hc So Cyclosporine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
30100417|EAP|CPT® 82390||0301 - LABORATORY - CHEMISTRY|Hc So Ceruloplasmin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.70|FSC: 400601; BFG: 52||Not reimbursed separately|35.70|FSC: 400601; BFG: 52||External grouping not supported
30100419|EAP|CPT® 82785||0301 - LABORATORY - CHEMISTRY|Hc So Assay Of Ige|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54.60|FSC: 400601; BFG: 52||Not reimbursed separately|54.60|FSC: 400601; BFG: 52||External grouping not supported
30100420|EAP|CPT® 82945||0301 - LABORATORY - CHEMISTRY|Hc So Glucose- Body Fluid Other Than Blood|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.60|FSC: 400601; BFG: 52||Not reimbursed separately|12.60|FSC: 400601; BFG: 52||External grouping not supported
30100422|EAP|CPT® 83003||0301 - LABORATORY - CHEMISTRY|Hc So Growth Hormone- Human|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|111.30|FSC: 400601; BFG: 52||Not reimbursed separately|111.30|FSC: 400601; BFG: 52||External grouping not supported
30100424|EAP|CPT® 83021||0301 - LABORATORY - CHEMISTRY|Hc So Hgb Chromatography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
30100426|EAP|CPT® 83051||0301 - LABORATORY - CHEMISTRY|Hc So Hgb Plasma|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
49000761|EAP|CPT® 62302||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Myelography Via Lumbar Injection Cervical W/ Rad S&i|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,821.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,821.75|FSC: 400601; BFG: 52||External grouping not supported
30100432|EAP|CPT® 83970||0301 - LABORATORY - CHEMISTRY|Hc So Parathormone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|136.50|FSC: 400601; BFG: 52||Not reimbursed separately|136.50|FSC: 400601; BFG: 52||External grouping not supported
30100433|EAP|CPT® 84145||0301 - LABORATORY - CHEMISTRY|Hc So Procalcitonin (pct)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
49000762|EAP|CPT® 62303||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Myelography Via Lumbar Injection Thoracic W/ Rad S&i|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,821.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,821.75|FSC: 400601; BFG: 52||External grouping not supported
30100434|EAP|CPT® 84260||0301 - LABORATORY - CHEMISTRY|Hc So Serotonin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|184.80|FSC: 400601; BFG: 52||Not reimbursed separately|184.80|FSC: 400601; BFG: 52||External grouping not supported
49000763|EAP|CPT® 62304||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Myelography Via Lumbar Injection Lumbosacral W/ Rad S&i|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,821.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,821.75|FSC: 400601; BFG: 52||External grouping not supported
30100435|EAP|CPT® 84480||0301 - LABORATORY - CHEMISTRY|Hc So T3 Total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
49000764|EAP|CPT® 62305||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Myelography Via Lumbar Injection >= 2 Regions|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,821.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,821.75|FSC: 400601; BFG: 52||External grouping not supported
30500061|EAP|CPT® 85520||0305 - LABORATORY - HEMATOLOGY|Hc So Heparin Assay|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.05|FSC: 400601; BFG: 52||Not reimbursed separately|43.05|FSC: 400601; BFG: 52||External grouping not supported
49000765|EAP|CPT® 22513||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Perc Kyphoplasty 1 Vertebral Body Thoracic W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,880.60|FSC: 400601; BFG: 52||Not reimbursed separately|14,880.60|FSC: 400601; BFG: 52||External grouping not supported
30200177|EAP|CPT® 86162||0302 - LABORATORY - IMMUNOLOGY|Hc So Complement Tot Hemolytic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.20|FSC: 400601; BFG: 52||Not reimbursed separately|67.20|FSC: 400601; BFG: 52||External grouping not supported
49000766|EAP|CPT® 22514||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Perc Kyphoplasty 1 Vertebral Body Lumbar W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14,880.60|FSC: 400601; BFG: 52||Not reimbursed separately|14,880.60|FSC: 400601; BFG: 52||External grouping not supported
30200179|EAP|CPT® 86334||0302 - LABORATORY - IMMUNOLOGY|Hc So Serum Immunofixation Electrophores|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|FSC: 400601; BFG: 52||Not reimbursed separately|73.50|FSC: 400601; BFG: 52||External grouping not supported
49000767|EAP|CPT® 22515||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Perc Kyphoplasty 1 Vertebral Body Ea Addl Thoracic Or Lumbar Vertebral Body W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|535.50|FSC: 400601; BFG: 52||Not reimbursed separately|535.50|FSC: 400601; BFG: 52||External grouping not supported
30200181|EAP|CPT® 86431||0302 - LABORATORY - IMMUNOLOGY|Hc So Quan Rheum Factor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.90|FSC: 400601; BFG: 52||Not reimbursed separately|18.90|FSC: 400601; BFG: 52||External grouping not supported
30200182|EAP|CPT® 86665||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Eb Vca|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
51000534|EAP|CPT® 20604||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Arthrocentesis Joint/bursa Small W/ Ultrasound Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
30200184|EAP|CPT® 86777||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Toxoplasma|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
30200185|EAP|CPT® 86778||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Toxoplasma Igm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
51000535|EAP|CPT® 20606||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Arthrocentesis Joint/bursa Intermediate W/ Ultrasound Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
30200187|EAP|CPT® 86788||0302 - LABORATORY - IMMUNOLOGY|Hc So West Nile Virus Ab Igm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30200188|EAP|CPT® 86789||0302 - LABORATORY - IMMUNOLOGY|Hc So West Nile Virus Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.25|FSC: 400601; BFG: 52||Not reimbursed separately|47.25|FSC: 400601; BFG: 52||External grouping not supported
51000536|EAP|CPT® 20611||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Arthrocentesis Joint/bursa Major W/ Ultrasound Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|709.80|FSC: 400601; BFG: 52||Not reimbursed separately|709.80|FSC: 400601; BFG: 52||External grouping not supported
30600121|EAP|CPT® 87045||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Aerob Bacterial Culture- Stool|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
30600123|EAP|CPT® 87077||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Aerobic Bact Cult Addtl Id|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.25|FSC: 400601; BFG: 52||Not reimbursed separately|26.25|FSC: 400601; BFG: 52||External grouping not supported
30600124|EAP|CPT® 87081||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Culture Presumptive Pathog Screen - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.05|FSC: 400601; BFG: 52||Not reimbursed separately|22.05|FSC: 400601; BFG: 52||External grouping not supported
30600125|EAP|CPT® 87106||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Fungus Culture Def Id- Yeast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.70|FSC: 400601; BFG: 52||Not reimbursed separately|140.70|FSC: 400601; BFG: 52||External grouping not supported
30600127|EAP|CPT® 87110||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Chlamydia Culture|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.55|FSC: 400601; BFG: 52||Not reimbursed separately|95.55|FSC: 400601; BFG: 52||External grouping not supported
30600133|EAP|CPT® 87176||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Homogeniz Tiss For Culture|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.50|FSC: 400601; BFG: 52||Not reimbursed separately|52.50|FSC: 400601; BFG: 52||External grouping not supported
30600134|EAP|CPT® 87177||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Ova & Parasites Dir Smr W Id|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
30600135|EAP|CPT® 87209||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Smear Complex Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.10|FSC: 400601; BFG: 52||Not reimbursed separately|86.10|FSC: 400601; BFG: 52||External grouping not supported
30600136|EAP|CPT® 87210||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Smear - Infectious Wet Mount|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
30600137|EAP|CPT® 87230||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Toxin Assay- Tissue Culture|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.75|FSC: 400601; BFG: 52||Not reimbursed separately|57.75|FSC: 400601; BFG: 52||External grouping not supported
30600138|EAP|CPT® 87252||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Virus Isolate Tissue Cult Inoc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.10|FSC: 400601; BFG: 52||Not reimbursed separately|86.10|FSC: 400601; BFG: 52||External grouping not supported
30600142|EAP|CPT® 87328||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Cryptosporidium Ag- Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30600145|EAP|CPT® 87497||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Cytomegalovirus Na Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|387.45|FSC: 400601; BFG: 52||Not reimbursed separately|387.45|FSC: 400601; BFG: 52||External grouping not supported
30100613|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hc Drug Test Presumptive Any Drug Class Any Device|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|192.15|FSC: 400601; BFG: 52||Not reimbursed separately|192.15|FSC: 400601; BFG: 52||External grouping not supported
30100615|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hc Drug Test Presumptive Any Drug Class Any Device/procedure By Instrument Analyzer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|192.15|FSC: 400601; BFG: 52||Not reimbursed separately|192.15|FSC: 400601; BFG: 52||External grouping not supported
30100616|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hc So Drug Test Presumptive Any Drug Class Any Device/procedure By Instrument Analyzer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|192.15|FSC: 400601; BFG: 52||Not reimbursed separately|192.15|FSC: 400601; BFG: 52||External grouping not supported
30100617|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hc Drug Test Presumptive Any Drug Class Any Device/procedure By Instrument Analyzer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|192.15|FSC: 400601; BFG: 52||Not reimbursed separately|192.15|FSC: 400601; BFG: 52||External grouping not supported
30100621|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC ALCOHOLS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.30|FSC: 400601; BFG: 52||Not reimbursed separately|300.30|FSC: 400601; BFG: 52||External grouping not supported
30100622|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO ALCOHOLS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|134.40|FSC: 400601; BFG: 52||Not reimbursed separately|134.40|FSC: 400601; BFG: 52||External grouping not supported
30102034|EAP|CPT® 80230||0301 - LABORATORY - CHEMISTRY|Hc Cch So Infliximab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|183.75|FSC: 400601; BFG: 52||Not reimbursed separately|183.75|FSC: 400601; BFG: 52||External grouping not supported
51000236|EAP|CPT® 12020||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Treatment Wound Dehiscence Simple Closure|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,307.25|FSC: 400601; BFG: 52||Not reimbursed separately|1,307.25|FSC: 400601; BFG: 52||External grouping not supported
51000239|EAP|CPT® 20612||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Aspiration/injection Ganglion Cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|662.55|FSC: 400601; BFG: 52||Not reimbursed separately|662.55|FSC: 400601; BFG: 52||External grouping not supported
30100636|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO ANTIDEPRESSANTS TRICYCLIC 1 OR 2 - A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
49001014|EAP|CPT® 62328||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Lumbar Puncture Diagnostic W/fluoro Or Ct Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,476.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,476.30|FSC: 400601; BFG: 52||External grouping not supported
51000256|EAP|CPT® 64425||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Injection Nerve Block Ilioinguinal/iliohypogastric|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
30100643|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO BENZODIAZEPINES 1-12|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
51000777|EAP|CPT® 20560||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Insertion Needle W/o Inj = < 2 Muscles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.01|FSC: 400601; BFG: 52||Not reimbursed separately|70.01|FSC: 400601; BFG: 52||External grouping not supported
30100645|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO BENZODIAZEPINES 13 OR MORE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
51000778|EAP|CPT® 20561||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Insertion Needle W/o Inj = > 3 Muscles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.01|FSC: 400601; BFG: 52||Not reimbursed separately|70.01|FSC: 400601; BFG: 52||External grouping not supported
30100649|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO CANNABINOIDS NATURAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
30100660|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO METHYLENEDIOXYAMPHETAMINES (MDA/MDEA/MDMA)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.65|FSC: 400601; BFG: 52||Not reimbursed separately|34.65|FSC: 400601; BFG: 52||External grouping not supported
30100663|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO OPIATES 1 OR MORE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
30100671|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO OXYCODONE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.25|FSC: 400601; BFG: 52||Not reimbursed separately|110.25|FSC: 400601; BFG: 52||External grouping not supported
51000344|EAP|CPT® 92081||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Examination Visual Field Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
35200020|EAP|CPT® 74176||0352 - CT SCAN - BODY SCAN|Hc Ct Abdomen & Pelvis W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,067.45|FSC: 400601; BFG: 52||Not reimbursed separately|2,067.45|FSC: 400601; BFG: 52||External grouping not supported
35200021|EAP|CPT® 74177||0352 - CT SCAN - BODY SCAN|Hc Ct Abdomen & Pelvis W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,071.65|FSC: 400601; BFG: 52||Not reimbursed separately|2,071.65|FSC: 400601; BFG: 52||External grouping not supported
35200022|EAP|CPT® 74178||0352 - CT SCAN - BODY SCAN|Hc Ct Abdomen & Pelvis W/ & W/o Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,639.70|FSC: 400601; BFG: 52||Not reimbursed separately|2,639.70|FSC: 400601; BFG: 52||External grouping not supported
40200055|EAP|CPT® 76882||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Us Limited Joint W/imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|362.25|FSC: 400601; BFG: 52||Not reimbursed separately|362.25|FSC: 400601; BFG: 52||External grouping not supported
49000421|EAP|CPT® 19001||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Puncture Aspiration Breast Cyst Each Addl Cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|172.20|FSC: 400601; BFG: 52||Not reimbursed separately|172.20|FSC: 400601; BFG: 52||External grouping not supported
51000385|EAP|CPT® 12031||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Repair Int Wound Scalp/axillae/trunk/extremities < = 2.5 Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|901.95|FSC: 400601; BFG: 52||Not reimbursed separately|901.95|FSC: 400601; BFG: 52||External grouping not supported
76100110|EAP|CPT® 36510||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Catheterization Umbilical Vein Newborn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|224.70|FSC: 400601; BFG: 52||Not reimbursed separately|224.70|FSC: 400601; BFG: 52||External grouping not supported
49000425|EAP|CPT® 38792||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection For Sentinel Node Identification|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
30600190|EAP|CPT® 87507||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Iadna-dna/rna Probe Tq 12-25|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,377.60|FSC: 400601; BFG: 52||Not reimbursed separately|1,377.60|FSC: 400601; BFG: 52||External grouping not supported
49000426|EAP|CPT® 49418||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Insertion Tunneled Intraperitoneal Catheter Complete Px|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,117.45|FSC: 400601; BFG: 52||Not reimbursed separately|3,117.45|FSC: 400601; BFG: 52||External grouping not supported
30600193|EAP|CPT® 87624||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Hpv High-risk Types|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
49000431|EAP|CPT® 64530||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Injection Anesthetic Celiac Plexus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
31200033|EAP|CPT® 88341||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Immunohisto/cyto Chem Each Addl Single Antibody Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|259.35|FSC: 400601; BFG: 52||Not reimbursed separately|259.35|FSC: 400601; BFG: 52||External grouping not supported
31200035|EAP|CPT® 88342||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Immunohisto/cyto Chem Initial Single Antibody Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
31200037|EAP|CPT® 88344||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Immunohisto/cyto Chem Each Multiplex Antibody Stain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|260.40|FSC: 400601; BFG: 52||Not reimbursed separately|260.40|FSC: 400601; BFG: 52||External grouping not supported
31200039|EAP|CPT® 88364||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Insitu Hybridization (fish) Per Speciman Single Each Addl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.20|FSC: 400601; BFG: 52||Not reimbursed separately|256.20|FSC: 400601; BFG: 52||External grouping not supported
27400190|EAP|HCPCS L3300||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Adjust-a-lift Heel Lift|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
27400096|EAP|HCPCS L3030||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|Hc Custom Foot Insert Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|735.00|FSC: 400601; BFG: 52||Not reimbursed separately|735.00|FSC: 400601; BFG: 52||External grouping not supported
27201706|EAP|Custom 27201706||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Drain Valve Heimlich Chest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|358.75|FSC: 400601; BFG: 52||Not reimbursed separately|358.75|FSC: 400601; BFG: 52||External grouping not supported
99900135|EAP|HCPCS G1011||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Applied Pathways|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900136|EAP|HCPCS G1001||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Evicore|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
27201609|EAP|Custom 27201609||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Sleeve Compress Regular Knee|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|400.40|FSC: 400601; BFG: 52||Not reimbursed separately|400.40|FSC: 400601; BFG: 52||External grouping not supported
99900137|EAP|HCPCS G1002||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Medcurrent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900138|EAP|HCPCS G1003||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Medicalis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900139|EAP|HCPCS G1004||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Ndsc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900140|EAP|HCPCS G1005||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|HC CLINICAL DECISION SUPPORT MECHANISM NIA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900141|EAP|HCPCS G1006||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|HC CLINICAL DECISION SUPPORT MECHANISM TEST APPROPRIATE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900142|EAP|HCPCS G1007||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Aim Specialty Health|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900143|EAP|HCPCS G1008||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Cranberry Peak|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900144|EAP|HCPCS G1009||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Sage Hms|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900145|EAP|HCPCS G1010||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Stanson|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900146|EAP|HCPCS G1011||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Qualified Tool Nos|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
27201713|EAP|Custom 27201713||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Pacing Catheter Reg Tip 5fr La|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|364.95|FSC: 400601; BFG: 52||Not reimbursed separately|364.95|FSC: 400601; BFG: 52||External grouping not supported
27205418|EAP|Custom 27205418||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Belmont Set Infusion 3-spike|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|682.50|FSC: 400601; BFG: 52||Not reimbursed separately|682.50|FSC: 400601; BFG: 52||External grouping not supported
30600198|EAP|CPT® 87651||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Strep A Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.95|FSC: 400601; BFG: 52||Not reimbursed separately|103.95|FSC: 400601; BFG: 52||External grouping not supported
30200223|EAP|CPT® 86705||0302 - LABORATORY - IMMUNOLOGY|Hc So Ab Hbcab Igm Ab|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
30100438|EAP|CPT® 82668||0301 - LABORATORY - CHEMISTRY|Hc So Erythropoietin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.95|FSC: 400601; BFG: 52||Not reimbursed separately|61.95|FSC: 400601; BFG: 52||External grouping not supported
76200003|EAP|HCPCS G0379||0762 - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM|Hc Direct Admit To Observation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|535.50|FSC: 400601; BFG: 52||Not reimbursed separately|535.50|FSC: 400601; BFG: 52||External grouping not supported
49000432|EAP|CPT® 64633||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Cervical/thoracic Paravert Joint Nerve Single Joint|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
49000433|EAP|CPT® 64635||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Lumbar/sacral Paravert Joint Nerve Single Joint|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,847.85|FSC: 400601; BFG: 52||Not reimbursed separately|4,847.85|FSC: 400601; BFG: 52||External grouping not supported
49000434|EAP|CPT® 64636||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Lumbar/sacral Paravert Joint Nerve Ea Addl Joint|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,830.15|FSC: 400601; BFG: 52||Not reimbursed separately|1,830.15|FSC: 400601; BFG: 52||External grouping not supported
49000435|EAP|CPT® 64634||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Cervical/thoracic Paravert Joint Nerve Ea Addl Joint|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,685.25|FSC: 400601; BFG: 52||Not reimbursed separately|1,685.25|FSC: 400601; BFG: 52||External grouping not supported
48300023|EAP|HCPCS C8928||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Echo Stress W/ Contrast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,821.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,821.75|FSC: 400601; BFG: 52||External grouping not supported
75000152|EAP|CPT® 45390||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Flexible W/ Endoscopic Mucosal Resection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
51000837|EAP|CPT® 64625||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Destruction By Rfa Scroliliac Joint Incl Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,061.52|FSC: 400601; BFG: 52||Not reimbursed separately|4,061.52|FSC: 400601; BFG: 52||External grouping not supported
51000838|EAP|CPT® 64451||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Injection Nerve Sacroilic Joint Incl Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,476.52|FSC: 400601; BFG: 52||Not reimbursed separately|1,476.52|FSC: 400601; BFG: 52||External grouping not supported
51000840|EAP|CPT® 64624||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Destruction By Neurolytic Agent (rfa) Genicular Nerve Branches Incl Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,061.52|FSC: 400601; BFG: 52||Not reimbursed separately|4,061.52|FSC: 400601; BFG: 52||External grouping not supported
99900155|EAP|HCPCS G1020||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Curbside|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900156|EAP|HCPCS G1021||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Ehealthline|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900157|EAP|HCPCS G1022||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Intermountain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900158|EAP|HCPCS G1023||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Persivia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
30600286|EAP|HCPCS U0001||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Cov 2 Cdc Testing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.01|FSC: 400601; BFG: 52||Not reimbursed separately|0.01|FSC: 400601; BFG: 52||External grouping not supported
30600287|EAP|HCPCS U0002||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cov 2 2019 Ncov Covid19  Non Cdc Testing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|341.25|FSC: 400601; BFG: 52||Not reimbursed separately|341.25|FSC: 400601; BFG: 52||External grouping not supported
30600288|EAP|HCPCS U0002||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Cov 2 2019 Ncov Covid19  Non Cdc Testing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|341.25|FSC: 400601; BFG: 52||Not reimbursed separately|341.25|FSC: 400601; BFG: 52||External grouping not supported
43000106|EAP|CPT® 97012||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Traction Mechanical By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.75|FSC: 400601; BFG: 52||Not reimbursed separately|57.75|FSC: 400601; BFG: 52||External grouping not supported
30200324|EAP|CPT® 86769||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Sars Covid 2 Covid 19 Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
30600293|EAP|HCPCS U0003||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Sars Cov 2 Covid 19 Amp Prb High Throughput Tech|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|341.25|FSC: 400601; BFG: 52||Not reimbursed separately|341.25|FSC: 400601; BFG: 52||External grouping not supported
99900147|EAP|HCPCS G1012||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Agilemd|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900148|EAP|HCPCS G1013||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Evidencecare Imaging Advisor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900149|EAP|HCPCS G1014||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Inveniqa Semantic Answers N Medicine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900150|EAP|HCPCS G1015||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Reliant Medical Group|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900151|EAP|HCPCS G1016||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Speed Of Care|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900152|EAP|HCPCS G1017||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Healthhelp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900153|EAP|HCPCS G1018||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Infinx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
99900154|EAP|HCPCS G1019||0999 - PATIENT CONVENIENCE ITEMS - OTHER PATIENT CONVENIENCE ITEM|Hc Clinical Decision Support Mechanism Logicnets Auc Solution|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
36000064|EAP|HCPCS S2900||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Cch Robotic Surgical System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 400601||Not reimbursed separately|0.00|FSC: 400601||External grouping not supported
30500099|EAP|CPT® 85250||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Clotting Factor Ix|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.00|FSC: 400601; BFG: 52||Not reimbursed separately|63.00|FSC: 400601; BFG: 52||External grouping not supported
30500100|EAP|CPT® 85270||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Clotting Factor Xi|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.80|FSC: 400601; BFG: 52||Not reimbursed separately|58.80|FSC: 400601; BFG: 52||External grouping not supported
27207888|EAP|Custom 27207888||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Disposable Mri For 65/115 Mr Injector System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|131.00|FSC: 400601; BFG: 52||Not reimbursed separately|131.00|FSC: 400601; BFG: 52||External grouping not supported
27219047|EAP|Custom 27219047||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Yueh Centesis Disposable Cath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.55|FSC: 400601; BFG: 52||Not reimbursed separately|126.55|FSC: 400601; BFG: 52||External grouping not supported
30100934|EAP|CPT® 80307||0301 - LABORATORY - CHEMISTRY|Hc Cch So Drug Test Presumptive Any Drug Class Any Device/procedure|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|192.15|FSC: 400601; BFG: 52||Not reimbursed separately|192.15|FSC: 400601; BFG: 52||External grouping not supported
30100945|EAP|CPT® 82731||0301 - LABORATORY - CHEMISTRY|Hc So Fetal Fibronectin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.95|FSC: 400601; BFG: 52||Not reimbursed separately|208.95|FSC: 400601; BFG: 52||External grouping not supported
30100957|EAP|CPT® 84157||0301 - LABORATORY - CHEMISTRY|Hc Cch So Total Protein Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.60|FSC: 400601; BFG: 52||Not reimbursed separately|12.60|FSC: 400601; BFG: 52||External grouping not supported
30200268|EAP|CPT® 86701||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Antibody Hiv-1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|118.65|FSC: 400601; BFG: 52||Not reimbursed separately|118.65|FSC: 400601; BFG: 52||External grouping not supported
30500102|EAP|CPT® 85461||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Fetal Hgb Screening Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
30600250|EAP|CPT® 87075||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Anerobic Bact Culture W Id|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.50|FSC: 400601; BFG: 52||Not reimbursed separately|31.50|FSC: 400601; BFG: 52||External grouping not supported
31200062|EAP|CPT® 88300||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Surg Path Level I Gross Only|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|FSC: 400601; BFG: 52||Not reimbursed separately|25.20|FSC: 400601; BFG: 52||External grouping not supported
31200063|EAP|CPT® 88302||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Surg Path Level Ii|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
31200064|EAP|CPT® 88304||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Surg Path Level Iii|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
31200065|EAP|CPT® 88309||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Surg Path Level Vi|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,447.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,447.95|FSC: 400601; BFG: 52||External grouping not supported
31200066|EAP|CPT® 88311||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Decalcification|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.85|FSC: 400601; BFG: 52||Not reimbursed separately|17.85|FSC: 400601; BFG: 52||External grouping not supported
27209143|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Electrode Onestep Adult Complete Resuscitation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|154.80|FSC: 400601; BFG: 52||Not reimbursed separately|154.80|FSC: 400601; BFG: 52||External grouping not supported
27209144|EAP|||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Electrode Onestep Pediatric Cpr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|146.25|FSC: 400601; BFG: 52||Not reimbursed separately|146.25|FSC: 400601; BFG: 52||External grouping not supported
30600298|EAP|CPT® 87636||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Iadna Sarscov2 & Infa & B Multi Amplified Probe Ta|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|254.10|FSC: 400601; BFG: 52||Not reimbursed separately|254.10|FSC: 400601; BFG: 52||External grouping not supported
32400006|EAP|CPT® 71047||0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY|Hc Radiology X-ray Chest 3 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
42000094|EAP|CPT® 97763||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Orthotic/prosthetic Management/ Training Subsequent Each 15 Mins By Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
43000090|EAP|CPT® 97763||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Orthotic/prosthetic Management/ Training Subsequent Each 15 Mins By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
27202318|EAP|Custom 27202318||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Adhesive Medical Sterile|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.00|FSC: 400601; BFG: 52||Not reimbursed separately|59.00|FSC: 400601; BFG: 52||External grouping not supported
30100440|EAP|CPT® 82105||0301 - LABORATORY - CHEMISTRY|Hc So Alpha-fetoprotein- Serum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
30100441|EAP|CPT® 84702||0301 - LABORATORY - CHEMISTRY|Hc So Hcg Quan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30200194|EAP|CPT® 86038||0302 - LABORATORY - IMMUNOLOGY|Hc So Antinuclear Ab (ana)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30200195|EAP|CPT® 86225||0302 - LABORATORY - IMMUNOLOGY|Hc So Dna Ab Native Or Ds|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30100443|EAP|HCPCS G0480||0301 - LABORATORY - CHEMISTRY|HC SO BARBITURATES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|183.75|FSC: 400601; BFG: 52||Not reimbursed separately|183.75|FSC: 400601; BFG: 52||External grouping not supported
15271|EAP|CPT® 15271||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|206.00|FSC: 46100; BFG: 52||Not reimbursed separately|206.00|FSC: 46100; BFG: 52||External grouping not supported
15272|EAP|CPT® 15272|||APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.00|FSC: 46100; BFG: 52||Not reimbursed separately|60.00|FSC: 46100; BFG: 52||External grouping not supported
15275|EAP|CPT® 15275|||SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|225.00|FSC: 46100; BFG: 52||Not reimbursed separately|225.00|FSC: 46100; BFG: 52||External grouping not supported
64633|EAP|CPT® 64633|||DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|607.00|FSC: 46100; BFG: 52||Not reimbursed separately|607.00|FSC: 46100; BFG: 52||External grouping not supported
64634|EAP|CPT® 64634|||DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|271.00|FSC: 46100; BFG: 52||Not reimbursed separately|271.00|FSC: 46100; BFG: 52||External grouping not supported
64635|EAP|CPT® 64635|||DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|600.00|FSC: 46100; BFG: 52||Not reimbursed separately|600.00|FSC: 46100; BFG: 52||External grouping not supported
64636|EAP|CPT® 64636|||DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|246.00|FSC: 46100; BFG: 52||Not reimbursed separately|246.00|FSC: 46100; BFG: 52||External grouping not supported
30600256|EAP|CPT® 87070||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc So Bacterial Culture - Othr Source|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.55|FSC: 400601; BFG: 52||Not reimbursed separately|95.55|FSC: 400601; BFG: 52||External grouping not supported
63600295|EAP|HCPCS J7120||0636 - PHARMACY - DRUGS REQUIRING DETAILED CODING|Hc Ringers Lactate Infusion To 1000 Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
31000287|EAP|CPT® 81420||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Fetal Chromosomal Aneuploidy Analysis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,032.80|FSC: 400601; BFG: 52||Not reimbursed separately|2,032.80|FSC: 400601; BFG: 52||External grouping not supported
31100133|EAP|CPT® 88182||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc So Cell Marker Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
31200083|EAP|CPT® 88377||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc So Insitu Hybridization Manual Per Specimen Multiplex Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.45|FSC: 400601; BFG: 52||Not reimbursed separately|345.45|FSC: 400601; BFG: 52||External grouping not supported
30900020|EAP|HCPCS G0103||0309 - LABORATORY - OTHER LABORATORY|Hc Cch So Psa Screening|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
32000248|EAP|CPT® 74019||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Abdomen 2 Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
32000249|EAP|CPT® 74021||0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION|Hc Radiology Exam Abdomen 3 Or More Views|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|306.60|FSC: 400601; BFG: 52||Not reimbursed separately|306.60|FSC: 400601; BFG: 52||External grouping not supported
34100078|EAP|CPT® 78226||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Hepatobiliary System Imaging Incl Gallbladder|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100079|EAP|CPT® 78227||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Hepatobiliary System Imaging Incl Gallbladder W/ Drug|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
34100080|EAP|CPT® 78579||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Pulmunary Ventilation Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|935.55|FSC: 400601; BFG: 52||Not reimbursed separately|935.55|FSC: 400601; BFG: 52||External grouping not supported
34100081|EAP|CPT® 78582||0341 - NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES|Hc Nuc Med Pulmonary Ventilation And Perfusion Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,212.75|FSC: 400601; BFG: 52||Not reimbursed separately|1,212.75|FSC: 400601; BFG: 52||External grouping not supported
35000028|EAP|CPT® 74174||0350 - CT SCAN - GENERAL CLASSIFICATION|Hc Cta Abdomen And Pelvis W/ Contrast And Postprocessing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,293.85|FSC: 400601; BFG: 52||Not reimbursed separately|3,293.85|FSC: 400601; BFG: 52||External grouping not supported
46000029|EAP|CPT® 94726||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Pulmonary Function Test Plethysmography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|666.75|FSC: 400601; BFG: 52||Not reimbursed separately|666.75|FSC: 400601; BFG: 52||External grouping not supported
46000032|EAP|CPT® 94729||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Diffusing Capacity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|143.85|FSC: 400601; BFG: 52||Not reimbursed separately|143.85|FSC: 400601; BFG: 52||External grouping not supported
49000447|EAP|CPT® 37191||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Insert Endovascular Vena Cava Filter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11,419.80|FSC: 400601; BFG: 52||Not reimbursed separately|11,419.80|FSC: 400601; BFG: 52||External grouping not supported
49000449|EAP|CPT® 37193||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Removal Endovascular Vena Cava Filter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,055.50|FSC: 400601; BFG: 52||Not reimbursed separately|3,055.50|FSC: 400601; BFG: 52||External grouping not supported
49000452|EAP|CPT® 49082||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Abdominal Paracentesis W/o Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,990.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,990.80|FSC: 400601; BFG: 52||External grouping not supported
49000453|EAP|CPT® 49083||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Abdominal Paracentesis W/ Imaging Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,990.80|FSC: 400601; BFG: 52||Not reimbursed separately|1,990.80|FSC: 400601; BFG: 52||External grouping not supported
27207949|EAP|Custom 27207949||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Valve Antireflux|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.00|FSC: 400601; BFG: 52||Not reimbursed separately|31.00|FSC: 400601; BFG: 52||External grouping not supported
27207965|EAP|Custom 27207965||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Packing Strip|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.30|FSC: 400601; BFG: 52||Not reimbursed separately|15.30|FSC: 400601; BFG: 52||External grouping not supported
27207967|EAP|Custom 27207967||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Dvt Hose Knee|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.90|FSC: 400601; BFG: 52||Not reimbursed separately|32.90|FSC: 400601; BFG: 52||External grouping not supported
27207968|EAP|Custom 27207968||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Dvt Hose Thigh|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.95|FSC: 400601; BFG: 52||Not reimbursed separately|60.95|FSC: 400601; BFG: 52||External grouping not supported
27207994|EAP|Custom 27207994||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Rfa Cannula|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|149.95|FSC: 400601; BFG: 52||Not reimbursed separately|149.95|FSC: 400601; BFG: 52||External grouping not supported
27208007|EAP|Custom 27208007||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Dressing Biopatch 1 In Disk 4mm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.25|FSC: 400601; BFG: 52||Not reimbursed separately|33.25|FSC: 400601; BFG: 52||External grouping not supported
27208011|EAP|Custom 27208011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Peritoneal Drainage|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,275.35|FSC: 400601; BFG: 52||Not reimbursed separately|1,275.35|FSC: 400601; BFG: 52||External grouping not supported
40100007|EAP|HCPCS G0279||0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY|Hc Diagnostic Mammo Tomo Bilateral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|415.80|FSC: 400601; BFG: 52||Not reimbursed separately|415.80|FSC: 400601; BFG: 52||External grouping not supported
25800006|EAP|HCPCS J7070||0258 - PHARMACY - IV SOLUTIONS|Hc Cch Dex 5% 1000ml|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.85|FSC: 400601; BFG: 52||Not reimbursed separately|82.85|FSC: 400601; BFG: 52||External grouping not supported
25800009|EAP|HCPCS J7060||0258 - PHARMACY - IV SOLUTIONS|Hc Cch Dex 5% 500ml|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.85|FSC: 400601; BFG: 52||Not reimbursed separately|82.85|FSC: 400601; BFG: 52||External grouping not supported
63600301|EAP|HCPCS J7121||0636 - PHARMACY - DRUGS REQUIRING DETAILED CODING|Hc Cch 5% Dex Ringers Lactate Infusion To 1000 Cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
43000092|EAP|CPT® 97545||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Work Hardening/conditioning Initial 2 Hours By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|241.50|FSC: 400601; BFG: 52||Not reimbursed separately|241.50|FSC: 400601; BFG: 52||External grouping not supported
43000093|EAP|CPT® 97546||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Work Hardening/conditioning Each Addl Hour By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|122.85|FSC: 400601; BFG: 52||Not reimbursed separately|122.85|FSC: 400601; BFG: 52||External grouping not supported
49000962|EAP|CPT® 62282||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Epidural Injection Neurolytic Lumbar/sacral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,799.70|FSC: 400601; BFG: 52||Not reimbursed separately|1,799.70|FSC: 400601; BFG: 52||External grouping not supported
49000963|EAP|CPT® 62292||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Injection Into Disk Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
49000964|EAP|CPT® 62350||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Implant/revise Epidural Cath Via External Or Implantable Pump|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,741.90|FSC: 400601; BFG: 52||Not reimbursed separately|9,741.90|FSC: 400601; BFG: 52||External grouping not supported
49000965|EAP|CPT® 62355||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Removal Previously Implanted Intrathecal Or Epidural Catheter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
49000966|EAP|CPT® 62362||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Implant/replace Drug Infusion Device Prog Pump W/w/o Prog|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44,020.20|FSC: 400601; BFG: 52||Not reimbursed separately|44,020.20|FSC: 400601; BFG: 52||External grouping not supported
49000967|EAP|CPT® 62365||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Removalsubcutaneous Pump|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,589.65|FSC: 400601; BFG: 52||Not reimbursed separately|9,589.65|FSC: 400601; BFG: 52||External grouping not supported
49000973|EAP|CPT® 64722||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Decompress Nerve(s)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,312.35|FSC: 400601; BFG: 52||Not reimbursed separately|4,312.35|FSC: 400601; BFG: 52||External grouping not supported
49000974|EAP|CPT® 64999||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Unlisted Procedure Nervous System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
27208070|EAP|Custom 27208070||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Set Needle Biop/coax 16gx10cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.40|FSC: 400601; BFG: 52||Not reimbursed separately|105.40|FSC: 400601; BFG: 52||External grouping not supported
27208071|EAP|Custom 27208071||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Set Needle Biop/coax 16gx16cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.40|FSC: 400601; BFG: 52||Not reimbursed separately|105.40|FSC: 400601; BFG: 52||External grouping not supported
30000101|EAP|CPT® 86860||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Rbc Ab Elution Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.05|FSC: 400601; BFG: 52||Not reimbursed separately|127.05|FSC: 400601; BFG: 52||External grouping not supported
30000102|EAP|CPT® 86870||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Ab Id/ Rbc/ Ea Panel Ea Techn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
30000103|EAP|CPT® 86886||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Antibody Titer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
30000104|EAP|CPT® 86902||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Cch So Bld Type Ag Scrn W Reagent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
30000105|EAP|CPT® 86905||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Cch So Bld Type Rbc Ag Not Abo/rhd|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
30000106|EAP|CPT® 86941||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Hemolysins/agglutinins Incubated|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.80|FSC: 400601; BFG: 52||Not reimbursed separately|58.80|FSC: 400601; BFG: 52||External grouping not supported
30000107|EAP|CPT® 86971||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Pretreat Rbc Enzymes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
30000108|EAP|CPT® 86975||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc Cch So Serum Pretx Drug Incubate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|214.20|FSC: 400601; BFG: 52||Not reimbursed separately|214.20|FSC: 400601; BFG: 52||External grouping not supported
30000109|EAP|CPT® 86978||0300 - LABORATORY - GENERAL CLASSIFICATION|Hc So Serum Pretx Rc Absorpt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|114.45|FSC: 400601; BFG: 52||Not reimbursed separately|114.45|FSC: 400601; BFG: 52||External grouping not supported
30100968|EAP|CPT® 80081||0301 - LABORATORY - CHEMISTRY|Hc Cch Obstetric Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|252.00|FSC: 400601; BFG: 52||Not reimbursed separately|252.00|FSC: 400601; BFG: 52||External grouping not supported
30100969|EAP|CPT® 80150||0301 - LABORATORY - CHEMISTRY|Hc Cch So Amikacin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.90|FSC: 400601; BFG: 52||Not reimbursed separately|102.90|FSC: 400601; BFG: 52||External grouping not supported
30100970|EAP|CPT® 80176||0301 - LABORATORY - CHEMISTRY|Hc Cch So Lidocaine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.25|FSC: 400601; BFG: 52||Not reimbursed separately|89.25|FSC: 400601; BFG: 52||External grouping not supported
30100971|EAP|CPT® 80200||0301 - LABORATORY - CHEMISTRY|Hc Cch So Tobramycin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
30100972|EAP|CPT® 89220||0301 - LABORATORY - CHEMISTRY|Hc Cch Aerosol Sputum Collection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|339.15|FSC: 400601; BFG: 52||Not reimbursed separately|339.15|FSC: 400601; BFG: 52||External grouping not supported
30100973|EAP|CPT® 80420||0301 - LABORATORY - CHEMISTRY|Hc Cch So Dexamethasone Suppression Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|342.30|FSC: 400601; BFG: 52||Not reimbursed separately|342.30|FSC: 400601; BFG: 52||External grouping not supported
30100974|EAP|CPT® 82128||0301 - LABORATORY - CHEMISTRY|Hc Cch So Amino Acids Multiple Qual Ea|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
30100975|EAP|CPT® 82757||0301 - LABORATORY - CHEMISTRY|Hc Cch So Fructose Semen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.45|FSC: 400601; BFG: 52||Not reimbursed separately|72.45|FSC: 400601; BFG: 52||External grouping not supported
30100976|EAP|CPT® 82760||0301 - LABORATORY - CHEMISTRY|Hc Cch So Galactose|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|180.60|FSC: 400601; BFG: 52||Not reimbursed separately|180.60|FSC: 400601; BFG: 52||External grouping not supported
30100977|EAP|CPT® 83663||0301 - LABORATORY - CHEMISTRY|Hc Cch So Fetal Lung - Fluoresc Polariz|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|469.35|FSC: 400601; BFG: 52||Not reimbursed separately|469.35|FSC: 400601; BFG: 52||External grouping not supported
30100978|EAP|CPT® 83872||0301 - LABORATORY - CHEMISTRY|Hc Cch So Mucin Synovial Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|FSC: 400601; BFG: 52||Not reimbursed separately|59.85|FSC: 400601; BFG: 52||External grouping not supported
30100979|EAP|CPT® 84081||0301 - LABORATORY - CHEMISTRY|Hc Cch So Phosphatidylglycerol|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|213.15|FSC: 400601; BFG: 52||Not reimbursed separately|213.15|FSC: 400601; BFG: 52||External grouping not supported
30100980|EAP|CPT® 84583||0301 - LABORATORY - CHEMISTRY|Hc Cch Urobilinogen Urine Semiquan|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.15|FSC: 400601; BFG: 52||Not reimbursed separately|24.15|FSC: 400601; BFG: 52||External grouping not supported
30100981|EAP|CPT® 84600||0301 - LABORATORY - CHEMISTRY|Hc Cch So Volatiles|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|77.70|FSC: 400601; BFG: 52||Not reimbursed separately|77.70|FSC: 400601; BFG: 52||External grouping not supported
30200286|EAP|CPT® 86280||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Hemagglutination Inhibition Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|FSC: 400601; BFG: 52||Not reimbursed separately|98.70|FSC: 400601; BFG: 52||External grouping not supported
30200287|EAP|CPT® 86325||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Iep Not Serum|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.15|FSC: 400601; BFG: 52||Not reimbursed separately|108.15|FSC: 400601; BFG: 52||External grouping not supported
30200288|EAP|CPT® 86593||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Syphilis Test Non-trep Quant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.00|FSC: 400601; BFG: 52||Not reimbursed separately|21.00|FSC: 400601; BFG: 52||External grouping not supported
30200289|EAP|CPT® 86602||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Ab Actinomyces|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
30200290|EAP|CPT® 86759||0302 - LABORATORY - IMMUNOLOGY|Hc Cch So Rotavirus Antibody|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.30|FSC: 400601; BFG: 52||Not reimbursed separately|48.30|FSC: 400601; BFG: 52||External grouping not supported
30500108|EAP|CPT® 85008||0305 - LABORATORY - HEMATOLOGY|Hc Cch Bl Smear W/o Diff Wbc Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7.35|FSC: 400601; BFG: 52||Not reimbursed separately|7.35|FSC: 400601; BFG: 52||External grouping not supported
30500109|EAP|CPT® 85041||0305 - LABORATORY - HEMATOLOGY|Hc Cch Automated Rbc Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.50|FSC: 400601; BFG: 52||Not reimbursed separately|10.50|FSC: 400601; BFG: 52||External grouping not supported
30500110|EAP|CPT® 85045||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Automated Reticulocyte Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.65|FSC: 400601; BFG: 52||Not reimbursed separately|13.65|FSC: 400601; BFG: 52||External grouping not supported
30500111|EAP|CPT® 85475||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Hemolysin Acid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|185.85|FSC: 400601; BFG: 52||Not reimbursed separately|185.85|FSC: 400601; BFG: 52||External grouping not supported
30500112|EAP|CPT® 85611||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Pt Substitution Plasma Fractions Each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.20|FSC: 400601; BFG: 52||Not reimbursed separately|46.20|FSC: 400601; BFG: 52||External grouping not supported
30600257|EAP|CPT® 87040||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Aerob Bacterial Blood Culture|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.20|FSC: 400601; BFG: 52||Not reimbursed separately|88.20|FSC: 400601; BFG: 52||External grouping not supported
30600258|EAP|CPT® 87086||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Bact Culture - Urine Quan Count|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.90|FSC: 400601; BFG: 52||Not reimbursed separately|60.90|FSC: 400601; BFG: 52||External grouping not supported
30600259|EAP|CPT® 87088||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Urine Bacteria Culture|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.15|FSC: 400601; BFG: 52||Not reimbursed separately|45.15|FSC: 400601; BFG: 52||External grouping not supported
30600260|EAP|CPT® 87168||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Macroscopic Exam Arthropod|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.80|FSC: 400601; BFG: 52||Not reimbursed separately|58.80|FSC: 400601; BFG: 52||External grouping not supported
30600261|EAP|CPT® 87278||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Legionella Pneumophila Ag By Dfa|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.95|FSC: 400601; BFG: 52||Not reimbursed separately|40.95|FSC: 400601; BFG: 52||External grouping not supported
30600262|EAP|CPT® 87320||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Chlamydia Trachomatis Ag Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.70|FSC: 400601; BFG: 52||Not reimbursed separately|140.70|FSC: 400601; BFG: 52||External grouping not supported
30600263|EAP|CPT® 87324||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Clostridium Ag Evaluation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
30600264|EAP|CPT® 87335||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So E Coli 0157 Ag Eia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.30|FSC: 400601; BFG: 52||Not reimbursed separately|90.30|FSC: 400601; BFG: 52||External grouping not supported
30600265|EAP|CPT® 87341||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Hepatitis B Surface Ag Eia Neutralization|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.65|FSC: 400601; BFG: 52||Not reimbursed separately|34.65|FSC: 400601; BFG: 52||External grouping not supported
30600266|EAP|CPT® 87590||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Neisseria Dir Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|96.60|FSC: 400601; BFG: 52||Not reimbursed separately|96.60|FSC: 400601; BFG: 52||External grouping not supported
30600267|EAP|CPT® 87640||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Staph A Dna Amp Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.50|FSC: 400601; BFG: 52||Not reimbursed separately|115.50|FSC: 400601; BFG: 52||External grouping not supported
30700009|EAP|CPT® 81002||0307 - LABORATORY - UROLOGY|Hc Cch So Urinalysis Total Non-automated W/o Micro|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.95|FSC: 400601; BFG: 52||Not reimbursed separately|19.95|FSC: 400601; BFG: 52||External grouping not supported
30700010|EAP|CPT® 81015||0307 - LABORATORY - UROLOGY|Hc Cch So Urinalysis Microscopic Only|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.10|FSC: 400601; BFG: 52||Not reimbursed separately|23.10|FSC: 400601; BFG: 52||External grouping not supported
30900022|EAP|CPT® 89300||0309 - LABORATORY - OTHER LABORATORY|Hc Cch Semen Presence & Motility W/ Huhner Test|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.40|FSC: 400601; BFG: 52||Not reimbursed separately|29.40|FSC: 400601; BFG: 52||External grouping not supported
31000338|EAP|CPT® 81220||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Vw Cystic Fibrosis Mutation Panel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|313.95|FSC: 400601; BFG: 52||Not reimbursed separately|313.95|FSC: 400601; BFG: 52||External grouping not supported
31000339|EAP|CPT® 81240||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Prothrombin Variant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|176.40|FSC: 400601; BFG: 52||Not reimbursed separately|176.40|FSC: 400601; BFG: 52||External grouping not supported
31000340|EAP|CPT® 81241||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Factor V Leiden|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|201.60|FSC: 400601; BFG: 52||Not reimbursed separately|201.60|FSC: 400601; BFG: 52||External grouping not supported
31000341|EAP|CPT® 81244||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Fmr1 Gene Characterization|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
31000342|EAP|CPT® 81291||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Mthfr Gene Analysis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
31000343|EAP|CPT® 81383||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Hla Class Ii Typing 1 Allele Hr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|218.40|FSC: 400601; BFG: 52||Not reimbursed separately|218.40|FSC: 400601; BFG: 52||External grouping not supported
31000344|EAP|CPT® 81510||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Ftl Cgen Abnor Three Anal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|408.45|FSC: 400601; BFG: 52||Not reimbursed separately|408.45|FSC: 400601; BFG: 52||External grouping not supported
31000345|EAP|CPT® 81511||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Ftl Cgen Abnor Four Anal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|492.45|FSC: 400601; BFG: 52||Not reimbursed separately|492.45|FSC: 400601; BFG: 52||External grouping not supported
31000346|EAP|CPT® 88333||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Intraop Cytologic Pathology Consult Initial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,447.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,447.95|FSC: 400601; BFG: 52||External grouping not supported
31000347|EAP|CPT® 88334||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Intraop Cytologic Pathology Consult Each Additional|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|FSC: 400601; BFG: 52||Not reimbursed separately|73.50|FSC: 400601; BFG: 52||External grouping not supported
31100144|EAP|CPT® 88108||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Cp Concentr Tech Smear|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
31100145|EAP|CPT® 88141||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Cp Cerv/vag|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.85|FSC: 400601; BFG: 52||Not reimbursed separately|17.85|FSC: 400601; BFG: 52||External grouping not supported
31100146|EAP|CPT® 88150||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Dx Pap Manual Screen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|FSC: 400601; BFG: 52||Not reimbursed separately|51.45|FSC: 400601; BFG: 52||External grouping not supported
31100147|EAP|CPT® 88173||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Eval Of Fna Int & Rep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.70|FSC: 400601; BFG: 52||Not reimbursed separately|119.70|FSC: 400601; BFG: 52||External grouping not supported
31200086|EAP|CPT® 88360||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Manual Tumor Im Histochem Per Specimen Single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|576.45|FSC: 400601; BFG: 52||Not reimbursed separately|576.45|FSC: 400601; BFG: 52||External grouping not supported
31200087|EAP|CPT® 88361||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Computer Morphometric Analysis Per Specimen Single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|323.40|FSC: 400601; BFG: 52||Not reimbursed separately|323.40|FSC: 400601; BFG: 52||External grouping not supported
31200088|EAP|CPT® 88368||0312 - LABORATORY PATHOLOGICAL - HISTOLOGY|Hc Cch So Insitu Hybridization Manual Per Specimen Single Initial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|319.20|FSC: 400601; BFG: 52||Not reimbursed separately|319.20|FSC: 400601; BFG: 52||External grouping not supported
30500113|EAP|CPT® 85576||0305 - LABORATORY - HEMATOLOGY|Hc Cch So Plt Aggregation (in Vitro) Ea Agent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|112.35|FSC: 400601; BFG: 52||Not reimbursed separately|112.35|FSC: 400601; BFG: 52||External grouping not supported
30100982|EAP|CPT® 80157||0301 - LABORATORY - CHEMISTRY|Hc So Carbamazepine Free|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.85|FSC: 400601; BFG: 52||Not reimbursed separately|80.85|FSC: 400601; BFG: 52||External grouping not supported
30600268|EAP|CPT® 87880||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Strep A Assay W/ Optic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
40200069|EAP|CPT® 76800||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Cch Us Spine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|301.35|FSC: 400601; BFG: 52||Not reimbursed separately|301.35|FSC: 400601; BFG: 52||External grouping not supported
30900023|EAP|HCPCS G0328||0301 - LABORATORY - CHEMISTRY|Hc Cch So Occult Bld Fhg Qual 1-3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.55|FSC: 400601; BFG: 52||Not reimbursed separately|74.55|FSC: 400601; BFG: 52||External grouping not supported
43000094|EAP|CPT® 29126||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Apply Short Arm Splint By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
43000095|EAP|CPT® 29131||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Apply Finger Splint By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
43000096|EAP|CPT® 29260||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Strapping Elbow Or Wrist By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.05|FSC: 400601; BFG: 52||Not reimbursed separately|85.05|FSC: 400601; BFG: 52||External grouping not supported
51000705|EAP|CPT® 29700||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Cch Remove Gauntlet Boot Or Body Cast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|635.25|FSC: 400601; BFG: 52||Not reimbursed separately|635.25|FSC: 400601; BFG: 52||External grouping not supported
49000977|EAP|CPT® 64632||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Cch Destruction By Neurolytic Agent (rfa) Plantar Digital Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.20|FSC: 400601; BFG: 52||Not reimbursed separately|655.20|FSC: 400601; BFG: 52||External grouping not supported
44400018|EAP|CPT® 92605||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Cch Evaluation For Non-speech Device First Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.85|FSC: 400601; BFG: 52||Not reimbursed separately|80.85|FSC: 400601; BFG: 52||External grouping not supported
44400019|EAP|CPT® 92606||0444 - SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION|Hc Cch Therapeutic Services For Non-speech Devices|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.85|FSC: 400601; BFG: 52||Not reimbursed separately|80.85|FSC: 400601; BFG: 52||External grouping not supported
48300025|EAP|CPT® 93351||0483 - CARDIOLOGY - ECHOCARDIOLOGY|Hc Cch Echo Stress Complete|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,303.05|FSC: 400601; BFG: 52||Not reimbursed separately|1,303.05|FSC: 400601; BFG: 52||External grouping not supported
46000041|EAP|CPT® 94200||0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION|Hc Cch Max Breathing Capacity/max Voluntary Ventilation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|281.40|FSC: 400601; BFG: 52||Not reimbursed separately|281.40|FSC: 400601; BFG: 52||External grouping not supported
43000098|EAP|CPT® 96110||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Developmental Screen W/ Scoring And Documentation By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|475.65|FSC: 400601; BFG: 52||Not reimbursed separately|475.65|FSC: 400601; BFG: 52||External grouping not supported
44000048|EAP|CPT® 96110||0440 - SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION|Hc Cch Developmental Screen W/ Scoring And Documentation By St|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|475.65|FSC: 400601; BFG: 52||Not reimbursed separately|475.65|FSC: 400601; BFG: 52||External grouping not supported
94000043|EAP|CPT® 96912||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Photochemotheraphy Puva|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.15|FSC: 400601; BFG: 52||Not reimbursed separately|150.15|FSC: 400601; BFG: 52||External grouping not supported
42000100|EAP|CPT® 97010||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Hot Or Cold Packs Therapy By Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.55|FSC: 400601; BFG: 52||Not reimbursed separately|32.55|FSC: 400601; BFG: 52||External grouping not supported
43000099|EAP|CPT® 97010||0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION|Hc Cch Hot Or Cold Packs Therapy By Ot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.55|FSC: 400601; BFG: 52||Not reimbursed separately|32.55|FSC: 400601; BFG: 52||External grouping not supported
42000102|EAP|CPT® 97026||0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION|Hc Infrared Therapy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|FSC: 400601; BFG: 52||Not reimbursed separately|51.45|FSC: 400601; BFG: 52||External grouping not supported
72200007|EAP|Custom 72200007||0722 - LABOR ROOM/DELIVERY - DELIVERY|Hc Cch Delivery First 2 Hours|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,895.50|FSC: 400601; BFG: 52||Not reimbursed separately|3,895.50|FSC: 400601; BFG: 52||External grouping not supported
72200008|EAP|Custom 72200008||0722 - LABOR ROOM/DELIVERY - DELIVERY|Hc Cch Delivery Each Addl Half Hour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|421.05|FSC: 400601; BFG: 52||Not reimbursed separately|421.05|FSC: 400601; BFG: 52||External grouping not supported
51000706|EAP|CPT® G0248||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Cch Demonstrate Home Inr Monitor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|304.50|FSC: 400601; BFG: 52||Not reimbursed separately|304.50|FSC: 400601; BFG: 52||External grouping not supported
36000062|EAP|Custom 36000062||0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION|Hc Cch Procedure Room Minor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|148.05|FSC: 400601; BFG: 52||Not reimbursed separately|148.05|FSC: 400601; BFG: 52||External grouping not supported
36000063|EAP|Custom 37000023||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Cch Procedure Room Major|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|955.50|FSC: 400601; BFG: 52||Not reimbursed separately|955.50|FSC: 400601; BFG: 52||External grouping not supported
76200004|EAP|HCPCS G0378||0762 - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM|Hc Cch Observation Ob|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.05|FSC: 400601; BFG: 52||Not reimbursed separately|64.05|FSC: 400601; BFG: 52||External grouping not supported
76200005|EAP|HCPCS G0378||0762 - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM|Hc Cch Observation Icu|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|96.60|FSC: 400601; BFG: 52||Not reimbursed separately|96.60|FSC: 400601; BFG: 52||External grouping not supported
94000044|EAP|Custom 94000044||0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION|Hc Cch Telemetry Observation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
27208116|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Centesis 5frx15cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.75|FSC: 400601; BFG: 52||Not reimbursed separately|105.75|FSC: 400601; BFG: 52||External grouping not supported
27208117|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Centesis 5frx7cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.35|FSC: 400601; BFG: 52||Not reimbursed separately|105.35|FSC: 400601; BFG: 52||External grouping not supported
27208118|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter One Step Drainage|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.95|FSC: 400601; BFG: 52||Not reimbursed separately|108.95|FSC: 400601; BFG: 52||External grouping not supported
27208119|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Drainage Locking Plus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|375.15|FSC: 400601; BFG: 52||Not reimbursed separately|375.15|FSC: 400601; BFG: 52||External grouping not supported
27208120|EAP|HCPCS C1729||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Guidewire Micropuncture Nitinol|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|314.35|FSC: 400601; BFG: 52||Not reimbursed separately|314.35|FSC: 400601; BFG: 52||External grouping not supported
27208165|EAP|Custom 27208165||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Percutaneous Drain Cath Fastener|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.10|FSC: 400601; BFG: 52||Not reimbursed separately|31.10|FSC: 400601; BFG: 52||External grouping not supported
27208121|EAP|Custom 27208121||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Concha Water Reservoir|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.55|FSC: 400601; BFG: 52||Not reimbursed separately|18.55|FSC: 400601; BFG: 52||External grouping not supported
27208122|EAP|Custom 27208122||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Humidifier Chamber|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.60|FSC: 400601; BFG: 52||Not reimbursed separately|70.60|FSC: 400601; BFG: 52||External grouping not supported
27208123|EAP|Custom 27208123||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Disposable Water Trap|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5.90|FSC: 400601; BFG: 52||Not reimbursed separately|5.90|FSC: 400601; BFG: 52||External grouping not supported
27100025|EAP|Custom 27100025||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hc Cch Extractor Foreign Body Katz|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|194.54|FSC: 400601; BFG: 52||Not reimbursed separately|194.54|FSC: 400601; BFG: 52||External grouping not supported
27208124|EAP|Custom 27208124||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Trach Tube Exchanger|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.35|FSC: 400601; BFG: 52||Not reimbursed separately|19.35|FSC: 400601; BFG: 52||External grouping not supported
27100026|EAP|Custom 27100026||0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY|Hc Cch Cushion Waffel Seat Air 17x17x1.5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|93.06|FSC: 400601; BFG: 52||Not reimbursed separately|93.06|FSC: 400601; BFG: 52||External grouping not supported
27208125|EAP|Custom 27208125||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Trach Care 12fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.60|FSC: 400601; BFG: 52||Not reimbursed separately|70.60|FSC: 400601; BFG: 52||External grouping not supported
27208126|EAP|Custom 27208126||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Trach Care 14fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|62.45|FSC: 400601; BFG: 52||Not reimbursed separately|62.45|FSC: 400601; BFG: 52||External grouping not supported
27208127|EAP|Custom 27208127||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Safety Drain|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.40|FSC: 400601; BFG: 52||Not reimbursed separately|19.40|FSC: 400601; BFG: 52||External grouping not supported
27208128|EAP|Custom 27208128||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Aerochamber W/ Medium Mask|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|156.30|FSC: 400601; BFG: 52||Not reimbursed separately|156.30|FSC: 400601; BFG: 52||External grouping not supported
27208129|EAP|Custom 27208129||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Trach Child|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|6.70|FSC: 400601; BFG: 52||Not reimbursed separately|6.70|FSC: 400601; BFG: 52||External grouping not supported
27208130|EAP|Custom 27208130||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Filter Breathing Circuit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.80|FSC: 400601; BFG: 52||Not reimbursed separately|35.80|FSC: 400601; BFG: 52||External grouping not supported
27208131|EAP|HCPCS C1880||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Filter Set Femoral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,789.90|FSC: 400601; BFG: 52||Not reimbursed separately|2,789.90|FSC: 400601; BFG: 52||External grouping not supported
27208132|EAP|Custom 27208132||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Introducer Celero|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.00|FSC: 400601; BFG: 52||Not reimbursed separately|65.00|FSC: 400601; BFG: 52||External grouping not supported
27208133|EAP|Custom 27208133||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Biopsy Device Celero|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|924.35|FSC: 400601; BFG: 52||Not reimbursed separately|924.35|FSC: 400601; BFG: 52||External grouping not supported
27208134|EAP|Custom 27208134||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tubing Wall Suction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.75|FSC: 400601; BFG: 52||Not reimbursed separately|52.75|FSC: 400601; BFG: 52||External grouping not supported
27208135|EAP|Custom 27208135||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Nasal Tampon|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|74.65|FSC: 400601; BFG: 52||Not reimbursed separately|74.65|FSC: 400601; BFG: 52||External grouping not supported
27208136|EAP|Custom 27208136||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Eye Patch|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.05|FSC: 400601; BFG: 52||Not reimbursed separately|29.05|FSC: 400601; BFG: 52||External grouping not supported
27208137|EAP|Custom 27208137||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Nasal Pac System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|189.85|FSC: 400601; BFG: 52||Not reimbursed separately|189.85|FSC: 400601; BFG: 52||External grouping not supported
27208138|EAP|Custom 27208138||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Manual Percussor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.45|FSC: 400601; BFG: 52||Not reimbursed separately|15.45|FSC: 400601; BFG: 52||External grouping not supported
27208139|EAP|Custom 27208139||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Embolectomy 5fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|313.85|FSC: 400601; BFG: 52||Not reimbursed separately|313.85|FSC: 400601; BFG: 52||External grouping not supported
27208141|EAP|Custom 27208141||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Drape L&d|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.90|FSC: 400601; BFG: 52||Not reimbursed separately|26.90|FSC: 400601; BFG: 52||External grouping not supported
27208142|EAP|Custom 27208142||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Elliptosphere|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|183.90|FSC: 400601; BFG: 52||Not reimbursed separately|183.90|FSC: 400601; BFG: 52||External grouping not supported
27208143|EAP|Custom 27208143||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Electrode Spiral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.65|FSC: 400601; BFG: 52||Not reimbursed separately|18.65|FSC: 400601; BFG: 52||External grouping not supported
27208144|EAP|Custom 27208144||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Irrigator Wound Shield|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.90|FSC: 400601; BFG: 52||Not reimbursed separately|92.90|FSC: 400601; BFG: 52||External grouping not supported
27208145|EAP|Custom 27208145||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ear Wick|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.35|FSC: 400601; BFG: 52||Not reimbursed separately|18.35|FSC: 400601; BFG: 52||External grouping not supported
27208146|EAP|Custom 27208146||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ocular Fluid Mgmt System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.75|FSC: 400601; BFG: 52||Not reimbursed separately|39.75|FSC: 400601; BFG: 52||External grouping not supported
27208147|EAP|Custom 27208147||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Electrode Infant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.35|FSC: 400601; BFG: 52||Not reimbursed separately|14.35|FSC: 400601; BFG: 52||External grouping not supported
27208148|EAP|Custom 27208148||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Applicator Vaginal|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.40|FSC: 400601; BFG: 52||Not reimbursed separately|39.40|FSC: 400601; BFG: 52||External grouping not supported
27208149|EAP|Custom 27208149||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline Wound Wash|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.60|FSC: 400601; BFG: 52||Not reimbursed separately|23.60|FSC: 400601; BFG: 52||External grouping not supported
27208150|EAP|Custom 27208150||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Stent Guide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|297.20|FSC: 400601; BFG: 52||Not reimbursed separately|297.20|FSC: 400601; BFG: 52||External grouping not supported
27208151|EAP|Custom 27208151||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Probe Cover 48"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.10|FSC: 400601; BFG: 52||Not reimbursed separately|39.10|FSC: 400601; BFG: 52||External grouping not supported
27208152|EAP|Custom 27208152||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Phototherapy Cover|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.25|FSC: 400601; BFG: 52||Not reimbursed separately|15.25|FSC: 400601; BFG: 52||External grouping not supported
27208153|EAP|Custom 27208153||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cable Pace|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.65|FSC: 400601; BFG: 52||Not reimbursed separately|108.65|FSC: 400601; BFG: 52||External grouping not supported
27208154|EAP|Custom 27208154||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Valve Tee Adapter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7.75|FSC: 400601; BFG: 52||Not reimbursed separately|7.75|FSC: 400601; BFG: 52||External grouping not supported
27208155|EAP|Custom 27208155||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Opticell Dressing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.75|FSC: 400601; BFG: 52||Not reimbursed separately|24.75|FSC: 400601; BFG: 52||External grouping not supported
27208156|EAP|Custom 27208156||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Solosite Dressing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9.50|FSC: 400601; BFG: 52||Not reimbursed separately|9.50|FSC: 400601; BFG: 52||External grouping not supported
27208157|EAP|Custom 27208157||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Biatain 5x5 Foam|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.45|FSC: 400601; BFG: 52||Not reimbursed separately|41.45|FSC: 400601; BFG: 52||External grouping not supported
27208158|EAP|Custom 27208158||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mepilex Dressing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.95|FSC: 400601; BFG: 52||Not reimbursed separately|22.95|FSC: 400601; BFG: 52||External grouping not supported
27208159|EAP|Custom 27208159||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Alginate Seasorb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.80|FSC: 400601; BFG: 52||Not reimbursed separately|29.80|FSC: 400601; BFG: 52||External grouping not supported
27208160|EAP|Custom 27208160||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Alldress Dressing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.50|FSC: 400601; BFG: 52||Not reimbursed separately|12.50|FSC: 400601; BFG: 52||External grouping not supported
27208161|EAP|Custom 27208161||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Curagel Dressing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.55|FSC: 400601; BFG: 52||Not reimbursed separately|12.55|FSC: 400601; BFG: 52||External grouping not supported
27208162|EAP|Custom 27208162||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Comprifore Bandage|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.40|FSC: 400601; BFG: 52||Not reimbursed separately|37.40|FSC: 400601; BFG: 52||External grouping not supported
27208163|EAP|Custom 27208163||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Rapide|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.65|FSC: 400601; BFG: 52||Not reimbursed separately|24.65|FSC: 400601; BFG: 52||External grouping not supported
27208164|EAP|Custom 27208164||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Plain Fast Absorb|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.35|FSC: 400601; BFG: 52||Not reimbursed separately|31.35|FSC: 400601; BFG: 52||External grouping not supported
27208171|EAP|Custom 27208171||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Adjustable Peep Valve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.35|FSC: 400601; BFG: 52||Not reimbursed separately|50.35|FSC: 400601; BFG: 52||External grouping not supported
27208172|EAP|Custom 27208172||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch 7' Oxygen Tubing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3.75|FSC: 400601; BFG: 52||Not reimbursed separately|3.75|FSC: 400601; BFG: 52||External grouping not supported
27208173|EAP|Custom 27208173||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Oxygen Face Tent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3.75|FSC: 400601; BFG: 52||Not reimbursed separately|3.75|FSC: 400601; BFG: 52||External grouping not supported
27208174|EAP|Custom 27208174||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Aerochamber W/ Small Mask|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|156.30|FSC: 400601; BFG: 52||Not reimbursed separately|156.30|FSC: 400601; BFG: 52||External grouping not supported
27208175|EAP|Custom 27208175||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Oxygen Trach Mask|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9.60|FSC: 400601; BFG: 52||Not reimbursed separately|9.60|FSC: 400601; BFG: 52||External grouping not supported
27208176|EAP|Custom 27208176||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Vented V60|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|187.05|FSC: 400601; BFG: 52||Not reimbursed separately|187.05|FSC: 400601; BFG: 52||External grouping not supported
27208177|EAP|Custom 27208177||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Dragon Pedi|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.40|FSC: 400601; BFG: 52||Not reimbursed separately|13.40|FSC: 400601; BFG: 52||External grouping not supported
27208178|EAP|Custom 27208178||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ez Wrap Cannula|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
27208179|EAP|Custom 27208179||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Filter Air Vent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.80|FSC: 400601; BFG: 52||Not reimbursed separately|35.80|FSC: 400601; BFG: 52||External grouping not supported
27208180|EAP|Custom 27208180||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Filter Micro Pft|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.55|FSC: 400601; BFG: 52||Not reimbursed separately|15.55|FSC: 400601; BFG: 52||External grouping not supported
27208181|EAP|Custom 27208181||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bulb Insufflator Blue|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.95|FSC: 400601; BFG: 52||Not reimbursed separately|38.95|FSC: 400601; BFG: 52||External grouping not supported
27208182|EAP|Custom 27208182||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cpm Softgoods|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.45|FSC: 400601; BFG: 52||Not reimbursed separately|87.45|FSC: 400601; BFG: 52||External grouping not supported
27208183|EAP|Custom 27208183||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Pulley Set Pt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.75|FSC: 400601; BFG: 52||Not reimbursed separately|58.75|FSC: 400601; BFG: 52||External grouping not supported
27208184|EAP|Custom 27208184||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Heelbo|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.75|FSC: 400601; BFG: 52||Not reimbursed separately|23.75|FSC: 400601; BFG: 52||External grouping not supported
27208185|EAP|Custom 27208185||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sponge Ob|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.75|FSC: 400601; BFG: 52||Not reimbursed separately|25.75|FSC: 400601; BFG: 52||External grouping not supported
27208186|EAP|Custom 27208186||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Latch Assist|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.20|FSC: 400601; BFG: 52||Not reimbursed separately|34.20|FSC: 400601; BFG: 52||External grouping not supported
27208187|EAP|Custom 27208187||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ostomy Powder|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.75|FSC: 400601; BFG: 52||Not reimbursed separately|14.75|FSC: 400601; BFG: 52||External grouping not supported
27208188|EAP|Custom 27208188||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Ostomy Skin Prep|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.10|FSC: 400601; BFG: 52||Not reimbursed separately|28.10|FSC: 400601; BFG: 52||External grouping not supported
27208189|EAP|Custom 27208189||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Probe Skin|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.25|FSC: 400601; BFG: 52||Not reimbursed separately|28.25|FSC: 400601; BFG: 52||External grouping not supported
27208190|EAP|Custom 27208190||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Brace-cash Ortho|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|396.15|FSC: 400601; BFG: 52||Not reimbursed separately|396.15|FSC: 400601; BFG: 52||External grouping not supported
27208191|EAP|Custom 27208191||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Insert Moldable 8"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.10|FSC: 400601; BFG: 52||Not reimbursed separately|126.10|FSC: 400601; BFG: 52||External grouping not supported
27208192|EAP|Custom 27208192||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Clipper Cord Clamp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.75|FSC: 400601; BFG: 52||Not reimbursed separately|50.75|FSC: 400601; BFG: 52||External grouping not supported
27208193|EAP|Custom 27208193||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Calibration Tip For Bilichek|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.75|FSC: 400601; BFG: 52||Not reimbursed separately|26.75|FSC: 400601; BFG: 52||External grouping not supported
27208194|EAP|Custom 27208194||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Defib Pads Infant/child|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|452.85|FSC: 400601; BFG: 52||Not reimbursed separately|452.85|FSC: 400601; BFG: 52||External grouping not supported
27208195|EAP|Custom 27208195||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cable 4 Lead System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|101.55|FSC: 400601; BFG: 52||Not reimbursed separately|101.55|FSC: 400601; BFG: 52||External grouping not supported
27208196|EAP|Custom 27208196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Intranasal Atomization Device|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.15|FSC: 400601; BFG: 52||Not reimbursed separately|24.15|FSC: 400601; BFG: 52||External grouping not supported
27208197|EAP|Custom 27208197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Matt Transfer 34"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|209.15|FSC: 400601; BFG: 52||Not reimbursed separately|209.15|FSC: 400601; BFG: 52||External grouping not supported
27208198|EAP|Custom 27208198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Leg Lift|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|62.25|FSC: 400601; BFG: 52||Not reimbursed separately|62.25|FSC: 400601; BFG: 52||External grouping not supported
27208199|EAP|Custom 27208199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Liquid Sol-o-pak|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|132.35|FSC: 400601; BFG: 52||Not reimbursed separately|132.35|FSC: 400601; BFG: 52||External grouping not supported
27208200|EAP|Custom 27208200||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tube Ureteral Connecting|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.65|FSC: 400601; BFG: 52||Not reimbursed separately|56.65|FSC: 400601; BFG: 52||External grouping not supported
27208201|EAP|Custom 27208201||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sheet Angiography|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|77.45|FSC: 400601; BFG: 52||Not reimbursed separately|77.45|FSC: 400601; BFG: 52||External grouping not supported
27208202|EAP|Custom 27208202||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Guidewire .018x80cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|158.80|FSC: 400601; BFG: 52||Not reimbursed separately|158.80|FSC: 400601; BFG: 52||External grouping not supported
27208203|EAP|CPT® 83986||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Amniotest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.60|FSC: 400601; BFG: 52||Not reimbursed separately|18.60|FSC: 400601; BFG: 52||External grouping not supported
27208204|EAP|Custom 27208204||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Strap Soft|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.20|FSC: 400601; BFG: 52||Not reimbursed separately|23.20|FSC: 400601; BFG: 52||External grouping not supported
27208228|EAP|Custom 27208228||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Armboard Adult|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54.30|FSC: 400601; BFG: 52||Not reimbursed separately|54.30|FSC: 400601; BFG: 52||External grouping not supported
27208229|EAP|Custom 27208229||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag 4000ml Drainage|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.35|FSC: 400601; BFG: 52||Not reimbursed separately|32.35|FSC: 400601; BFG: 52||External grouping not supported
27208230|EAP|Custom 27208230||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag Resuscitation Infant Manual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.85|FSC: 400601; BFG: 52||Not reimbursed separately|90.85|FSC: 400601; BFG: 52||External grouping not supported
27208231|EAP|Custom 27208231||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag Resuscitation Pediatric Manual|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|99.15|FSC: 400601; BFG: 52||Not reimbursed separately|99.15|FSC: 400601; BFG: 52||External grouping not supported
27208232|EAP|Custom 27208232||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bag Infuser Pressure 500ml|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|101.85|FSC: 400601; BFG: 52||Not reimbursed separately|101.85|FSC: 400601; BFG: 52||External grouping not supported
27208233|EAP|Custom 27208233||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Basket Retrieval 3 Wire Spiral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,341.55|FSC: 400601; BFG: 52||Not reimbursed separately|1,341.55|FSC: 400601; BFG: 52||External grouping not supported
27208234|EAP|Custom 27208234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Canister Rigid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.80|FSC: 400601; BFG: 52||Not reimbursed separately|19.80|FSC: 400601; BFG: 52||External grouping not supported
27208235|EAP|Custom 27208235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cannula Divider Salter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.30|FSC: 400601; BFG: 52||Not reimbursed separately|15.30|FSC: 400601; BFG: 52||External grouping not supported
27208236|EAP|Custom 27208236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Cath Coude Tip 20fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|54.20|FSC: 400601; BFG: 52||Not reimbursed separately|54.20|FSC: 400601; BFG: 52||External grouping not supported
27208237|EAP|Custom 27208237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Epidural|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 400601; BFG: 52||Not reimbursed separately|35.00|FSC: 400601; BFG: 52||External grouping not supported
27208238|EAP|Custom 27208238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Femoral|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|79.25|FSC: 400601; BFG: 52||Not reimbursed separately|79.25|FSC: 400601; BFG: 52||External grouping not supported
27208239|EAP|Custom 27208239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Cath 12fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.90|FSC: 400601; BFG: 52||Not reimbursed separately|22.90|FSC: 400601; BFG: 52||External grouping not supported
27208240|EAP|Custom 27208240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Cath 18fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.20|FSC: 400601; BFG: 52||Not reimbursed separately|29.20|FSC: 400601; BFG: 52||External grouping not supported
27208241|EAP|Custom 27208241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Foley Cath 14fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.90|FSC: 400601; BFG: 52||Not reimbursed separately|29.90|FSC: 400601; BFG: 52||External grouping not supported
27208242|EAP|Custom 27208242||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Cath 8fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.90|FSC: 400601; BFG: 52||Not reimbursed separately|32.90|FSC: 400601; BFG: 52||External grouping not supported
27208243|EAP|Custom 27208243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Cath 10fr|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.85|FSC: 400601; BFG: 52||Not reimbursed separately|34.85|FSC: 400601; BFG: 52||External grouping not supported
27208244|EAP|Custom 27208244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Catheter Trocar All Sizes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.30|FSC: 400601; BFG: 52||Not reimbursed separately|100.30|FSC: 400601; BFG: 52||External grouping not supported
27208245|EAP|Custom 27208245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Catheter Trocar|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|182.85|FSC: 400601; BFG: 52||Not reimbursed separately|182.85|FSC: 400601; BFG: 52||External grouping not supported
27208246|EAP|Custom 27208246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Catheter 2 Way|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.35|FSC: 400601; BFG: 52||Not reimbursed separately|49.35|FSC: 400601; BFG: 52||External grouping not supported
27208247|EAP|Custom 27208247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Catheter 3 Way|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.95|FSC: 400601; BFG: 52||Not reimbursed separately|57.95|FSC: 400601; BFG: 52||External grouping not supported
27208248|EAP|Custom 27208248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Chest Drainage Dual Extension Set|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|FSC: 400601; BFG: 52||Not reimbursed separately|41.25|FSC: 400601; BFG: 52||External grouping not supported
27208249|EAP|Custom 27208249||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Connector Fiberoptic Double Swivel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|81.80|FSC: 400601; BFG: 52||Not reimbursed separately|81.80|FSC: 400601; BFG: 52||External grouping not supported
27208250|EAP|Custom 27208250||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch T-pod Combat Pelvic Stabilization|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|486.70|FSC: 400601; BFG: 52||Not reimbursed separately|486.70|FSC: 400601; BFG: 52||External grouping not supported
27208251|EAP|Custom 27208251||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Duoderm 8x8|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.95|FSC: 400601; BFG: 52||Not reimbursed separately|55.95|FSC: 400601; BFG: 52||External grouping not supported
27208252|EAP|Custom 27208252||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Optifoam Dressing 7x7|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.00|FSC: 400601; BFG: 52||Not reimbursed separately|52.00|FSC: 400601; BFG: 52||External grouping not supported
27208253|EAP|Custom 27208253||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Quikclot Hemostatic|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|305.45|FSC: 400601; BFG: 52||Not reimbursed separately|305.45|FSC: 400601; BFG: 52||External grouping not supported
27208254|EAP|Custom 27208254||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Dressing Large Granufoam|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|335.10|FSC: 400601; BFG: 52||Not reimbursed separately|335.10|FSC: 400601; BFG: 52||External grouping not supported
27208255|EAP|Custom 27208255||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Electrode Small|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.15|FSC: 400601; BFG: 52||Not reimbursed separately|66.15|FSC: 400601; BFG: 52||External grouping not supported
27208256|EAP|Custom 27208256||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Electrode Meditrace|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3.35|FSC: 400601; BFG: 52||Not reimbursed separately|3.35|FSC: 400601; BFG: 52||External grouping not supported
27208257|EAP|Custom 27208257||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foley Cath Urine Meter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.35|FSC: 400601; BFG: 52||Not reimbursed separately|71.35|FSC: 400601; BFG: 52||External grouping not supported
27208258|EAP|Custom 27208258||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Forcep Grasping|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|860.90|FSC: 400601; BFG: 52||Not reimbursed separately|860.90|FSC: 400601; BFG: 52||External grouping not supported
27208259|EAP|Custom 27208259||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Forcep Biopsy Colon|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|231.35|FSC: 400601; BFG: 52||Not reimbursed separately|231.35|FSC: 400601; BFG: 52||External grouping not supported
27208260|EAP|Custom 27208260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Forcep Biopsy Bronch|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|328.70|FSC: 400601; BFG: 52||Not reimbursed separately|328.70|FSC: 400601; BFG: 52||External grouping not supported
27208261|EAP|Custom 27208261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Guidewire J Arrow|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.40|FSC: 400601; BFG: 52||Not reimbursed separately|59.40|FSC: 400601; BFG: 52||External grouping not supported
27208262|EAP|Custom 27208262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Holder Tube Endotracheal Anchorfast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.25|FSC: 400601; BFG: 52||Not reimbursed separately|57.25|FSC: 400601; BFG: 52||External grouping not supported
27208263|EAP|Custom 27208263||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Holder Transducer|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.65|FSC: 400601; BFG: 52||Not reimbursed separately|46.65|FSC: 400601; BFG: 52||External grouping not supported
27208264|EAP|Custom 27208264||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Introducer Device 3 Lumen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|656.75|FSC: 400601; BFG: 52||Not reimbursed separately|656.75|FSC: 400601; BFG: 52||External grouping not supported
27208265|EAP|Custom 27208265||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Intubating Stylet|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.80|FSC: 400601; BFG: 52||Not reimbursed separately|17.80|FSC: 400601; BFG: 52||External grouping not supported
27208266|EAP|Custom 27208266||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Gastric Lavage|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.15|FSC: 400601; BFG: 52||Not reimbursed separately|128.15|FSC: 400601; BFG: 52||External grouping not supported
27208267|EAP|Custom 27208267||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Label System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.25|FSC: 400601; BFG: 52||Not reimbursed separately|15.25|FSC: 400601; BFG: 52||External grouping not supported
27208268|EAP|Custom 27208268||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Airway Laryngeal Mask Sz 1 .5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|144.30|FSC: 400601; BFG: 52||Not reimbursed separately|144.30|FSC: 400601; BFG: 52||External grouping not supported
27208269|EAP|Custom 27208269||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Airway Laryngeal Mask Sz 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.45|FSC: 400601; BFG: 52||Not reimbursed separately|95.45|FSC: 400601; BFG: 52||External grouping not supported
27208270|EAP|Custom 27208270||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Airway Laryngeal Mask Sz 2.5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|195.15|FSC: 400601; BFG: 52||Not reimbursed separately|195.15|FSC: 400601; BFG: 52||External grouping not supported
27208271|EAP|Custom 27208271||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Airway Laryngeal Mask Sz 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.80|FSC: 400601; BFG: 52||Not reimbursed separately|65.80|FSC: 400601; BFG: 52||External grouping not supported
27208272|EAP|Custom 27208272||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Airway Laryngeal Mask Sz 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.30|FSC: 400601; BFG: 52||Not reimbursed separately|52.30|FSC: 400601; BFG: 52||External grouping not supported
27208273|EAP|Custom 27208273||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Airway Laryngeal Mask Sz 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.60|FSC: 400601; BFG: 52||Not reimbursed separately|150.60|FSC: 400601; BFG: 52||External grouping not supported
27208274|EAP|Custom 27208274||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Aspiration Transbronchial Endoscopy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|474.10|FSC: 400601; BFG: 52||Not reimbursed separately|474.10|FSC: 400601; BFG: 52||External grouping not supported
27208275|EAP|Custom 27208275||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Endoscopy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|163.70|FSC: 400601; BFG: 52||Not reimbursed separately|163.70|FSC: 400601; BFG: 52||External grouping not supported
27208276|EAP|Custom 27208276||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Huber 19ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.35|FSC: 400601; BFG: 52||Not reimbursed separately|32.35|FSC: 400601; BFG: 52||External grouping not supported
27208277|EAP|Custom 27208277||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Huber 22ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.60|FSC: 400601; BFG: 52||Not reimbursed separately|60.60|FSC: 400601; BFG: 52||External grouping not supported
27208278|EAP|Custom 27208278||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Spinal 22ga 5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.75|FSC: 400601; BFG: 52||Not reimbursed separately|25.75|FSC: 400601; BFG: 52||External grouping not supported
27208279|EAP|Custom 27208279||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Spinal 22ga 7"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.70|FSC: 400601; BFG: 52||Not reimbursed separately|17.70|FSC: 400601; BFG: 52||External grouping not supported
27208280|EAP|Custom 27208280||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Spinal 25ga 5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.90|FSC: 400601; BFG: 52||Not reimbursed separately|71.90|FSC: 400601; BFG: 52||External grouping not supported
27208281|EAP|Custom 27208281||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Spinal Whitacre 22ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.80|FSC: 400601; BFG: 52||Not reimbursed separately|30.80|FSC: 400601; BFG: 52||External grouping not supported
27208282|EAP|Custom 27208282||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Stimuplex 20ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.40|FSC: 400601; BFG: 52||Not reimbursed separately|75.40|FSC: 400601; BFG: 52||External grouping not supported
27208283|EAP|Custom 27208283||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Stimuplex W/ext Set 22ga X 1 3/8"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.05|FSC: 400601; BFG: 52||Not reimbursed separately|68.05|FSC: 400601; BFG: 52||External grouping not supported
27208284|EAP|Custom 27208284||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Insulated Stimuplex W/ext Set 21ga X2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.60|FSC: 400601; BFG: 52||Not reimbursed separately|64.60|FSC: 400601; BFG: 52||External grouping not supported
27208285|EAP|Custom 27208285||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Tuohy 17ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.95|FSC: 400601; BFG: 52||Not reimbursed separately|57.95|FSC: 400601; BFG: 52||External grouping not supported
27208286|EAP|Custom 27208286||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Tuohy 18ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.95|FSC: 400601; BFG: 52||Not reimbursed separately|57.95|FSC: 400601; BFG: 52||External grouping not supported
27208287|EAP|Custom 27208287||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Tuohy 20ga|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.65|FSC: 400601; BFG: 52||Not reimbursed separately|33.65|FSC: 400601; BFG: 52||External grouping not supported
27208288|EAP|Custom 27208288||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Kit Ostomy Colostomy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.60|FSC: 400601; BFG: 52||Not reimbursed separately|22.60|FSC: 400601; BFG: 52||External grouping not supported
27208289|EAP|Custom 27208289||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Packing Strip Iodoform|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.30|FSC: 400601; BFG: 52||Not reimbursed separately|20.30|FSC: 400601; BFG: 52||External grouping not supported
27208290|EAP|Custom 27208290||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Pad Electrode|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.65|FSC: 400601; BFG: 52||Not reimbursed separately|66.65|FSC: 400601; BFG: 52||External grouping not supported
27208291|EAP|Custom 27208291||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Defib Pad Adult|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.35|FSC: 400601; BFG: 52||Not reimbursed separately|196.35|FSC: 400601; BFG: 52||External grouping not supported
27208292|EAP|Custom 27208292||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Probe Bipolar Hemostasis Solar Single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|930.75|FSC: 400601; BFG: 52||Not reimbursed separately|930.75|FSC: 400601; BFG: 52||External grouping not supported
27208293|EAP|Custom 27208293||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Reservoir 100ml|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.30|FSC: 400601; BFG: 52||Not reimbursed separately|29.30|FSC: 400601; BFG: 52||External grouping not supported
27208294|EAP|Custom 27208294||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sensor Spo2 Adult Lncs Masimo|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.35|FSC: 400601; BFG: 52||Not reimbursed separately|72.35|FSC: 400601; BFG: 52||External grouping not supported
27208295|EAP|Custom 27208295||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Set Airaway Adapter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.75|FSC: 400601; BFG: 52||Not reimbursed separately|67.75|FSC: 400601; BFG: 52||External grouping not supported
27208296|EAP|Custom 27208296||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Sling Post-op|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|364.30|FSC: 400601; BFG: 52||Not reimbursed separately|364.30|FSC: 400601; BFG: 52||External grouping not supported
27208297|EAP|Custom 27208297||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Snare Polypectomy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.90|FSC: 400601; BFG: 52||Not reimbursed separately|63.90|FSC: 400601; BFG: 52||External grouping not supported
27208298|EAP|Custom 27208298||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Splint One Step|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.00|FSC: 400601; BFG: 52||Not reimbursed separately|115.00|FSC: 400601; BFG: 52||External grouping not supported
27208299|EAP|Custom 27208299||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Ethilon|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.80|FSC: 400601; BFG: 52||Not reimbursed separately|19.80|FSC: 400601; BFG: 52||External grouping not supported
27208300|EAP|Custom 27208300||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Prolene 0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.70|FSC: 400601; BFG: 52||Not reimbursed separately|16.70|FSC: 400601; BFG: 52||External grouping not supported
27208301|EAP|Custom 27208301||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Silk|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.05|FSC: 400601; BFG: 52||Not reimbursed separately|21.05|FSC: 400601; BFG: 52||External grouping not supported
27208302|EAP|Custom 27208302||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Suture Vicryl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.40|FSC: 400601; BFG: 52||Not reimbursed separately|21.40|FSC: 400601; BFG: 52||External grouping not supported
27208303|EAP|Custom 27208303||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Syringe Glass Tip 5cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.70|FSC: 400601; BFG: 52||Not reimbursed separately|40.70|FSC: 400601; BFG: 52||External grouping not supported
27208304|EAP|Custom 27208304||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tape Foam|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.75|FSC: 400601; BFG: 52||Not reimbursed separately|29.75|FSC: 400601; BFG: 52||External grouping not supported
27208305|EAP|Custom 27208305||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tourniquet Abdominal Aortic Junctional|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,091.95|FSC: 400601; BFG: 52||Not reimbursed separately|1,091.95|FSC: 400601; BFG: 52||External grouping not supported
27208306|EAP|Custom 27208306||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tourniquet Combat|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|192.40|FSC: 400601; BFG: 52||Not reimbursed separately|192.40|FSC: 400601; BFG: 52||External grouping not supported
27208307|EAP|Custom 27208307||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tray Chest Tube|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|133.15|FSC: 400601; BFG: 52||Not reimbursed separately|133.15|FSC: 400601; BFG: 52||External grouping not supported
27208308|EAP|Custom 27208308||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tube Lavage|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.30|FSC: 400601; BFG: 52||Not reimbursed separately|36.30|FSC: 400601; BFG: 52||External grouping not supported
27208309|EAP|Custom 27208309||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Tube Trach Extended|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|424.15|FSC: 400601; BFG: 52||Not reimbursed separately|424.15|FSC: 400601; BFG: 52||External grouping not supported
27208310|EAP|Custom 27208310||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch 21' Oxygen Tubing|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5.90|FSC: 400601; BFG: 52||Not reimbursed separately|5.90|FSC: 400601; BFG: 52||External grouping not supported
27208311|EAP|Custom 27208311||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Valve Bronch Suction|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.40|FSC: 400601; BFG: 52||Not reimbursed separately|39.40|FSC: 400601; BFG: 52||External grouping not supported
27208312|EAP|Custom 27208312||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Water Irrigation Pour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.40|FSC: 400601; BFG: 52||Not reimbursed separately|39.40|FSC: 400601; BFG: 52||External grouping not supported
27208313|EAP|HCPCS A6010||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Collagen Dry Filler|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|171.00|FSC: 400601; BFG: 52||Not reimbursed separately|171.00|FSC: 400601; BFG: 52||External grouping not supported
27208314|EAP|HCPCS A6011||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Collagen Wet Filler|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|161.25|FSC: 400601; BFG: 52||Not reimbursed separately|161.25|FSC: 400601; BFG: 52||External grouping not supported
27208315|EAP|HCPCS A6196||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Alginate Dressing <= 16 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.00|FSC: 400601; BFG: 52||Not reimbursed separately|36.00|FSC: 400601; BFG: 52||External grouping not supported
27208316|EAP|HCPCS A6197||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Alginate Dressing >16 <= 48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|136.90|FSC: 400601; BFG: 52||Not reimbursed separately|136.90|FSC: 400601; BFG: 52||External grouping not supported
27208317|EAP|HCPCS A6198||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Alginate Dressing >48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|83.35|FSC: 400601; BFG: 52||Not reimbursed separately|83.35|FSC: 400601; BFG: 52||External grouping not supported
27208318|EAP|HCPCS A6199||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Alginate Dressing Wound Filler Per 6 In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.35|FSC: 400601; BFG: 52||Not reimbursed separately|34.35|FSC: 400601; BFG: 52||External grouping not supported
27208319|EAP|HCPCS A6207||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Contact Layer >16 <= 48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.10|FSC: 400601; BFG: 52||Not reimbursed separately|41.10|FSC: 400601; BFG: 52||External grouping not supported
27208320|EAP|HCPCS A6209||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing <= 16 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.80|FSC: 400601; BFG: 52||Not reimbursed separately|27.80|FSC: 400601; BFG: 52||External grouping not supported
27208321|EAP|HCPCS A6210||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing >16 <= 48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.25|FSC: 400601; BFG: 52||Not reimbursed separately|52.25|FSC: 400601; BFG: 52||External grouping not supported
27208322|EAP|HCPCS A6212||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing <= 16 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.55|FSC: 400601; BFG: 52||Not reimbursed separately|59.55|FSC: 400601; BFG: 52||External grouping not supported
27208323|EAP|HCPCS A6213||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing >16 <= 48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.45|FSC: 400601; BFG: 52||Not reimbursed separately|78.45|FSC: 400601; BFG: 52||External grouping not supported
27208324|EAP|HCPCS A6215||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing Wound Filler Per Gm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.85|FSC: 400601; BFG: 52||Not reimbursed separately|22.85|FSC: 400601; BFG: 52||External grouping not supported
27208325|EAP|HCPCS A6234||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing <= 16 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.95|FSC: 400601; BFG: 52||Not reimbursed separately|23.95|FSC: 400601; BFG: 52||External grouping not supported
27208326|EAP|HCPCS A6235||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing >16 <= 48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.20|FSC: 400601; BFG: 52||Not reimbursed separately|57.20|FSC: 400601; BFG: 52||External grouping not supported
27208327|EAP|HCPCS A6236||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing >48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.15|FSC: 400601; BFG: 52||Not reimbursed separately|80.15|FSC: 400601; BFG: 52||External grouping not supported
27208328|EAP|HCPCS A6237||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing <= 16 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.10|FSC: 400601; BFG: 52||Not reimbursed separately|33.10|FSC: 400601; BFG: 52||External grouping not supported
27208329|EAP|HCPCS A6238||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing >16 <= 48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.50|FSC: 400601; BFG: 52||Not reimbursed separately|60.50|FSC: 400601; BFG: 52||External grouping not supported
27208330|EAP|HCPCS A6239||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing >48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.15|FSC: 400601; BFG: 52||Not reimbursed separately|80.15|FSC: 400601; BFG: 52||External grouping not supported
27208331|EAP|HCPCS A6240||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing Wound Filler Paste Per Oz|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.55|FSC: 400601; BFG: 52||Not reimbursed separately|42.55|FSC: 400601; BFG: 52||External grouping not supported
27208332|EAP|HCPCS A6241||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrocolloid Dressing Wound Filler Dry Per Gm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.80|FSC: 400601; BFG: 52||Not reimbursed separately|33.80|FSC: 400601; BFG: 52||External grouping not supported
27208333|EAP|HCPCS A6242||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing <= 16 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.85|FSC: 400601; BFG: 52||Not reimbursed separately|22.85|FSC: 400601; BFG: 52||External grouping not supported
27208334|EAP|HCPCS A6243||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing >16 <= 48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.80|FSC: 400601; BFG: 52||Not reimbursed separately|27.80|FSC: 400601; BFG: 52||External grouping not supported
27208335|EAP|HCPCS A6244||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing >48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.40|FSC: 400601; BFG: 52||Not reimbursed separately|36.40|FSC: 400601; BFG: 52||External grouping not supported
27208336|EAP|HCPCS A6245||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing <= 16 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.80|FSC: 400601; BFG: 52||Not reimbursed separately|43.80|FSC: 400601; BFG: 52||External grouping not supported
27208337|EAP|HCPCS A6246||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing >16 <= 48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.90|FSC: 400601; BFG: 52||Not reimbursed separately|88.90|FSC: 400601; BFG: 52||External grouping not supported
27208338|EAP|HCPCS A6247||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing >48 Sq In W/adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|96.30|FSC: 400601; BFG: 52||Not reimbursed separately|96.30|FSC: 400601; BFG: 52||External grouping not supported
27208339|EAP|HCPCS A6248||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hydrogel Dressing Wound Filler Gel Per Oz|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.00|FSC: 400601; BFG: 52||Not reimbursed separately|67.00|FSC: 400601; BFG: 52||External grouping not supported
27208340|EAP|HCPCS A6251||0623 - MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS|Hc Cch Absorptive Dressing <= 16 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.55|FSC: 400601; BFG: 52||Not reimbursed separately|28.55|FSC: 400601; BFG: 52||External grouping not supported
27208341|EAP|HCPCS A6252||0623 - MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS|Hc Cch Absorptive Dressing >16 <= 48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.10|FSC: 400601; BFG: 52||Not reimbursed separately|13.10|FSC: 400601; BFG: 52||External grouping not supported
27208342|EAP|HCPCS A6253||0623 - MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS|Hc Cch Absorptive Dressing >48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.20|FSC: 400601; BFG: 52||Not reimbursed separately|19.20|FSC: 400601; BFG: 52||External grouping not supported
27208343|EAP|HCPCS A6254||0623 - MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS|Hc Cch Absorptive Dressing <= 16 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.45|FSC: 400601; BFG: 52||Not reimbursed separately|16.45|FSC: 400601; BFG: 52||External grouping not supported
27208344|EAP|HCPCS A6255||0623 - MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS|Hc Cch Absorptive Dressing >16 <= 48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.45|FSC: 400601; BFG: 52||Not reimbursed separately|16.45|FSC: 400601; BFG: 52||External grouping not supported
27208345|EAP|HCPCS A6256||0623 - MEDICAL/SURGICAL SUPPLIES - SURGICAL DRESSINGS|Hc Cch Absorptive Dressing >48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3.35|FSC: 400601; BFG: 52||Not reimbursed separately|3.35|FSC: 400601; BFG: 52||External grouping not supported
27208346|EAP|HCPCS A6260||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Wound Cleanser|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.60|FSC: 400601; BFG: 52||Not reimbursed separately|19.60|FSC: 400601; BFG: 52||External grouping not supported
27208347|EAP|HCPCS A6261||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Wound Filler Gel/paste Per Oz|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|94.85|FSC: 400601; BFG: 52||Not reimbursed separately|94.85|FSC: 400601; BFG: 52||External grouping not supported
27208348|EAP|HCPCS A6262||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Wound Filler Dry Form Per Gm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.80|FSC: 400601; BFG: 52||Not reimbursed separately|27.80|FSC: 400601; BFG: 52||External grouping not supported
27208349|EAP|HCPCS A6441||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Padding Bandage >=3" <5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9.55|FSC: 400601; BFG: 52||Not reimbursed separately|9.55|FSC: 400601; BFG: 52||External grouping not supported
27208350|EAP|HCPCS A6443||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Conforming Bandage >=3" <5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|6.80|FSC: 400601; BFG: 52||Not reimbursed separately|6.80|FSC: 400601; BFG: 52||External grouping not supported
27208351|EAP|HCPCS A6449||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Light Compression Bandage >=3" <5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.05|FSC: 400601; BFG: 52||Not reimbursed separately|13.05|FSC: 400601; BFG: 52||External grouping not supported
27208352|EAP|HCPCS A6454||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Self Adherent Bandage >=3" <5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.25|FSC: 400601; BFG: 52||Not reimbursed separately|13.25|FSC: 400601; BFG: 52||External grouping not supported
27208353|EAP|HCPCS A6456||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Zinc Paste Band|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.55|FSC: 400601; BFG: 52||Not reimbursed separately|47.55|FSC: 400601; BFG: 52||External grouping not supported
27208354|EAP|HCPCS A6550||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Negative Pressure Wound Therapy Dressing Set|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.40|FSC: 400601; BFG: 52||Not reimbursed separately|100.40|FSC: 400601; BFG: 52||External grouping not supported
27208355|EAP|Custom 27208355||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Negative Pressure Wound Therapy Pump|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|96.70|FSC: 400601; BFG: 52||Not reimbursed separately|96.70|FSC: 400601; BFG: 52||External grouping not supported
27208356|EAP|HCPCS G0168||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Wound Closure By Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|259.30|FSC: 400601; BFG: 52||Not reimbursed separately|259.30|FSC: 400601; BFG: 52||External grouping not supported
27208357|EAP|Custom 27208357||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Bubble Humidifier|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.35|FSC: 400601; BFG: 52||Not reimbursed separately|19.35|FSC: 400601; BFG: 52||External grouping not supported
27208358|EAP|Custom 27208358||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Adult Oxygen Mask Non Rebreather|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.20|FSC: 400601; BFG: 52||Not reimbursed separately|21.20|FSC: 400601; BFG: 52||External grouping not supported
27208359|EAP|Custom 27208359||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Aerosol|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
27208360|EAP|Custom 27208360||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Multivent|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.35|FSC: 400601; BFG: 52||Not reimbursed separately|17.35|FSC: 400601; BFG: 52||External grouping not supported
27208361|EAP|Custom 27208361||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Mask Pedi|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.55|FSC: 400601; BFG: 52||Not reimbursed separately|11.55|FSC: 400601; BFG: 52||External grouping not supported
27208362|EAP|Custom 27208362||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Nebulizer Updraft|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.95|FSC: 400601; BFG: 52||Not reimbursed separately|29.95|FSC: 400601; BFG: 52||External grouping not supported
27208364|EAP|HCPCS A6214||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing >48 Sq In W/ Adhesive|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|81.75|FSC: 400601; BFG: 52||Not reimbursed separately|81.75|FSC: 400601; BFG: 52||External grouping not supported
27208365|EAP|HCPCS A6211||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Foam Dressing >48 Sq In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.25|FSC: 400601; BFG: 52||Not reimbursed separately|52.25|FSC: 400601; BFG: 52||External grouping not supported
40200070|EAP|CPT® 76886||0402 - OTHER IMAGING SERVICES - ULTRASOUND|Hc Cch Us Infant Hips Limited|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.90|FSC: 400601; BFG: 52||Not reimbursed separately|165.90|FSC: 400601; BFG: 52||External grouping not supported
27208366|EAP|Custom 27208366||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .2% W/dext 5% 1000cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208367|EAP|Custom 27208367||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .45% W/dext 5% 1000cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208368|EAP|Custom 27208368||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .9% W/dext 5% 1000cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208369|EAP|Custom 27208369||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .9% 250cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208370|EAP|Custom 27208370||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .9% 500cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208371|EAP|Custom 27208371||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .9% 1000cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208372|EAP|Custom 27208372||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline .45% 1000cc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.90|FSC: 400601; BFG: 52||Not reimbursed separately|78.90|FSC: 400601; BFG: 52||External grouping not supported
27208373|EAP|Custom 27208373||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Saline Irrigation Pour|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.40|FSC: 400601; BFG: 52||Not reimbursed separately|39.40|FSC: 400601; BFG: 52||External grouping not supported
37000026|EAP|Custom 37000026||0370 - ANESTHESIA - GENERAL CLASSIFICATION|Hc Cch Local Nurse Monitor|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|106.05|FSC: 400601; BFG: 52||Not reimbursed separately|106.05|FSC: 400601; BFG: 52||External grouping not supported
27208374|EAP|Custom 27208374||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Compression Bandage 4 In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.10|FSC: 400601; BFG: 52||Not reimbursed separately|51.10|FSC: 400601; BFG: 52||External grouping not supported
27208375|EAP|Custom 27208375||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Compression Bandage 6 In|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.25|FSC: 400601; BFG: 52||Not reimbursed separately|63.25|FSC: 400601; BFG: 52||External grouping not supported
27208376|EAP|Custom 27208376||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Fastrack|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.90|FSC: 400601; BFG: 52||Not reimbursed separately|47.90|FSC: 400601; BFG: 52||External grouping not supported
27208377|EAP|Custom 27208377||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Esophageal Stethoscope|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.05|FSC: 400601; BFG: 52||Not reimbursed separately|28.05|FSC: 400601; BFG: 52||External grouping not supported
27208378|EAP|Custom 27208378||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Eye Shield|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.10|FSC: 400601; BFG: 52||Not reimbursed separately|33.10|FSC: 400601; BFG: 52||External grouping not supported
27208379|EAP|Custom 27208379||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Headrest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.50|FSC: 400601; BFG: 52||Not reimbursed separately|100.50|FSC: 400601; BFG: 52||External grouping not supported
27208380|EAP|Custom 27208380||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Hme Filter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.40|FSC: 400601; BFG: 52||Not reimbursed separately|36.40|FSC: 400601; BFG: 52||External grouping not supported
31000350|EAP|CPT® 81539||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Oncology Prostate Probability Score|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,034.90|FSC: 400601; BFG: 52||Not reimbursed separately|2,034.90|FSC: 400601; BFG: 52||External grouping not supported
30600270|EAP|CPT® 87486||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Chlamydia P Amplif Na Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|151.20|FSC: 400601; BFG: 52||Not reimbursed separately|151.20|FSC: 400601; BFG: 52||External grouping not supported
76100142|EAP|CPT® 54150||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Cch Circumcision W/ Regional Block|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,540.20|FSC: 400601; BFG: 52||Not reimbursed separately|4,540.20|FSC: 400601; BFG: 52||External grouping not supported
76200006|EAP|HCPCS G0378||0762 - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM|Hc Cch Observation Progressive/intermediate|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.65|FSC: 400601; BFG: 52||Not reimbursed separately|55.65|FSC: 400601; BFG: 52||External grouping not supported
27208444|EAP|Custom 27208444||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Needle Hawkins Ii|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|276.00|FSC: 400601; BFG: 52||Not reimbursed separately|276.00|FSC: 400601; BFG: 52||External grouping not supported
27208445|EAP|Custom 27208445||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Cch Drain Catheter Fastener-stayfix|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.50|FSC: 400601; BFG: 52||Not reimbursed separately|42.50|FSC: 400601; BFG: 52||External grouping not supported
27804527|EAP|HCPCS C1897||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|Hc Cch Infinion 16 Trial Lead Kit 50 Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,794.45|FSC: 400601; BFG: 52||Not reimbursed separately|1,794.45|FSC: 400601; BFG: 52||External grouping not supported
49000981|EAP|CPT® 10005||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Fine Needle Aspiration Bx W/ Ultrasound Guidance First Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,550.85|FSC: 400601; BFG: 52||Not reimbursed separately|1,550.85|FSC: 400601; BFG: 52||External grouping not supported
49000982|EAP|CPT® 10006||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Fine Needle Aspiration Bx W/ Ultrasound Guidance Each Addl Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|387.45|FSC: 400601; BFG: 52||Not reimbursed separately|387.45|FSC: 400601; BFG: 52||External grouping not supported
49000985|EAP|CPT® 10009||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Fine Needle Aspiration Bx W/ Ct Guidance First Lesion|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,522.50|FSC: 400601; BFG: 52||Not reimbursed separately|1,522.50|FSC: 400601; BFG: 52||External grouping not supported
51000717|EAP|CPT® 43762||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Replacement G-tube W/o Imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|619.50|FSC: 400601; BFG: 52||Not reimbursed separately|619.50|FSC: 400601; BFG: 52||External grouping not supported
31100154|EAP|CPT® 88164||0311 - LABORATORY PATHOLOGICAL - CYTOLOGY|Hc Cch So Cytopathology Bethesda Pap Manual Screen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.85|FSC: 400601; BFG: 52||Not reimbursed separately|38.85|FSC: 400601; BFG: 52||External grouping not supported
30100991|EAP|CPT® 84160||0301 - LABORATORY - CHEMISTRY|Hc Cch So Protein Total By Refractometry Any Source|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.80|FSC: 400601; BFG: 52||Not reimbursed separately|16.80|FSC: 400601; BFG: 52||External grouping not supported
11102|EAP|CPT® 11102|||TANGENTIAL BIOPSY SKIN SINGLE LESION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|188.54|FSC: 46100; BFG: 52||Not reimbursed separately|188.54|FSC: 46100; BFG: 52||External grouping not supported
11104|EAP|CPT® 11104|||PUNCH BIOPSY SKIN SINGLE LESION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|178.74|FSC: 46100; BFG: 52||Not reimbursed separately|178.74|FSC: 46100; BFG: 52||External grouping not supported
11106|EAP|CPT® 11106|||INCISIONAL BIOPSY SKIN SINGLE LESION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,809.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,809.00|FSC: 46100; BFG: 52||External grouping not supported
G2012|EAP|HCPCS G2012||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Brief check in by md/qhp|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.00|FSC: 46100; BFG: 52||Not reimbursed separately|34.00|FSC: 46100; BFG: 52||External grouping not supported
31000368|EAP|CPT® 88230||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Tissue Culture Lymphocyte|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|385.35|FSC: 400601; BFG: 52||Not reimbursed separately|385.35|FSC: 400601; BFG: 52||External grouping not supported
31000369|EAP|CPT® 88233||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Tissue Culture Skin Or Solid Bx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|465.15|FSC: 400601; BFG: 52||Not reimbursed separately|465.15|FSC: 400601; BFG: 52||External grouping not supported
31000371|EAP|CPT® 88235||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Tissue Culture Amniotic Fluid|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|712.95|FSC: 400601; BFG: 52||Not reimbursed separately|712.95|FSC: 400601; BFG: 52||External grouping not supported
31000373|EAP|CPT® 88237||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Tissue Culture Bm Blood Cells|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|611.10|FSC: 400601; BFG: 52||Not reimbursed separately|611.10|FSC: 400601; BFG: 52||External grouping not supported
31000382|EAP|CPT® 88262||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Chromosone Analysis 15-20 Cells|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|411.60|FSC: 400601; BFG: 52||Not reimbursed separately|411.60|FSC: 400601; BFG: 52||External grouping not supported
31000384|EAP|CPT® 88264||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch So Chrom Analysis 20-25 Cells|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|615.30|FSC: 400601; BFG: 52||Not reimbursed separately|615.30|FSC: 400601; BFG: 52||External grouping not supported
31000472|EAP|CPT® 88280||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Chrom Analy Addtl Karyot Ea Study|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.80|FSC: 400601; BFG: 52||Not reimbursed separately|121.80|FSC: 400601; BFG: 52||External grouping not supported
31000475|EAP|CPT® 88285||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Chrom Analy Addtl Cell Counts|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
31000476|EAP|CPT® 88289||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc So Chrom Analy Addtl Hi Resoln|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|166.95|FSC: 400601; BFG: 52||Not reimbursed separately|166.95|FSC: 400601; BFG: 52||External grouping not supported
49000996|EAP|CPT® 36573||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Insertion Picc W/o Pump/port W/imaging > 5 Years Old|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,929.50|FSC: 400601; BFG: 52||Not reimbursed separately|2,929.50|FSC: 400601; BFG: 52||External grouping not supported
51000737|EAP|CPT® 51798||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Ultrasound Post Voiding Urine|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|132.30|FSC: 400601; BFG: 52||Not reimbursed separately|132.30|FSC: 400601; BFG: 52||External grouping not supported
51000738|EAP|CPT® 51700||0761 - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM|Hc Bladder Irrigation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|614.25|FSC: 400601; BFG: 52||Not reimbursed separately|614.25|FSC: 400601; BFG: 52||External grouping not supported
49000998|EAP|CPT® 32550||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Insertion Pleural Cath W/ Cuff|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,117.45|FSC: 400601; BFG: 52||Not reimbursed separately|3,117.45|FSC: 400601; BFG: 52||External grouping not supported
31000505|EAP|CPT® 81335||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch Tpmt Gene Analysis Common Variants|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|481.95|FSC: 400601; BFG: 52||Not reimbursed separately|481.95|FSC: 400601; BFG: 52||External grouping not supported
30101025|EAP|CPT® 82642||0301 - LABORATORY - CHEMISTRY|Hc Cch Dihydrotestosterone|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.90|FSC: 400601; BFG: 52||Not reimbursed separately|39.90|FSC: 400601; BFG: 52||External grouping not supported
39000037|EAP|||0390 - BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING AND STORAGE - GENERAL CLASSIFICATION|Hc Cryo Pool Rule|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|588.00|FSC: 400601||Not reimbursed separately|588.00|FSC: 400601||External grouping not supported
30600278|EAP|CPT® 87158||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Culture Typing Other Methods|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|84.00|FSC: 400601; BFG: 52||Not reimbursed separately|84.00|FSC: 400601; BFG: 52||External grouping not supported
31900001|EAP|CPT® 81364||0319 - LABORATORY PATHOLOGICAL - OTHER|Hc Cch Hbb Full Gene Sequence|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|869.40|FSC: 400601; BFG: 52||Not reimbursed separately|869.40|FSC: 400601; BFG: 52||External grouping not supported
31000509|EAP|CPT® 81306||0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION|Hc Cch Nudt 15 Gene Analysis Common Variants|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|780.15|FSC: 400601; BFG: 52||Not reimbursed separately|780.15|FSC: 400601; BFG: 52||External grouping not supported
30600279|EAP|CPT® 87634||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch Iadna Dna/rna Amplified Probe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.95|FSC: 400601; BFG: 52||Not reimbursed separately|208.95|FSC: 400601; BFG: 52||External grouping not supported
30600280|EAP|CPT® 87801||0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY|Hc Cch So Dna/rna Multi Org Amp (blood Panl Id By Pcr)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|242.55|FSC: 400601; BFG: 52||Not reimbursed separately|242.55|FSC: 400601; BFG: 52||External grouping not supported
49000461|EAP|CPT® 62272||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Hc Lumbar Puncture Therapeutic W/o Guidance|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,455.30|FSC: 400601; BFG: 52||Not reimbursed separately|1,455.30|FSC: 400601; BFG: 52||External grouping not supported
51000456|EAP|CPT® 64430||0510 - CLINIC - GENERAL CLASSIFICATION|Hc Injection Anesthetic Pudendal Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,918.26|FSC: 400601; BFG: 52||Not reimbursed separately|1,918.26|FSC: 400601; BFG: 52||External grouping not supported
27202969|EAP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Hc Guidewire Amplatz Super Stiff|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.75|FSC: 400601; BFG: 52||Not reimbursed separately|108.75|FSC: 400601; BFG: 52||External grouping not supported
30100485|EAP|CPT® 82670||0301 - LABORATORY - CHEMISTRY|Hc So Estradiol|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.40|FSC: 400601; BFG: 52||Not reimbursed separately|92.40|FSC: 400601; BFG: 52||External grouping not supported
75000113|EAP|CPT® 43257||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Egd Flexible Transoral W/ Thermal Energy Delivery|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,937.90|FSC: 400601; BFG: 52||Not reimbursed separately|2,937.90|FSC: 400601; BFG: 52||External grouping not supported
30100487|EAP|CPT® 82533||0301 - LABORATORY - CHEMISTRY|Hc So Cortisol-total|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.55|FSC: 400601; BFG: 52||Not reimbursed separately|53.55|FSC: 400601; BFG: 52||External grouping not supported
75000116|EAP|CPT® 44392||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Stoma W/ Removal Hot Bx Forceps|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
75000117|EAP|CPT® 44394||0750 - GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION|Hc Colonoscopy Stoma W/removal By Snare|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,507.40|FSC: 400601; BFG: 52||Not reimbursed separately|2,507.40|FSC: 400601; BFG: 52||External grouping not supported
26600|EAP|CPT® 26600||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Closed Tx Metacarpal Fx W/o Manip,each|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|440.00|FSC: 46100; BFG: 52||Not reimbursed separately|440.00|FSC: 46100; BFG: 52||External grouping not supported
26770|EAP|CPT® 26770|||Pr Closed Rx Ip Jt Dislocation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|406.00|FSC: 46100; BFG: 52||Not reimbursed separately|406.00|FSC: 46100; BFG: 52||External grouping not supported
27096|EAP|CPT® 27096|||INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|485.00|FSC: 46100; BFG: 52||Not reimbursed separately|485.00|FSC: 46100; BFG: 52||External grouping not supported
27130|EAP|CPT® 27130|||Pr Total Hip Arthroplasty|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,040.00|FSC: 46100; BFG: 52||Not reimbursed separately|2,040.00|FSC: 46100; BFG: 52||External grouping not supported
27447|EAP|CPT® 27447|||Pr Total Knee Arthroplasty|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,038.00|FSC: 46100; BFG: 52||Not reimbursed separately|2,038.00|FSC: 46100; BFG: 52||External grouping not supported
27654|EAP|CPT® 27654|||Pr Repair Achilles Tendon,secondary|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,287.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,287.00|FSC: 46100; BFG: 52||External grouping not supported
27685|EAP|CPT® 27685|||Pr Length/short Leg/ankl Tendon,single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,175.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,175.00|FSC: 46100; BFG: 52||External grouping not supported
27691|EAP|CPT® 27691|||Pr Xfer Single Deep Low Leg Tendon|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,235.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,235.00|FSC: 46100; BFG: 52||External grouping not supported
27786|EAP|CPT® 27786||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Closed Tx Dist Fibula Fx W/o Manip|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|485.00|FSC: 46100; BFG: 52||Not reimbursed separately|485.00|FSC: 46100; BFG: 52||External grouping not supported
27792|EAP|CPT® 27792|||Pr Open Rx Lat Malleolus Fx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,430.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,430.00|FSC: 46100; BFG: 52||External grouping not supported
27840|EAP|CPT® 27840|||Pr Closed Rx Ankle Dislocatn|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|790.00|FSC: 46100; BFG: 52||Not reimbursed separately|790.00|FSC: 46100; BFG: 52||External grouping not supported
28124|EAP|CPT® 28124|||Pr Part Remv Phalanx Of Toe|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|715.00|FSC: 46100; BFG: 52||Not reimbursed separately|715.00|FSC: 46100; BFG: 52||External grouping not supported
28234|EAP|CPT® 28234|||Pr Incision Exten Foot/toe Tendon|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.00|FSC: 46100; BFG: 52||Not reimbursed separately|655.00|FSC: 46100; BFG: 52||External grouping not supported
99307|EAP|CPT® 99307||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|SBSQ NURSING FACILITY CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
99308|EAP|CPT® 99308||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|SBSQ NURSING FACIL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.00|FSC: 46100; BFG: 52||Not reimbursed separately|105.00|FSC: 46100; BFG: 52||External grouping not supported
99309|EAP|CPT® 99309||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|SBSQ NURSING FACIL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.00|FSC: 46100; BFG: 52||Not reimbursed separately|140.00|FSC: 46100; BFG: 52||External grouping not supported
99310|EAP|CPT® 99310||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|SBSQ NURS FACIL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.00|FSC: 46100; BFG: 52||Not reimbursed separately|205.00|FSC: 46100; BFG: 52||External grouping not supported
28800|EAP|CPT® 28800|||Pr Amputation Foot,midtarsal-chopart|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,020.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,020.00|FSC: 46100; BFG: 52||External grouping not supported
29065|EAP|CPT® 29065||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Apply Long Arm Cast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|220.00|FSC: 46100; BFG: 52||Not reimbursed separately|220.00|FSC: 46100; BFG: 52||External grouping not supported
29075|EAP|CPT® 29075||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Apply Cast,short Arm,elbow-finger|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|190.00|FSC: 46100; BFG: 52||Not reimbursed separately|190.00|FSC: 46100; BFG: 52||External grouping not supported
29125|EAP|CPT® 29125||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Apply Short Arm Splint,static|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|FSC: 46100; BFG: 52||Not reimbursed separately|125.00|FSC: 46100; BFG: 52||External grouping not supported
29405|EAP|CPT® 29405||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Apply Short Leg Cast|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.00|FSC: 46100; BFG: 52||Not reimbursed separately|205.00|FSC: 46100; BFG: 52||External grouping not supported
99326|EAP|CPT® 99326||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|DOMICIL/REST HOME NEW PT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|215.00|FSC: 46100; BFG: 52||Not reimbursed separately|215.00|FSC: 46100; BFG: 52||External grouping not supported
29515|EAP|CPT® 29515||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Apply Short Leg Splint, Calf-foot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.00|FSC: 46100; BFG: 52||Not reimbursed separately|140.00|FSC: 46100; BFG: 52||External grouping not supported
29540|EAP|CPT® 29540||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Strapping; Ankle &/or Foot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.00|FSC: 46100; BFG: 52||Not reimbursed separately|60.00|FSC: 46100; BFG: 52||External grouping not supported
29580|EAP|CPT® 29580||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Apply Of Unna Boot|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|FSC: 46100; BFG: 52||Not reimbursed separately|95.00|FSC: 46100; BFG: 52||External grouping not supported
99334|EAP|CPT® 99334||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|DOM/R-HOME E/M EST PT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|FSC: 46100; BFG: 52||Not reimbursed separately|95.00|FSC: 46100; BFG: 52||External grouping not supported
99335|EAP|CPT® 99335||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|DOM/R-HOME E/M EST PT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|145.00|FSC: 46100; BFG: 52||Not reimbursed separately|145.00|FSC: 46100; BFG: 52||External grouping not supported
30300|EAP|CPT® 30300||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Remove Nasal Foreign Body|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|340.00|FSC: 46100; BFG: 52||Not reimbursed separately|340.00|FSC: 46100; BFG: 52||External grouping not supported
30901|EAP|CPT® 30901||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Ctrl Nosebleed,anter,simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|197.00|FSC: 46100; BFG: 52||Not reimbursed separately|197.00|FSC: 46100; BFG: 52||External grouping not supported
30903|EAP|CPT® 30903||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Ctrl Nosebleed,anter,complex|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|310.00|FSC: 46100; BFG: 52||Not reimbursed separately|310.00|FSC: 46100; BFG: 52||External grouping not supported
30905|EAP|CPT® 30905||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Ctrl Nosebleed,post,w/packs &/or Caut|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|465.00|FSC: 46100; BFG: 52||Not reimbursed separately|465.00|FSC: 46100; BFG: 52||External grouping not supported
31500|EAP|CPT® 31500|||Pr Insert Emergency Endotrach Airway|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|245.00|FSC: 46100; BFG: 52||Not reimbursed separately|245.00|FSC: 46100; BFG: 52||External grouping not supported
36556|EAP|CPT® 36556|||Pr Insert Non-tunnel Cv Cath,age 5 Or Older|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|842.00|FSC: 46100; BFG: 52||Not reimbursed separately|842.00|FSC: 46100; BFG: 52||External grouping not supported
36558|EAP|CPT® 36558|||INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,600.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,600.00|FSC: 46100; BFG: 52||External grouping not supported
36561|EAP|CPT® 36561|||INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,602.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,602.00|FSC: 46100; BFG: 52||External grouping not supported
36590|EAP|CPT® 36590|||RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|397.00|FSC: 46100; BFG: 52||Not reimbursed separately|397.00|FSC: 46100; BFG: 52||External grouping not supported
36620|EAP|CPT® 36620|||Pr Insert Cath,art,percut,shortterm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|90.00|FSC: 46100; BFG: 52||Not reimbursed separately|90.00|FSC: 46100; BFG: 52||External grouping not supported
38525|EAP|CPT® 38525|||Pr Bx/remv,lymph Node,deep Axill|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|675.00|FSC: 46100; BFG: 52||Not reimbursed separately|675.00|FSC: 46100; BFG: 52||External grouping not supported
43235|EAP|CPT® 43235||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|500.00|FSC: 46100; BFG: 52||Not reimbursed separately|500.00|FSC: 46100; BFG: 52||External grouping not supported
43239|EAP|CPT® 43239||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|EGD TRANSORAL BIOPSY SINGLE/MULTIPLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|570.00|FSC: 46100; BFG: 52||Not reimbursed separately|570.00|FSC: 46100; BFG: 52||External grouping not supported
43249|EAP|CPT® 43249||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,450.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,450.00|FSC: 46100; BFG: 52||External grouping not supported
44970|EAP|CPT® 44970|||Pr Lap,appendectomy|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,017.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,017.00|FSC: 46100; BFG: 52||External grouping not supported
45378|EAP|CPT® 45378||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|653.00|FSC: 46100; BFG: 52||Not reimbursed separately|653.00|FSC: 46100; BFG: 52||External grouping not supported
45380|EAP|CPT® 45380||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|772.00|FSC: 46100; BFG: 52||Not reimbursed separately|772.00|FSC: 46100; BFG: 52||External grouping not supported
45381|EAP|CPT® 45381||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|750.00|FSC: 46100; BFG: 52||Not reimbursed separately|750.00|FSC: 46100; BFG: 52||External grouping not supported
45385|EAP|CPT® 45385||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|874.00|FSC: 46100; BFG: 52||Not reimbursed separately|874.00|FSC: 46100; BFG: 52||External grouping not supported
46050|EAP|CPT® 46050||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr I&d Perianal Abscess,superficial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|295.00|FSC: 46100; BFG: 52||Not reimbursed separately|295.00|FSC: 46100; BFG: 52||External grouping not supported
49505|EAP|CPT® 49505|||Pr Repair Ing Hernia,5+y/o,reducibl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|945.00|FSC: 46100; BFG: 52||Not reimbursed separately|945.00|FSC: 46100; BFG: 52||External grouping not supported
49520|EAP|CPT® 49520|||Pr Repair Recurr Inguin Hern,reducibl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|975.00|FSC: 46100; BFG: 52||Not reimbursed separately|975.00|FSC: 46100; BFG: 52||External grouping not supported
49585|EAP|CPT® 49585|||Pr Repair Umbilical Hern,5+y/o,reduc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|810.00|FSC: 46100; BFG: 52||Not reimbursed separately|810.00|FSC: 46100; BFG: 52||External grouping not supported
50590|EAP|CPT® 50590|||Pr Fragment Kidney Stone/ Eswl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,900.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,900.00|FSC: 46100; BFG: 52||External grouping not supported
51705|EAP|CPT® 51705||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Change Of Bladder Tube,simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.00|FSC: 46100; BFG: 52||Not reimbursed separately|165.00|FSC: 46100; BFG: 52||External grouping not supported
51798|EAP|CPT® 51798||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Meas,post-void Res,us,non-imaging|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 46100; BFG: 52||Not reimbursed separately|35.00|FSC: 46100; BFG: 52||External grouping not supported
52000|EAP|CPT® 52000||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Cystourethroscopy For Diagnosis|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.00|FSC: 46100; BFG: 52||Not reimbursed separately|275.00|FSC: 46100; BFG: 52||External grouping not supported
52005|EAP|CPT® 52005|||Pr Cystourethroscopy,ureter Catheter|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|536.00|FSC: 46100; BFG: 52||Not reimbursed separately|536.00|FSC: 46100; BFG: 52||External grouping not supported
52204|EAP|CPT® 52204|||Pr Cystourethroscopy,biopsies|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|735.00|FSC: 46100; BFG: 52||Not reimbursed separately|735.00|FSC: 46100; BFG: 52||External grouping not supported
52310|EAP|CPT® 52310|||Pr Cystoscopy,remv Calculus,simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|435.00|FSC: 46100; BFG: 52||Not reimbursed separately|435.00|FSC: 46100; BFG: 52||External grouping not supported
52351|EAP|CPT® 52351|||Pr Cysto/uretero/pyeloscopy, Dx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|938.00|FSC: 46100; BFG: 52||Not reimbursed separately|938.00|FSC: 46100; BFG: 52||External grouping not supported
55000|EAP|CPT® 55000|||Pr Drainage Of Hydrocele,tunica|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|175.00|FSC: 46100; BFG: 52||Not reimbursed separately|175.00|FSC: 46100; BFG: 52||External grouping not supported
55040|EAP|CPT® 55040|||Pr Removal Of Hydrocele,tunica,unilat|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|565.00|FSC: 46100; BFG: 52||Not reimbursed separately|565.00|FSC: 46100; BFG: 52||External grouping not supported
56405|EAP|CPT® 56405||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr I&d Of Vulva/perineum Abscess|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.00|FSC: 46100; BFG: 52||Not reimbursed separately|205.00|FSC: 46100; BFG: 52||External grouping not supported
62270|EAP|CPT® 62270|||DIAGNOSTIC LUMBAR SPINAL PUNCTURE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|240.00|FSC: 46100; BFG: 52||Not reimbursed separately|240.00|FSC: 46100; BFG: 52||External grouping not supported
64405|EAP|CPT® 64405||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|INJECTION AA&/STRD GREATER OCCIPITAL NERVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|240.00|FSC: 46100; BFG: 52||Not reimbursed separately|240.00|FSC: 46100; BFG: 52||External grouping not supported
64420|EAP|CPT® 64420|||INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|427.00|FSC: 46100; BFG: 52||Not reimbursed separately|427.00|FSC: 46100; BFG: 52||External grouping not supported
64421|EAP|CPT® 64421|||INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|650.00|FSC: 46100; BFG: 52||Not reimbursed separately|650.00|FSC: 46100; BFG: 52||External grouping not supported
64425|EAP|CPT® 64425|||INJECTION AA&/STRD ILIOINGUINAL IH NERVES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.00|FSC: 46100; BFG: 52||Not reimbursed separately|300.00|FSC: 46100; BFG: 52||External grouping not supported
64445|EAP|CPT® 64445|||INJECTION AA&/STRD SCIATIC NERVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.00|FSC: 46100; BFG: 52||Not reimbursed separately|205.00|FSC: 46100; BFG: 52||External grouping not supported
64447|EAP|CPT® 64447|||INJECTION AA&/STRD FEMORAL NERVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|180.00|FSC: 46100; BFG: 52||Not reimbursed separately|180.00|FSC: 46100; BFG: 52||External grouping not supported
64450|EAP|CPT® 64450||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|135.00|FSC: 46100; BFG: 52||Not reimbursed separately|135.00|FSC: 46100; BFG: 52||External grouping not supported
64520|EAP|CPT® 64520|||Pr Inject Nerv Blck,paravert Sympath|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|270.00|FSC: 46100; BFG: 52||Not reimbursed separately|270.00|FSC: 46100; BFG: 52||External grouping not supported
64640|EAP|CPT® 64640|||Pr Inject Rx Other Periph Nerve|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|601.00|FSC: 46100; BFG: 52||Not reimbursed separately|601.00|FSC: 46100; BFG: 52||External grouping not supported
64721|EAP|CPT® 64721|||Pr Revise Median N/carpal Tunnel Surg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|638.00|FSC: 46100; BFG: 52||Not reimbursed separately|638.00|FSC: 46100; BFG: 52||External grouping not supported
65205|EAP|CPT® 65205||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Remv F.b.,eye,superf Conjunc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|FSC: 46100; BFG: 52||Not reimbursed separately|125.00|FSC: 46100; BFG: 52||External grouping not supported
65220|EAP|CPT® 65220||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Remv F.b.,eye,cornea,no Slit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.00|FSC: 46100; BFG: 52||Not reimbursed separately|130.00|FSC: 46100; BFG: 52||External grouping not supported
69000|EAP|CPT® 69000||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Drain Ext Ear Absc/blood,simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|280.00|FSC: 46100; BFG: 52||Not reimbursed separately|280.00|FSC: 46100; BFG: 52||External grouping not supported
69200|EAP|CPT® 69200||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Remv Fb,ext Aud Canal,w/o Anes|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|185.00|FSC: 46100; BFG: 52||Not reimbursed separately|185.00|FSC: 46100; BFG: 52||External grouping not supported
69210|EAP|CPT® 69210||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
71100|EAP|CPT® 71100|||Pr X-ray Ribs 2 Vw Unilat|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.00|FSC: 46100; BFG: 52||Not reimbursed separately|108.00|FSC: 46100; BFG: 52||External grouping not supported
71130|EAP|CPT® 71130|||Pr X-ray Sterno-clavicluar Jt|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.00|FSC: 46100; BFG: 52||Not reimbursed separately|80.00|FSC: 46100; BFG: 52||External grouping not supported
72040|EAP|CPT® 72040|||RADEX SPINE CERVICAL 2 OR 3 VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
72050|EAP|CPT® 72050|||RADEX SPINE CERVICAL 4 OR 5 VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|FSC: 46100; BFG: 52||Not reimbursed separately|95.00|FSC: 46100; BFG: 52||External grouping not supported
72052|EAP|CPT® 72052|||RADEX SPINE CERVICAL 6 OR MORE VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.00|FSC: 46100; BFG: 52||Not reimbursed separately|115.00|FSC: 46100; BFG: 52||External grouping not supported
72070|EAP|CPT® 72070|||Pr X-ray Thoracic Spine 2 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.00|FSC: 46100; BFG: 52||Not reimbursed separately|80.00|FSC: 46100; BFG: 52||External grouping not supported
72100|EAP|CPT® 72100|||Pr X-ray Lumbar Spine 2/3 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.00|FSC: 46100; BFG: 52||Not reimbursed separately|80.00|FSC: 46100; BFG: 52||External grouping not supported
72120|EAP|CPT® 72120|||RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.00|FSC: 46100; BFG: 52||Not reimbursed separately|115.00|FSC: 46100; BFG: 52||External grouping not supported
72170|EAP|CPT® 72170|||Pr X-ray Pelvis 1/2 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.00|FSC: 46100; BFG: 52||Not reimbursed separately|65.00|FSC: 46100; BFG: 52||External grouping not supported
73000|EAP|CPT® 73000|||Pr X-ray Clavicle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
73030|EAP|CPT® 73030|||Pr X-ray Shoulder 2+ Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73060|EAP|CPT® 73060|||Pr X-ray Humerus|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
73080|EAP|CPT® 73080|||Pr X-ray Elbow 3+ Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73090|EAP|CPT® 73090|||Pr X-ray Forearm 2 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73100|EAP|CPT® 73100|||Pr X-ray Wrist 2 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73110|EAP|CPT® 73110|||Pr X-ray Wrist 3+ Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73130|EAP|CPT® 73130|||Pr X-ray Hand 3+ Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.00|FSC: 46100; BFG: 52||Not reimbursed separately|65.00|FSC: 46100; BFG: 52||External grouping not supported
73140|EAP|CPT® 73140|||Pr X-ray Exam Of Finger(s)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.00|FSC: 46100; BFG: 52||Not reimbursed separately|60.00|FSC: 46100; BFG: 52||External grouping not supported
73560|EAP|CPT® 73560|||Pr X-ray Knee 1 Or 2 View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
73562|EAP|CPT® 73562|||Pr X-ray Knee 3 View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
73564|EAP|CPT® 73564|||Pr X-ray Knee 4+ View|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.00|FSC: 46100; BFG: 52||Not reimbursed separately|150.00|FSC: 46100; BFG: 52||External grouping not supported
73600|EAP|CPT® 73600|||Pr X-ray Ankle 2 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73610|EAP|CPT® 73610|||Pr X-ray Ankle 3+ Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73620|EAP|CPT® 73620|||Pr X-ray Foot 2 Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
73630|EAP|CPT® 73630|||Pr X-ray Foot 3+ Vw|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.00|FSC: 46100; BFG: 52||Not reimbursed separately|80.00|FSC: 46100; BFG: 52||External grouping not supported
73650|EAP|CPT® 73650|||Pr X-ray Heel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|80.00|FSC: 46100; BFG: 52||Not reimbursed separately|80.00|FSC: 46100; BFG: 52||External grouping not supported
76815|EAP|CPT® 76815||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Us,pregnant Uterus,limited, 1/> Fetuses|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|122.00|FSC: 46100; BFG: 52||Not reimbursed separately|122.00|FSC: 46100; BFG: 52||External grouping not supported
76942|EAP|CPT® 76942|||Pr Sono Guide Needle Placement|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.40|FSC: 46100; BFG: 52||Not reimbursed separately|125.40|FSC: 46100; BFG: 52||External grouping not supported
82274|EAP|CPT® 82274||0300 - LABORATORY - GENERAL CLASSIFICATION|Chg Blood,occult,fecal Hgb,feces,1-3 Simult|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.00|FSC: 46100; BFG: 52||Not reimbursed separately|25.00|FSC: 46100; BFG: 52||External grouping not supported
97597|EAP|CPT® 97597||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Active Wound Care/20 Cm Or <|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|119.00|FSC: 46100; BFG: 52||Not reimbursed separately|119.00|FSC: 46100; BFG: 52||External grouping not supported
97598|EAP|CPT® 97598|||Pr Active Wound Care > 20 Cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.00|FSC: 46100; BFG: 52||Not reimbursed separately|85.00|FSC: 46100; BFG: 52||External grouping not supported
92950|EAP|CPT® 92950|||Pr Heart/lung Resuscitation (cpr)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|490.00|FSC: 46100; BFG: 52||Not reimbursed separately|490.00|FSC: 46100; BFG: 52||External grouping not supported
99024|EAP|CPT® 99024|||Post-op Follow-up Visit|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 46100||Not reimbursed separately|0.00|FSC: 46100||External grouping not supported
99201|EAP|CPT® 99201||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE OUTPT NEW VISIT LEVEL 1|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.00|FSC: 46100; BFG: 52||Not reimbursed separately|65.00|FSC: 46100; BFG: 52||External grouping not supported
99202|EAP|CPT® 99202||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
99203|EAP|CPT® 99203||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.00|FSC: 46100; BFG: 52||Not reimbursed separately|160.00|FSC: 46100; BFG: 52||External grouping not supported
99204|EAP|CPT® 99204||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|FSC: 46100; BFG: 52||Not reimbursed separately|250.00|FSC: 46100; BFG: 52||External grouping not supported
99205|EAP|CPT® 99205||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|310.00|FSC: 46100; BFG: 52||Not reimbursed separately|310.00|FSC: 46100; BFG: 52||External grouping not supported
99211|EAP|CPT® 99211||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 46100; BFG: 52||Not reimbursed separately|35.00|FSC: 46100; BFG: 52||External grouping not supported
99212|EAP|CPT® 99212||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.00|FSC: 46100; BFG: 52||Not reimbursed separately|65.00|FSC: 46100; BFG: 52||External grouping not supported
99213|EAP|CPT® 99213||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
99214|EAP|CPT® 99214||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.00|FSC: 46100; BFG: 52||Not reimbursed separately|160.00|FSC: 46100; BFG: 52||External grouping not supported
99215|EAP|CPT® 99215||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|215.00|FSC: 46100; BFG: 52||Not reimbursed separately|215.00|FSC: 46100; BFG: 52||External grouping not supported
99217|EAP|CPT® 99217|||OBSERVATION CARE DISCHARGE MANAGEMENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
99218|EAP|CPT® 99218|||INITIAL OBSERVATION CARE/DAY 30 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.00|FSC: 46100; BFG: 52||Not reimbursed separately|150.00|FSC: 46100; BFG: 52||External grouping not supported
99219|EAP|CPT® 99219|||INITIAL OBSERVATION CARE/DAY 50 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.00|FSC: 46100; BFG: 52||Not reimbursed separately|205.00|FSC: 46100; BFG: 52||External grouping not supported
99220|EAP|CPT® 99220|||INITIAL OBSERVATION CARE/DAY 70 MINUTES|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|280.00|FSC: 46100; BFG: 52||Not reimbursed separately|280.00|FSC: 46100; BFG: 52||External grouping not supported
99221|EAP|CPT® 99221|||INITIAL HOSPITAL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|155.00|FSC: 46100; BFG: 52||Not reimbursed separately|155.00|FSC: 46100; BFG: 52||External grouping not supported
99222|EAP|CPT® 99222|||INITIAL HOSPITAL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|210.00|FSC: 46100; BFG: 52||Not reimbursed separately|210.00|FSC: 46100; BFG: 52||External grouping not supported
99223|EAP|CPT® 99223|||INITIAL HOSPITAL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|310.00|FSC: 46100; BFG: 52||Not reimbursed separately|310.00|FSC: 46100; BFG: 52||External grouping not supported
99231|EAP|CPT® 99231|||SBSQ HOSPITAL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
99232|EAP|CPT® 99232|||SBSQ HOSPITAL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
99233|EAP|CPT® 99233|||SBSQ HOSPITAL CARE/DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.00|FSC: 46100; BFG: 52||Not reimbursed separately|160.00|FSC: 46100; BFG: 52||External grouping not supported
99235|EAP|CPT® 99235|||OBSERVATION/INPATIENT HOSP CARE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|330.00|FSC: 46100; BFG: 52||Not reimbursed separately|330.00|FSC: 46100; BFG: 52||External grouping not supported
99236|EAP|CPT® 99236|||OBSERVATION/INPATIENT HOSP CARE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|395.00|FSC: 46100; BFG: 52||Not reimbursed separately|395.00|FSC: 46100; BFG: 52||External grouping not supported
99238|EAP|CPT® 99238|||PR HOSPITAL DISCHARGE DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.00|FSC: 46100; BFG: 52||Not reimbursed separately|108.00|FSC: 46100; BFG: 52||External grouping not supported
99239|EAP|CPT® 99239|||PR HOSPITAL DISCHARGE DAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.00|FSC: 46100; BFG: 52||Not reimbursed separately|165.00|FSC: 46100; BFG: 52||External grouping not supported
99241|EAP|CPT® 99241|||OFFICE CONSULT NEW/ESTAB|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|FSC: 46100; BFG: 52||Not reimbursed separately|95.00|FSC: 46100; BFG: 52||External grouping not supported
99242|EAP|CPT® 99242|||OFFICE CONSULTAT NEW/ESTAB|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|FSC: 46100; BFG: 52||Not reimbursed separately|125.00|FSC: 46100; BFG: 52||External grouping not supported
99243|EAP|CPT® 99243|||OFFICE CONSULT NEW/ESTAB|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|175.00|FSC: 46100; BFG: 52||Not reimbursed separately|175.00|FSC: 46100; BFG: 52||External grouping not supported
99244|EAP|CPT® 99244|||OFFICE CONSULT NEW/ESTAB|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|255.00|FSC: 46100; BFG: 52||Not reimbursed separately|255.00|FSC: 46100; BFG: 52||External grouping not supported
99251|EAP|CPT® 99251|||INITL INPATIENT CONSULT NEW/EST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.00|FSC: 46100; BFG: 52||Not reimbursed separately|85.00|FSC: 46100; BFG: 52||External grouping not supported
99252|EAP|CPT® 99252|||INITL INPATIENT CONSULT NEW/EST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
99253|EAP|CPT® 99253|||INITL INPATIENT CONSULT NEW/EST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.00|FSC: 46100; BFG: 52||Not reimbursed separately|165.00|FSC: 46100; BFG: 52||External grouping not supported
99254|EAP|CPT® 99254|||INITL INPATIENT CONSULT NEW/EST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|235.00|FSC: 46100; BFG: 52||Not reimbursed separately|235.00|FSC: 46100; BFG: 52||External grouping not supported
99255|EAP|CPT® 99255|||INITIAL INPATIENT CONSULT NEW/EST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|285.00|FSC: 46100; BFG: 52||Not reimbursed separately|285.00|FSC: 46100; BFG: 52||External grouping not supported
99282|EAP|CPT® 99282|||EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
99283|EAP|CPT® 99283|||EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.00|FSC: 46100; BFG: 52||Not reimbursed separately|100.00|FSC: 46100; BFG: 52||External grouping not supported
99284|EAP|CPT® 99284|||EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|180.00|FSC: 46100; BFG: 52||Not reimbursed separately|180.00|FSC: 46100; BFG: 52||External grouping not supported
99285|EAP|CPT® 99285|||EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|265.00|FSC: 46100; BFG: 52||Not reimbursed separately|265.00|FSC: 46100; BFG: 52||External grouping not supported
99291|EAP|CPT® 99291|||CRITICAL CARE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|415.00|FSC: 46100; BFG: 52||Not reimbursed separately|415.00|FSC: 46100; BFG: 52||External grouping not supported
99292|EAP|CPT® 99292|||CRITICAL CARE, ADDITIONAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|190.00|FSC: 46100; BFG: 52||Not reimbursed separately|190.00|FSC: 46100; BFG: 52||External grouping not supported
99347|EAP|CPT® 99347||0522 - FREE-STANDING CLINIC - HOME VISIT BY RHC/FQHC PRACTITIONER|HOME VISIT EST PT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.00|FSC: 46100; BFG: 52||Not reimbursed separately|85.00|FSC: 46100; BFG: 52||External grouping not supported
99356|EAP|CPT® 99356|||PROLONGED SVC I/P OR OBS SETTING 1ST HOUR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.00|FSC: 46100; BFG: 52||Not reimbursed separately|140.00|FSC: 46100; BFG: 52||External grouping not supported
99357|EAP|CPT® 99357|||PROLONGED SVC I/P|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.00|FSC: 46100; BFG: 52||Not reimbursed separately|140.00|FSC: 46100; BFG: 52||External grouping not supported
99358|EAP|CPT® 99358|||PROLNG E/M SVC BEFORE&/AFTER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|180.00|FSC: 46100; BFG: 52||Not reimbursed separately|180.00|FSC: 46100; BFG: 52||External grouping not supported
99387|EAP|CPT® 99387|||Pr Prevent Vst, New Pt 65 & Older|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|230.00|FSC: 46100; BFG: 52||Not reimbursed separately|230.00|FSC: 46100; BFG: 52||External grouping not supported
G0105|EAP|HCPCS G0105||0490 - AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION|Colorectal Scrn; Hi Risk Ind|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|725.00|FSC: 46100; BFG: 52||Not reimbursed separately|725.00|FSC: 46100; BFG: 52||External grouping not supported
15004|EAP|CPT® 15004|||Pr Wnd Prep Ped, Face/nck/hnd/ft/gen|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|610.00|FSC: 46100; BFG: 52||Not reimbursed separately|610.00|FSC: 46100; BFG: 52||External grouping not supported
19301|EAP|CPT® 19301|||Pr Mastectomy, Partial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,000.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,000.00|FSC: 46100; BFG: 52||External grouping not supported
25607|EAP|CPT® 25607|||Pr Open Rx Distal Radius Fx, Extra-articular|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,660.75|FSC: 46100; BFG: 52||Not reimbursed separately|1,660.75|FSC: 46100; BFG: 52||External grouping not supported
77002|EAP|CPT® 77002|||FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|135.00|FSC: 46100; BFG: 52||Not reimbursed separately|135.00|FSC: 46100; BFG: 52||External grouping not supported
77073|EAP|CPT® 77073|||Pr X-rays, Bone Length Studies|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|89.83|FSC: 46100; BFG: 52||Not reimbursed separately|89.83|FSC: 46100; BFG: 52||External grouping not supported
Q4010|EAP|HCPCS Q4010|||Cast Sup Sht Arm Adult Fbrgl|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 46100; BFG: 52||Not reimbursed separately|35.00|FSC: 46100; BFG: 52||External grouping not supported
S2900|EAP|HCPCS S2900|||Robotic Surgical System|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|FSC: 46100||Not reimbursed separately|0.00|FSC: 46100||External grouping not supported
10021|EAP|CPT® 10021||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|220.00|FSC: 46100; BFG: 52||Not reimbursed separately|220.00|FSC: 46100; BFG: 52||External grouping not supported
10060|EAP|CPT® 10060||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Drain Skin Abscess Simple/single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|242.33|FSC: 46100; BFG: 52||Not reimbursed separately|242.33|FSC: 46100; BFG: 52||External grouping not supported
10061|EAP|CPT® 10061|||Pr Drain Skin Abscess Complic/multiple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|310.00|FSC: 46100; BFG: 52||Not reimbursed separately|310.00|FSC: 46100; BFG: 52||External grouping not supported
10080|EAP|CPT® 10080||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Drain Pilonidal Cyst Simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|265.00|FSC: 46100; BFG: 52||Not reimbursed separately|265.00|FSC: 46100; BFG: 52||External grouping not supported
10120|EAP|CPT® 10120||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Incision/remove Fb Subq Simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|225.00|FSC: 46100; BFG: 52||Not reimbursed separately|225.00|FSC: 46100; BFG: 52||External grouping not supported
10160|EAP|CPT® 10160||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Puncture/drain, Abscess/hematoma/cyst|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|195.00|FSC: 46100; BFG: 52||Not reimbursed separately|195.00|FSC: 46100; BFG: 52||External grouping not supported
10180|EAP|CPT® 10180|||Pr I/d Complex, Postop Wound Infection|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|415.00|FSC: 46100; BFG: 52||Not reimbursed separately|415.00|FSC: 46100; BFG: 52||External grouping not supported
11042|EAP|CPT® 11042||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Debridement, Skin, Sub-q Tissue|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|185.00|FSC: 46100; BFG: 52||Not reimbursed separately|185.00|FSC: 46100; BFG: 52||External grouping not supported
11043|EAP|CPT® 11043|||Pr Debridement, Skin, Sub-q Tissue,muscle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|490.00|FSC: 46100; BFG: 52||Not reimbursed separately|490.00|FSC: 46100; BFG: 52||External grouping not supported
11055|EAP|CPT® 11055||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Trim Hyperkeratotic Skin Lesion, One|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
11056|EAP|CPT® 11056|||Pr Trim Hyperkeratotic Skin Lesion,2-4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.00|FSC: 46100; BFG: 52||Not reimbursed separately|85.00|FSC: 46100; BFG: 52||External grouping not supported
11400|EAP|CPT® 11400||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Exc Skin Benig </= 0.5cm Trunk,arm,leg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|181.00|FSC: 46100; BFG: 52||Not reimbursed separately|181.00|FSC: 46100; BFG: 52||External grouping not supported
11403|EAP|CPT® 11403|||Pr Exc Skin Benig 2.1-3cm Trunk,arm,leg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|285.00|FSC: 46100; BFG: 52||Not reimbursed separately|285.00|FSC: 46100; BFG: 52||External grouping not supported
11421|EAP|CPT® 11421|||Pr Exc Skin Benig 0.6-1cm Remaindr Body|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|235.00|FSC: 46100; BFG: 52||Not reimbursed separately|235.00|FSC: 46100; BFG: 52||External grouping not supported
11602|EAP|CPT® 11602||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Exc Skin Malig 1.1-2cm Trunk,arm,leg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|365.00|FSC: 46100; BFG: 52||Not reimbursed separately|365.00|FSC: 46100; BFG: 52||External grouping not supported
11603|EAP|CPT® 11603|||Pr Exc Skin Malig 2.1-3cm Trunk,arm,leg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|415.00|FSC: 46100; BFG: 52||Not reimbursed separately|415.00|FSC: 46100; BFG: 52||External grouping not supported
11604|EAP|CPT® 11604|||Pr Exc Skin Malig 3.1-4cm Trunk,arm,leg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|465.00|FSC: 46100; BFG: 52||Not reimbursed separately|465.00|FSC: 46100; BFG: 52||External grouping not supported
11606|EAP|CPT® 11606||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Exc Skin Malig > 4cm Trunk,arm,leg|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|670.00|FSC: 46100; BFG: 52||Not reimbursed separately|670.00|FSC: 46100; BFG: 52||External grouping not supported
11621|EAP|CPT® 11621|||Pr Exc Skin Malig 0.6-1cm Remaindr Body|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|340.00|FSC: 46100; BFG: 52||Not reimbursed separately|340.00|FSC: 46100; BFG: 52||External grouping not supported
11641|EAP|CPT® 11641|||Pr Exc Skin Malig 0.6-1cm Face,facial|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|360.00|FSC: 46100; BFG: 52||Not reimbursed separately|360.00|FSC: 46100; BFG: 52||External grouping not supported
11719|EAP|CPT® 11719||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Trim Nail(s)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.00|FSC: 46100; BFG: 52||Not reimbursed separately|35.00|FSC: 46100; BFG: 52||External grouping not supported
11720|EAP|CPT® 11720|||Pr Debridement Of Nail(s), 1-5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.00|FSC: 46100; BFG: 52||Not reimbursed separately|70.00|FSC: 46100; BFG: 52||External grouping not supported
11721|EAP|CPT® 11721|||Pr Debridement Of Nails, 6 Or More|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|FSC: 46100; BFG: 52||Not reimbursed separately|95.00|FSC: 46100; BFG: 52||External grouping not supported
11730|EAP|CPT® 11730||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Removal,nail Plate,simple/single|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|154.00|FSC: 46100; BFG: 52||Not reimbursed separately|154.00|FSC: 46100; BFG: 52||External grouping not supported
11740|EAP|CPT® 11740||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Drain Blood From Under Nail|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|FSC: 46100; BFG: 52||Not reimbursed separately|75.00|FSC: 46100; BFG: 52||External grouping not supported
11750|EAP|CPT® 11750||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Removal Of Nail Bed|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|335.00|FSC: 46100; BFG: 52||Not reimbursed separately|335.00|FSC: 46100; BFG: 52||External grouping not supported
11760|EAP|CPT® 11760||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Reconstruc Of Nail Bed|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|340.00|FSC: 46100; BFG: 52||Not reimbursed separately|340.00|FSC: 46100; BFG: 52||External grouping not supported
11900|EAP|CPT® 11900||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Injection, Intralesional, Up To And Including 7 Lesions|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|85.00|FSC: 46100; BFG: 52||Not reimbursed separately|85.00|FSC: 46100; BFG: 52||External grouping not supported
12001|EAP|CPT® 12001||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Repr Superf Wnd Body </= 2.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|190.00|FSC: 46100; BFG: 52||Not reimbursed separately|190.00|FSC: 46100; BFG: 52||External grouping not supported
12002|EAP|CPT® 12002|||Pr Repr Superf Wnd Body 2.6-7.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.00|FSC: 46100; BFG: 52||Not reimbursed separately|205.00|FSC: 46100; BFG: 52||External grouping not supported
12004|EAP|CPT® 12004||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Repr Superf Wnd Body 7.6-12.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|240.00|FSC: 46100; BFG: 52||Not reimbursed separately|240.00|FSC: 46100; BFG: 52||External grouping not supported
12011|EAP|CPT® 12011||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Repr Superf Wnd Face </= 2.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|200.00|FSC: 46100; BFG: 52||Not reimbursed separately|200.00|FSC: 46100; BFG: 52||External grouping not supported
12013|EAP|CPT® 12013||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Repr Superf Wnd Face 2.6-5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|225.00|FSC: 46100; BFG: 52||Not reimbursed separately|225.00|FSC: 46100; BFG: 52||External grouping not supported
12014|EAP|CPT® 12014|||Pr Repr Superf Wnd Face 5.1-7.5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|260.00|FSC: 46100; BFG: 52||Not reimbursed separately|260.00|FSC: 46100; BFG: 52||External grouping not supported
12020|EAP|CPT® 12020||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Closure Superf Wnd Dehis Simple|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|450.00|FSC: 46100; BFG: 52||Not reimbursed separately|450.00|FSC: 46100; BFG: 52||External grouping not supported
12031|EAP|CPT® 12031||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Layr Clos Wnd Trunk,arm,leg </= 2.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|350.00|FSC: 46100; BFG: 52||Not reimbursed separately|350.00|FSC: 46100; BFG: 52||External grouping not supported
12032|EAP|CPT® 12032|||Pr Layr Clos Wnd Trunk,arm,leg 2.6-7.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|440.00|FSC: 46100; BFG: 52||Not reimbursed separately|440.00|FSC: 46100; BFG: 52||External grouping not supported
12034|EAP|CPT® 12034||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Layr Clos Wnd Trunk,arm,leg 7.6-12.5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|460.00|FSC: 46100; BFG: 52||Not reimbursed separately|460.00|FSC: 46100; BFG: 52||External grouping not supported
12037|EAP|CPT® 12037|||Pr Layr Clos Wnd Trunk,arm,leg >30cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|704.00|FSC: 46100; BFG: 52||Not reimbursed separately|704.00|FSC: 46100; BFG: 52||External grouping not supported
12041|EAP|CPT® 12041||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Layr Clos Wnd Rest Body </= 2.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|355.00|FSC: 46100; BFG: 52||Not reimbursed separately|355.00|FSC: 46100; BFG: 52||External grouping not supported
12042|EAP|CPT® 12042|||Pr Layr Clos Wnd Rest Body 2.6-7.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|425.00|FSC: 46100; BFG: 52||Not reimbursed separately|425.00|FSC: 46100; BFG: 52||External grouping not supported
12051|EAP|CPT® 12051||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Layr Clos Wnd Face,facial </= 2.5cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|380.00|FSC: 46100; BFG: 52||Not reimbursed separately|380.00|FSC: 46100; BFG: 52||External grouping not supported
13131|EAP|CPT® 13131|||Pr Repr Cmpl Wnd Head,fac,hand 1.1-2.5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|610.00|FSC: 46100; BFG: 52||Not reimbursed separately|610.00|FSC: 46100; BFG: 52||External grouping not supported
14040|EAP|CPT® 14040|||Pr Adj Tiss Xfer Head,fac,hand <10sqcm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,135.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,135.00|FSC: 46100; BFG: 52||External grouping not supported
16020|EAP|CPT® 16020||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Dress/debrid Small Burn <5%tbsa|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.00|FSC: 46100; BFG: 52||Not reimbursed separately|120.00|FSC: 46100; BFG: 52||External grouping not supported
17110|EAP|CPT® 17110||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Destruc Benign Lesion, Up To 14 Lesions|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|161.00|FSC: 46100; BFG: 52||Not reimbursed separately|161.00|FSC: 46100; BFG: 52||External grouping not supported
17250|EAP|CPT® 17250||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|CHEMICAL CAUTERIZATION OF GRANULATION TISSUE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.00|FSC: 46100; BFG: 52||Not reimbursed separately|120.00|FSC: 46100; BFG: 52||External grouping not supported
19125|EAP|CPT® 19125|||Pr Excise Breast Les W Xray Marker|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|930.00|FSC: 46100; BFG: 52||Not reimbursed separately|930.00|FSC: 46100; BFG: 52||External grouping not supported
20103|EAP|CPT® 20103|||Pr Explore Wound,extremity|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|865.00|FSC: 46100; BFG: 52||Not reimbursed separately|865.00|FSC: 46100; BFG: 52||External grouping not supported
20525|EAP|CPT® 20525||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Removal Of Foreign Body Deep/complica|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|705.00|FSC: 46100; BFG: 52||Not reimbursed separately|705.00|FSC: 46100; BFG: 52||External grouping not supported
20526|EAP|CPT® 20526|||Pr Inject Carpal Tunnel|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.00|FSC: 46100; BFG: 52||Not reimbursed separately|115.00|FSC: 46100; BFG: 52||External grouping not supported
20550|EAP|CPT® 20550||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Inject Tendon Sheath/ligament|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.00|FSC: 46100; BFG: 52||Not reimbursed separately|130.00|FSC: 46100; BFG: 52||External grouping not supported
20551|EAP|CPT® 20551|||Pr Inject Tendon Origin/insert|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|FSC: 46100; BFG: 52||Not reimbursed separately|125.00|FSC: 46100; BFG: 52||External grouping not supported
20552|EAP|CPT® 20552||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Inject Trigger Point,si/mult, 1-2 Musc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.00|FSC: 46100; BFG: 52||Not reimbursed separately|120.00|FSC: 46100; BFG: 52||External grouping not supported
20553|EAP|CPT® 20553|||Pr Inject Trigger Points,si/mult,3+musc|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|FSC: 46100; BFG: 52||Not reimbursed separately|125.00|FSC: 46100; BFG: 52||External grouping not supported
20600|EAP|CPT® 20600||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.00|FSC: 46100; BFG: 52||Not reimbursed separately|100.00|FSC: 46100; BFG: 52||External grouping not supported
20605|EAP|CPT® 20605|||ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|FSC: 46100; BFG: 52||Not reimbursed separately|110.00|FSC: 46100; BFG: 52||External grouping not supported
20610|EAP|CPT® 20610||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|155.00|FSC: 46100; BFG: 52||Not reimbursed separately|155.00|FSC: 46100; BFG: 52||External grouping not supported
20612|EAP|CPT® 20612|||Pr Aspirat/injection Ganglion Cyst(s)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.00|FSC: 46100; BFG: 52||Not reimbursed separately|100.00|FSC: 46100; BFG: 52||External grouping not supported
20680|EAP|CPT® 20680|||Pr Removal Deep Implant|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|930.00|FSC: 46100; BFG: 52||Not reimbursed separately|930.00|FSC: 46100; BFG: 52||External grouping not supported
20692|EAP|CPT® 20692|||Pr Apply Bone Multiplan,ext Fix Dev|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,715.00|FSC: 46100; BFG: 52||Not reimbursed separately|1,715.00|FSC: 46100; BFG: 52||External grouping not supported
21550|EAP|CPT® 21550|||Pr Biopsy Soft Tissue Neck/chest|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|380.00|FSC: 46100; BFG: 52||Not reimbursed separately|380.00|FSC: 46100; BFG: 52||External grouping not supported
23120|EAP|CPT® 23120|||Pr Partial Removal, Clavicle|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|868.00|FSC: 46100; BFG: 52||Not reimbursed separately|868.00|FSC: 46100; BFG: 52||External grouping not supported
23500|EAP|CPT® 23500||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Closed Tx Clavicle Fracture W/o Manip|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|321.00|FSC: 46100; BFG: 52||Not reimbursed separately|321.00|FSC: 46100; BFG: 52||External grouping not supported
23650|EAP|CPT® 23650||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Closed Rx Shldr Dislocation|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|463.00|FSC: 46100; BFG: 52||Not reimbursed separately|463.00|FSC: 46100; BFG: 52||External grouping not supported
23655|EAP|CPT® 23655|||Pr Closed Rx Shldr Disloc,anesthesia|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|594.00|FSC: 46100; BFG: 52||Not reimbursed separately|594.00|FSC: 46100; BFG: 52||External grouping not supported
24075|EAP|CPT® 24075|||Pr Exc Tumor Soft Tiss Upper Arm/elbow Subq <3cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|735.00|FSC: 46100; BFG: 52||Not reimbursed separately|735.00|FSC: 46100; BFG: 52||External grouping not supported
24640|EAP|CPT® 24640||0521 - FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC|Pr Closed Rx Radial Head Disloc,child|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|146.00|FSC: 46100; BFG: 52||Not reimbursed separately|146.00|FSC: 46100; BFG: 52||External grouping not supported
25111|EAP|CPT® 25111|||Pr Excis Primary Ganglion Wrist|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|495.00|FSC: 46100; BFG: 52||Not reimbursed separately|495.00|FSC: 46100; BFG: 52||External grouping not supported
25530|EAP|CPT® 25530|||Pr Closed Rx Ulna Shaft Fx|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|405.00|FSC: 46100; BFG: 52||Not reimbursed separately|405.00|FSC: 46100; BFG: 52||External grouping not supported
25565|EAP|CPT® 25565|||Pr Closed Rx Rad/ulna Shaft Fx,manip|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|761.00|FSC: 46100; BFG: 52||Not reimbursed separately|761.00|FSC: 46100; BFG: 52||External grouping not supported
25176|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEALER-LIGASURE CURVER SMALL JAW|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,200.63|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,200.63|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25175|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEALER-LAP BLUNG TIP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,339.38|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,339.38|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25176|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEALER - LIGASURE CURVED SMALL JAW|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,018.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,018.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25178|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-SCP 2/ACCUPORT SIDE-DELIVERY 11GA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5,900.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|5,900.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25205|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|APPLIER CLIP AUTO ENDO 5CLIP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|620.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|620.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25184|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PROGRIP MESH 15X10CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,048.24|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,048.24|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25175|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEALER LIGASURE BLUNT TIP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,018.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,018.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25177|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SEALER LIGASURE CURVED LARGE JAW OPEN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,300.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,300.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25179|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOE JOINT POROUS COATED SM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25180|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOE JOINT POROUS COATED MS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25181|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOE JOINT POROUS COATED MD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25182|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOE JOINT POROUS COATED ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25183|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOE JOINT POROUS COATED LG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,500.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25192|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR-BALLOON 6-7-8 EZDILATE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|860.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|860.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25193|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR-BALLOON 8.5-9.5-10 EZDILATE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|860.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|860.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25194|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DILATOR-BALLOON 11-12-13 EZDILATE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|860.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|860.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25195|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INFLATION DEVICE FOR EGD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|175.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|175.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25196|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|QUICKCLIP PRO 230CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|739.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|739.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25198|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLER EHELON FLEX 60|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,066.38|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,066.38|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25199|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELOAD ENDO LINEAR WHITE 60|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|960.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|960.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25206|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VIDEOSCOPE FLEXIBLE AMBU ASCOPE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|914.04|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|914.04|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25230|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE CLIPPER 3M|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000007|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SECURESTRAP FIXATION DEVICE 5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,497.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,497.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000010|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MASK LMA SUPREME AIRWAY SZ3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000011|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MASK LMA AIRWAY SUPREME SIZE 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000012|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MASK LMA AIRWAY SUPREME SIZE 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000019|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ON-Q INFUSION PUMP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|777.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|777.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000029|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR 3.0MM ROUND FLUTED 5120-10-30|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|358.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|358.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000030|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING SILVERLON 4IN X 8IN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|125.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000031|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING SILVERLON 4IN X 11IN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|167.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|167.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000038|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPONGE SURGIFOAM GELATIN 8CMX12.5CMX1CM SIZE 100|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|103.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000041|SUP|Custom 27000001||0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION|ENDOSCOPIC TATTOO 5ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|190.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|190.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000045|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|AUTOPLEX WITH VERAPLEX HV|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,612.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,612.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000046|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|IVAS 13G 15MM BALLOON KIT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,333.32|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|3,333.32|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000047|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|13G IVAS DRILL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|750.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|750.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000048|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|13G IVAS BONE BIOPSY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|507.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|507.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000074|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAIN CHEST DRY SUCTION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|158.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|158.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000075|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY THORACENTESIS SAFETY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|283.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|283.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000076|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY THORACIC VENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|684.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|684.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000087|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HANDPIECE MINERVA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,100.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,100.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000098|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLEURX DRAINAGE KIT 1000ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|339.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|339.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000099|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ENDO STITCH SURGIDAC 2-0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|775.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|775.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000100|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ENDO STITCH SURGIDAC 0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|775.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|775.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000106|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLIP RESOLUTION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|818.31|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|818.31|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000115|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET PERICARDIOCENTESIS G02433|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|530.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|530.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000116|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT CRICOTHYROTOMY 100/465/060|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|637.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|637.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000121|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KII DISSECTING BALLOON SYSTEM OVAL-AF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,050.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,050.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000126|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEPS-GRASPING FORCEPS/RETRIEVAL BASKET FG-54D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|643.44|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|643.44|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000132|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD PROXIMATE 75MM LINEAR GREEN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|342.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|342.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000146|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEP BIOPSY DISP FB-231D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|117.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|117.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000172|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY PERICARDIOCENTESIS CATHETER TRAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|627.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|627.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000173|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET MELKER EMERGENCY CUFFED CRICOTHYROTOMY CATHETER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|675.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|675.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000174|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR OPTICAL RPF 5-12MM VISIPORT PLUS W/SLEEVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|309.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|309.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000192|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MOSS GASTROSTOMY TUBE 18FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|765.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|765.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000194|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE EXCELON BRONCHIAL ASPIRATION NEEDLE 19G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|558.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|558.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000195|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE EXCELON BRONCHIAL ASPIRATION NEEDLE 21G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|558.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|558.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000203|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CERVICAL BALLOON W/STYLET COOK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|208.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000226|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE ONESTEP COMPLETE RESUSCITATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|344.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|344.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000227|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE ONESTEP PEDIATRIC CPR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|325.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|325.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000262|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SURGIFOAM ABSORBABLE GELATIN SPONGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|103.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000283|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEPS GRASPING 3FR SPIRAL BASKET DISPOSABLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|604.11|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|604.11|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000294|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE ANCHOR NANO CORKSCREW|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|4,250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000298|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FIBERLOOP 4-0 10" WHITE W/TAPERED NEEDLE, 12.7MM 1/2 CIRCLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000318|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DISPOSABLE BALLOON CATHETER (B5-2C)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|560.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|560.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000323|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FLEXSEAL FMS SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|806.94|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|806.94|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000328|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH PROLENE 12X12 ETHICON PML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|715.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|715.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000330|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 30 X 30 CM NON-COATED POLYPROPYLENE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000348|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VICRYL 30X30 VKML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,444.86|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,444.86|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000349|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KNIFE CUTTING INEGRA SAFEGUARD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|868.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|868.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000350|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEPS CUTTING HALO PKS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,442.82|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,442.82|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000351|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|JET-X MINI DISTAL RADIUS KIT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5,239.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|5,239.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000468|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER RESOLVE LOCKING DRAINAGE 10FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|299.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|299.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000490|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COMMON BILE DUCT EXPLORATION SET|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,905.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,905.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000530|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLASMA LOOP MEDIUM 12|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,322.88|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,322.88|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000523|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLASMA BAND 12|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,322.88|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,322.88|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000524|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLASMA BUTTON|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,380.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,380.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000525|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLASMA OVAL BUTTON|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,093.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,093.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000526|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PLASMA ROLLER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,322.88|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,322.88|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000566|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ENDOSCOPIC SUTURE DEVICE ENDO STITCH 10MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,085.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,085.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000627|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 10FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000628|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 12FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000629|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 14FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000630|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 16FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000631|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 18FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000632|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 20FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000633|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 22FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000634|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER DILATATION HEYMAN FOLLOWER 24FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000638|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE BUGBEE 5FR 58CM LONG BE-558|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|346.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|346.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000680|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NCIRCLE TIPLESS STONE EXTRACTOR 2.2Fr. X 115CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|634.26|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|634.26|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000681|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NGAGE NITINOL STONE EXTRACTOR 1.7Fr. X 115CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|707.13|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|707.13|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000682|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BASKET UROLOGICAL TIPLESS 115cm 4 wire 1.5fr Nitinol 10mm DISPOSABLE NCIRCLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|716.13|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|716.13|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000683|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Basket Urological Tipless 115cm 4 wire 2.5fr Nitinol 10mm di|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|707.13|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|707.13|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000684|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Motion PTFE-Nitinol Hybrid Guidewire .038 150cm Straight 3cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|319.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|319.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000685|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|Motion PTFE-Nitinol Hybrid Guidewire .035 150cm Straight 3cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|319.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|319.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000686|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HIWIRE NITINOL CORE WIRE GUIDE WITH HYDROPHILIC COATING .035|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|165.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000687|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HIWIRE NITINOL CORE WIRE GUIDE WITH HYDROPHILIC COATING .035|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|167.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|167.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000688|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6french X 20 cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000689|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6french X 22 cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000690|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6french X 24 cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000691|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6french X 26 cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000692|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6french X 28 cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000693|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6french X 30 cm|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000694|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 6FRENCH MULTILENGTH|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000695|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 5FRENCH X 24CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000696|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|UNIVERSA FIRM URETERAL STENT SET 5FRENCH X 26CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|300.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|300.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000697|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AQ LONG TAPER URETERAL DILATOR 6-12FR 60CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|106.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|106.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000698|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|URETERAL DILATOR SET 6FR-18FR 60CM DILATORS WITH AQ HYDROPHI|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|871.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|871.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000699|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AMPLATZ RENAL DILATOR SET|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|660.93|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|660.93|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000700|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DUAL LUMEN URETERAL CATHETER 10FR 50CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|170.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|170.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000701|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FLEXOR URETERAL ACCESS SHEATH 12FR 28CM WITH AQ HYDROPHILIC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|665.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|665.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000702|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FLEXOR URETERAL ACCESS SHEATH 12FR 35CM WITH AQ HYDROPHILIC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|665.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|665.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000703|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FLEXOR URETERAL ACCESS SHEATH 12FR 45CM WITH AQ HYDROPHILIC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|665.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|665.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000706|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CUP BIOPSY FORCEPS 3FR 115CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,006.44|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,006.44|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000707|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ULTRAXX NEPHROSTOMY BALLOON SET 10MM X 15CM WITH TFE SHEATH|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|822.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|822.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000708|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COOK QUANTA OPTICAL FIBER 272 UM - SINGLE USE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|701.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|701.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000709|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COOK QUANTA OPTICAL FIBER 200UM - SINGLE USE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|701.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|701.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000710|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COOK QUANTA OPTICAL FIBER 365UM - SINGLE USE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|825.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|825.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000711|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COOK QUANTA OPTICAL FIBER 1000UM - SINGLE USE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,140.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,140.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000737|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FULGUR ELECTRODE SHORT TIP 105CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|511.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|511.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000742|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOCKPULSE PROBE 3.76MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,389.72|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,389.72|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000747|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TEMPLATES 17G UA2006|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|261.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|261.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000753|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KNIFE LANCET OLYMPUS A3555|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.77|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|655.77|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000754|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KNIFE SEMI CIRCULAR A3558|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.77|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|655.77|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25249|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|IRRISEPT DEVICE JET LAVAGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|308.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|308.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001043|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SCOPE CLEARIFY VISUALIZATION SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.04|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|95.04|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000679|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INJETAK CYSTOSCOPY NEEDLE 70CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|158.63|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|158.63|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001123|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAD POSITIONING SYSTEM PINK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|465.53|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|465.53|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001124|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE FIBERWIRE 3 AR 7227 01|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|49.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001136|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETRACTOR O SMALL ALEXIS C8401|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|121.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001141|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ARTERIOCYTE BMA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,050.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|4,050.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001150|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NGAGE NITINOL STONE EXTRACTOR 2.2Fr. X 115CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|463.79|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|463.79|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001108|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPACEOAR HYDROGEL SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,346.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|7,346.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000927|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE VISICOIL PLATINUM 18GA 20CM TWIN LINE MR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|582.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|582.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000928|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE VISICOIL PLATINUM 19GS 20CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|312.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|312.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001104|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FIBER STRIPPER QUA-2004|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|248.18|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|248.18|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001105|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FIBER STRIPPER QUA-2005|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|248.18|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|248.18|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000767|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET DILATOR CATHETER 5FR L65CM BALLOON 34CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|704.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|704.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000780|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY SUPRAPUBIC 14G BONANNO CATHETER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|389.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|389.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000788|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CEMENT BONE VOID FILLER 10ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|4,158.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|4,158.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000789|SUP|HCPCS C1820||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM MICROSURESCAN MRI RECHARGEABLE NEUROSTEIMLULATOR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23,360.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23,360.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000790|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COMM HANDSET KIT TH90P01 GU SU PROX|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,900.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|3,900.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000791|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURSCAN MRI LEAD KIT 2.16MM-28CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000792|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURSCAN MRI LEAD KIT 2.16MM-33CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000793|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURSCAN MRI LEAD KIT 2.16MM-41CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000794|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURSCAN MRI LEAD KIT 4.32MM-28CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000795|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURSCAN MRI LEAD KIT 4.32MM-33CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000796|SUP|HCPCS C1778||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM SURSCAN MRI LEAD KIT 4.32MM-41CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,108.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000797|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RECHARGE KIT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,700.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,700.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000798|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BELT SIZE SMALL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000799|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BELT SIZE MEDIUM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000800|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BELT SIZE LARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000801|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BELT SIZE XLARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000802|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VERIFY XTERNAL NEUROSTIMULATOR (ENS)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,200.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,200.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000803|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|REVISION KIT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,185.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,185.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000804|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PERCUTANEOUS EXTERNSION CABLE FOR 2.16MM INTERSTIM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|750.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|750.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000805|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PERCUTANEOUS EXTERNSION CABLE FOR 4.32MM INTERSTIM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|750.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|750.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000806|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE 041839 FORAMN 5" 20GA 2PK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000817|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TISSUE REINFORCEMENT BIO-A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,479.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,479.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000848|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HANDPICE AQUABEAM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|5,000.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|5,000.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000849|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE LITHOTOMY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000864|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|4-PORT WASTE MANAGEMENT MANIFOLD SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|144.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|144.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000899|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CHIPS CANCELLOUS 15CM 4-10MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|855.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|855.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000900|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLOSURE SKIN PRINEO DERMABOND 22CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|393.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|393.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000940|SUP|HCPCS C1767||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INTERSTIM II IPG 3058|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23,360.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23,360.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000941|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MID LEF MEDIUM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|991.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|991.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000942|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MID LEFT LARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|630.03|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|630.03|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000943|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MID LEFT XLARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|695.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|695.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000944|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MID RIGHT MEDIUM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|991.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|991.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000945|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MID LEFT LARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|630.03|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|630.03|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000946|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH 3D MID LEFT XLARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|695.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|695.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000947|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH FLAT SHEET 15X15CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|239.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|239.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000948|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH FLAT SHEET 25X35.5CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|410.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|410.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000949|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALIGHT ECHO 2 11CM CIRCLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,188.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,188.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000950|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALIGHT ECHO 2 10X15CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,126.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,126.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000951|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALIGHT ECHO 2 15CM CIRCLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,764.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,764.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000952|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALIGHT ECHO 2 15CMX20CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,126.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,126.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000953|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH VENTRALIGHT ECHO 2 18X23CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,782.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,782.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000954|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|OPTIFIX 30 OBSORABLE FASTNER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,000.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,000.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000955|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLIP APPLIER FILSHIE STERISHOT II|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|834.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|834.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000977|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|LYNX SUPRAPUBIC MID-URETHRAL SLING SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,122.56|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|3,122.56|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000978|SUP|HCPCS L8606||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|COAPTITE IMPLANT 1ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,337.13|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,337.13|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000979|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|COAPTITE SIDEKICK NEEDLE 14.6" 21GA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|276.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|276.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000980|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER SUREFORM 60 SPU IS4000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,060.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,060.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000981|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD SUREFORM 60 2.5 WHITE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|690.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|690.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000982|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD SUREFORM 60 3.5 BLUE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|690.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|690.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000983|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD SUREFORM 60 4.3 GREEN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|690.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|690.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000984|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER SUREFORM 45 SPU IS4000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,380.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,380.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000985|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD SUREFORM 45 2.5 WHITE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000986|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD SUREFORM 45 3.5 BLUE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70000987|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RELOAD SUREFORM 45 4.3 GREEN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001041|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE VLOC 180 2-0|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|485.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|485.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001049|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|12MM STAPLER CANNULA SEAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|100.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001050|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE INSTRUMENT ARM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|260.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|260.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001060|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLIPS HEM-O-LOK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|130.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001068|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-V-LOC 90 3-0 VIOLET GS-21|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|174.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|174.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001069|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE V-LOC 180 0 GREEN GS-21|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|183.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|183.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001071|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIP COVER ACCESSORY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|100.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001072|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|8MM BLADELESS OBTURATOR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|150.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001073|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|8MM BLADELESS OBTURATOR LONG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|150.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001096|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DISPOSABLE LEG HOLDER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|558.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|558.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001156|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE V LOC 180 2-0 9"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|462.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|462.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001177|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPACEOAR VUE HYDROGEL SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|6,890.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|6,890.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001194|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|UTERINE MANIPULATOR 32MM CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|317.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|317.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001195|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|UTERINE MANIPULATOR 34MM CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|317.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|317.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001196|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|UTERINE MANIPULATOR 37MM CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|317.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|317.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001197|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|UTERINE MANIPULATOR 40MM CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|317.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|317.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001199|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE ENDOBRONCHIAL BRONCO-CATH 39FR LEFT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|256.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001200|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE ENDOBRONCHIAL BRONCO-CATH 39FR RIGHT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|256.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001201|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE ENDOBRONCHIAL BRONCO-CATH 41FR LEFT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|256.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
70001202|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE ENDOBRONCHIAL BRONCO-CATH 41FR RIGHT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|256.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|256.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24060|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETAINER-VISCERA FISH(3204)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|122.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|122.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22373|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER-CHOLANGICATH 6.0 PI-63|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|105.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24190|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST SM RT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|72.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24191|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST MEDIUM RT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|73.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22000|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP LADIES LARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22192|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|MANIPULATOR-UTERINE 4.5 (1151)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|157.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|157.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25130|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOURNIQUET-ABDOMINAL AORTIC JUNCTIONAL (AAJT)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,087.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,087.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21336|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIP-VACURETTE 8MM 20317|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|22.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22001|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP MEN SMALL (106714)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|53.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23124|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WALKER-SHORT LEG LARGE 64101|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|266.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|266.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24192|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST LARGE RT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|73.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21337|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBING-COLLECTION SET (23116)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22003|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP MEN LARGE (106726)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22007|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP LADIES SMALL (111027)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24024|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP MEN XLG (106727)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|52.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|52.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24646|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP ORTHOWEDGE (OQ1B)SMALL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|75.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23557|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WALKER-ROYLAN HI MEDIUM CA414-5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|334.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|334.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23560|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WALKER-ROLYAN HI SMALL CA414-4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|334.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|334.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21382|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIP-VACURETTE 10MM (21553)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22421|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BASKET-HELICAL 4-WIRE 3.0FR 8.5MMX90CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|640.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|640.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24193|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST XLG RT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24194|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST SMALL LT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|72.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24195|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST MED LT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24196|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST LARGE LT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25129|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE-T-POD COMBAT PELVIC STABLIZATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|449.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|449.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24197|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-COCKUP WRIST XLG LT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|72.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|72.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24186|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAD-DEFIB (M3718A) PHILIPS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|151.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|151.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23088|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLAMP-RAYPORT MUSCLE BIOPSY SU130-1112|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|146.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|146.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21116|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-ONE STEP 4X15 (76415A)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|26.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23271|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PANTALOON SZ 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|585.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|585.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22807|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PANTALOON SZ 8|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|585.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|585.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23958|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADAPTER-G-U TEK (URETERAL CATH CONNECTOR)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|75.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21142|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EXTENSION-BUCKS TRACTION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24022|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PANTALOON SZ 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|585.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|585.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24840|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CUFF-TOURNIQUET MEDIUM (YELLOW)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|324.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|324.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20539|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RESTRICTOR-FEMORAL CEMENT UNIVERSAL (B0001240)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|660.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|660.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21056|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CEMENT-VERSABOND BONE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|487.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|487.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21156|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STIMULATOR-NERVE (0003)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|186.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|186.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24912|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROBE-RF 90 DEGREE WHIRLWIND|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|611.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|611.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24913|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROBE-RF 50 DEGREE CROSS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,359.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,359.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24914|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROBE-RF 30 DEGREE HOOK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,359.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,359.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24155|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYSTEM-CEMENT MIXING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|671.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|671.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24891|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-TOTAL HIP PREP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|925.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|925.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22128|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-UNIVERSAL CANNULA 7MM (012421)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|126.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22142|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-UNIVERSAL CANNULA 012405 (5MM)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|132.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|132.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22371|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-BOVIE NEEDLE (139102) DISPOSABLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22396|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-LOOP LARGE (60-5180-104)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|58.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22397|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-LOOP MEDIUM (60-5180-102)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|79.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|79.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22398|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-EXTENDED BLADE 139107|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22399|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-LOOP SMALL (60-5180-101)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|58.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|58.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24637|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BOVIE-W/SMOKE EVACUATOR 60-751005 (GOLDVAC)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|156.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|156.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24946|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALL-PIN .045" YELLOW JURGAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|30.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24947|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALL-PIN .054/.062" GREEN JURGAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|30.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24948|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALL-PIN 5/64" BLUE JURGAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|30.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24949|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALL-PIN 3/32" CREAM JURGAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|30.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21546|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-EMBOLECTOMY 4FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|255.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|255.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23180|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-EMBOLECTOMY 3FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|255.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|255.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24824|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIP-VACURETTE 6MM (21665)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|22.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24955|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEP-DISSECTING 5MM/33CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|930.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|930.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21555|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIP-VACUETTE 12MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|198.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|198.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20965|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACHEOSTOMY 4DCT (SHILEY)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|161.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|161.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22134|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LEAD-UNIVERSAL W/ALLIGATOR CLIPS (5833SL)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|337.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|337.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22301|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-WEBRIL 6" 2554 STERILE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24166|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACH 6.0 EXTENDED PROXIMAL 60XLTCP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|304.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|304.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24168|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACH 7.0 EXTENDED PROXIMAL 70XLTCP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|304.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|304.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24945|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-LINQ ACCESSORY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|475.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|475.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25036|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-SCD KNEE LENGTH SMALL COMFORT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|177.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|177.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22016|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BOVIE CORD ENDOSCOPIC E0503|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24169|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACH 8.0 EXTENDED DISTAL 80XLTCD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|304.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|304.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24838|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-INTRAOSSEOUS AD 45MM:15GA (PTS 40KG+)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|625.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|625.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24083|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WARMER-SCOPE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21059|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STOCKINETTE-IMPERVIOUS LG 9"X48"1586|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21073|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STOCKINETTE-IMPERVIOUS X-LG 12"X48" 1587|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21688|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLANKET-WARMING FULL BODY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|22.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21689|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLANKET-ARMS OUT WARMING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|22.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24174|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HEARTSTART PADS DP2/DP6 (AED FR2)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|139.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|139.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24187|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAD-DEFIB INFANT/CHILD M3719A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|111.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|111.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24200|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET-DILATOR AMPLATZ RENAL (075000)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|637.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|637.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25128|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOURNIQUET-COMBAT APPLICATION ORANGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|140.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21568|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-GASTROSTOMY 24FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|150.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|150.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21595|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-GASTROSTOMY 18FR 0100-18|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|155.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|155.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21585|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-COLON 24FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21586|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-COLON 28FR 30" LONG *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21587|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-COLON 30FR 30" LONG *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|67.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21588|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-COLON 32FR 30" LONG *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|175.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|175.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21578|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-T 14FR CATTELL *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|66.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21615|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|METER-URINE DRAIN 2000ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|50.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21614|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BAG-URINE DRAINAGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23869|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA-DIVIDED SALTER (ANESTHESIA)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25039|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|APPLICATOR-AH FLEX TIP 38CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|75.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24648|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBING SET FOR LEEP PROCEDURES (EVACUATION)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|103.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|103.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24818|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADVINCULA DELINEATOR 2.5CM ULTEM PLASTIC CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|907.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|907.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24819|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADVINCULA DELINEATOR 3.0CM ULTEM PLASTIC CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|907.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|907.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24820|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADVINCULA DELINEATOR 3.5CM ULTEM PLASTIC CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|907.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|907.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24821|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADVINCULA DELINEATOR 4.0CM ULTEM PLASTIC CUP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|907.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|907.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24927|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-BALL LOOP 5MM 12CM SHAFT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|113.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|113.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21609|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHEST DRAINAGE-WATER SEAL 2002-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21401|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEXTROSE 10% IN H2O 1000CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21412|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLYCINE IRRIGATION 1.5% 3000CC 2B7317|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21641|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET-Y TYPE IRRIGATION *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|33.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|33.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22054|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VAMP MONITOR W/TRANS PX-VMP172|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|125.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24890|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PERI-STRIPS DRY 45 UNIV. REINFOREMENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|623.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|623.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21395|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEXTROSE 5% IN H2O 500CC 2B0063Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21396|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEXTROSE 5% IN H2O 1000CC 2B0064|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21397|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .9% 250CC 2B1322Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21398|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .9% 500CC 2B1323Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21399|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .9% 1000CC 2B1324X|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21400|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .9% W/DEXT 5% 1000CC 2B1064X|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21404|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LACTATED RINGER W/DEXT 5% 2B2074|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21406|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .2% W/DEXT 5% 1000CC 2B1094|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21408|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WATER IRRIGATION 3000CC 2B7117|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|26.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21409|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .45% 1000CC 2B1314X|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21410|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE .45% W/DEXT 5% 1000CC 2B1074X|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21413|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE IRRIGATION POUR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|39.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21414|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WATER IRRIGATION POUR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24188|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LACTATED RINGERS 500ML INJECTION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23881|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CORD-BIPOLAR CODMAN|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|122.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|122.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21428|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET-THORACENTESIS 4653-48|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23020|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CONNECTOR-FIBEROPTIC DOUBLE SWIVEL 625191|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|51.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21153|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BRUSH-INTRAMEDULLARY (6198001514)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|225.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|225.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24970|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA RF 100MM 20G 10MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|900.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|900.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24971|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA RF 150MM 20G 10MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|900.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|900.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24972|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA RF 100MM 20G 5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|900.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|900.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24973|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAD-ELECTRODE NEUTRAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,373.76|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,373.76|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24157|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUCTION/IRRIGATION SYSTEM (210-114)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|183.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|183.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24159|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TIP-FEMORAL CANAL (210-008)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|50.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24156|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANNULA-FEMORAL PRESSURIZER (206-566)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|135.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|135.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20998|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTUBATING-STYLET ENDOTRACH 15FR. BOUGIE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|48.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22110|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-GASTRIC LAVAGE #2055|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|194.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|194.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23229|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUCTION/IRRIGATOR STRYKER 250-070-500|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|201.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|201.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24889|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBING-FLOSTEADY IRRIGATION 250-800-006|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|267.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|267.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21407|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SALINE IRRIGATION 3000CC 2B7127|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|26.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23781|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 2.5 PEDI|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|31.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23782|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 1 PEDI|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|31.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22969|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|69.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23780|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|31.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23783|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 1.5 PEDI|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|69.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24218|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AIRWAY-NASOPHARYNGEAL 26FR LTX FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24220|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AIRWAY-NASOPHARYNGEAL 30FR LTX FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24221|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AIRWAY-NASOPHARYNGEAL 32FR LTX FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24223|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AIRWAY-NASOPHARYNGEAL 36FR LTX FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22967|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|69.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22968|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LMA SZ 4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|69.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22070|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BAG-PRESSURE INFUSOR-1000CC (IN-9000)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|30.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|30.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24931|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANISTER-WOUND VAC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|201.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|201.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21080|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING&SWATHE-UNIVERSAL 79-84230 (OR) *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|35.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21157|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-FINGER STRIP-PADDED 2" ALUMINUM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|49.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21084|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ARM XSM 79-84022|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21081|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ARM LG 79-84027|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21082|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ARM MD 79-84025|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21083|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ARM SM 79-84023|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21097|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-BUCKS TRACTION SM (79-83063)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21098|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-BUCKS TRACTION MED (79-83065)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21099|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-BUCKS TRACTION LG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24285|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ULTRA POST-OP LARGE 11-0138-4-13130|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|235.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|235.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24286|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ULTRA POST-OP MEDIUM 11-0138-2-13130|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|235.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|235.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24287|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLING-ULTRA POST-OP SMALL 11-0138-2-13130|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|236.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|236.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20852|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-SKIN 3M PRECISE DS-5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20853|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-SKIN 3M PRECISE DS-15|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|24.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21114|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-ONE STEP 3X12|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|22.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21115|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-ONE STEP 3X35 (86335)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|50.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21117|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-ONE STEP 4X30 (76430)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|49.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21119|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-ONE STEP 5X45 (86545)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|87.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21146|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ATHLETIC SUPPORTER-MEDIUM (WAIST 33-38")*LX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|46.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21147|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ATHLETIC SUPPORTER-LARGE (WAIST 39-44") *LX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|46.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21691|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|POUCH-IRRIGATION 3M #1016|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22177|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAPE-FOAM 4" *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22809|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ATHLETIC SUPPORTER-X-LARGE(WAIST 44"-50")*LX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22972|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WRAP-COBAN 6" SELF ADHERENT 2086S|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23922|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LABEL SYSTEM-CORRECT MEDICATION (OR)(3302)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20350|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SIGMOIDOSCOPE SPECULUM DISP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20577|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CONTAINER TRANSPEC (EZ-8390)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|92.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21644|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-PNEUMOTHORAX C-TPT-100|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|863.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|863.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22050|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLANKET-HOT ICE ST012|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|87.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21760|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAD-POSITIONER DISP 1002-P|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|129.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|129.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21290|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-LEEP SQUARE (DLP-SQ1)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22494|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-LOOP 25MM X 8MM (DLP-B11)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|75.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24781|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-VACUUM DELIVERY PALM PUMP KIWI|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|130.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24089|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HEADREST-OSI 1937 7" RT INTUBATION SLOT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|63.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23092|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|APPLICATOR-VAGINAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|55.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|55.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21289|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOURNICOT-LARGE TCL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22173|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STRAP-DISTRACTOR FOOT (01440)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|245.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|245.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22141|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROTECTOR-ULNAR NERVE W95-534|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22971|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HEADREST-SLOTTED RICHARD PADS (930161)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|87.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25021|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-BONE MARROW APRIATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,960.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,960.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24902|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SCORPION MULTIFIRE (AR13995N)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|850.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|850.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25020|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-PRP (PLATELET RICH PLASMA)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|885.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|885.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25123|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-FIBERWIRE 2-0 AR-7220|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|110.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25170|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET-BELMONT 3 SPIKE BAG (RAPID INFUSOR)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|656.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|656.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24843|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BRACE-KNEE POST-OP UNIVERSAL T-SCOPE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|737.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|737.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24904|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-KNEE/SHOULDER COLD THERAPY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|923.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|923.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20964|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACHEOSTOMY 8DCT (SHILEY)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|175.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|175.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20967|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACHEOSTOMY 6DCT (SHILEY)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|161.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|161.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21544|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-BRONCHO LFT 37FR CPAP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21545|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-BRONCHO RT 37FR CPAP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|251.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|251.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21552|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-BRONCHO RT 35FR 85815|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|284.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|284.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21576|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-SALEM SUMP 18FR 266148 W/REFLEX VALVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21610|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CHEST DRAINAGE-DUAL EXTENSION SET (714200)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|73.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21723|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-KNEE SM REG 7071|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|37.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21724|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH SMALL REG 3130LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|66.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21725|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-KNEE MED REG 7115|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21726|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-KNEE LG REG 7203|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21727|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-KNEE XLG REG 7604|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21728|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH MED REG 3416LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|62.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|62.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21729|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH LG REG 3728LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|61.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21835|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-MEDITRACE (31115788)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22195|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-SCD THIGH LENGTH MEDIUM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|248.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|248.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23116|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-SCD THIGH LENGTH LARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|297.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|297.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23629|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BAG-DRAINAGE TUR 4000ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23708|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-SCD THIGH LENGTH SMALL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|236.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|236.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24126|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-SALEM SUMP 14FR (266247) W/REFLEX VALVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|71.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24127|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-SALEM SUMP 16FR 266262 W/REFLEX VALVE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|71.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24656|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-KNEE XXLG REG 7470|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|71.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24657|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-KNEE XXXLG REG 7472|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|71.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24658|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH XLG REG 3181|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|92.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|92.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24659|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH XXLG REG 3184|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24661|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH SMALL LONG 3222LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|24.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24662|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH MED SHORT 3310LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24663|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH MED LONG 3549LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|66.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24665|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH LG LONG 3856LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|65.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24666|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH XLG SHORT 3180|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|126.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|126.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24668|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH XXLG SHORT 3183|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24669|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH XXLG LONG 3185|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25028|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-SCD KNEE LENGTH MEDIUM EXPRESS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|161.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|161.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25029|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-SCD KNEE LENGTH LARGE EXPRESS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|435.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|435.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21845|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BINDER-ABDOMINAL 12" 30"-45"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|64.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23054|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BINDER-ABDOMINAL 9" 60-75"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|81.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|81.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24735|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOLDER-TRANSDUCER SINGLE USE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|29.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|29.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21780|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BINDER-ABDOMINAL 9" 46"-62"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|61.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21844|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BINDER-ABDOMINAL 12" 46"-62"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|73.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23044|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ARMBOARD-A-LINE ADULT 650|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23055|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BINDER-ABDOMINAL 12" 60-75"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|91.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|91.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23574|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BINDER-ABDOMINAL 9" 30"-45"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|53.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20995|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STETHOSCOPE-ESOPHAGEAL 18FR (400 SERIES)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|10.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22094|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RESTRAINT-LIMB HOLDER M2029|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|10.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23176|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PILLOW-SHOULDER ABDUCTION LARGE *LATEX|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|251.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|251.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24217|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PILLOW-SHOULDER ABDUCTION SMALL *LATEX|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24900|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WRAP-COBAN 2" SELF AHESIVE 30-402|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23175|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PILLOW-SHOULDER ABDUCTION MEDIUM *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|204.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|204.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22193|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROTECTOR-EYE OPTIGUARD (DU28300)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|25.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20428|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLE-RELOAD 55MM TCR55|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|235.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|235.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20429|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLE-RELOAD 75MM TCR75|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|351.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|351.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20848|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-CIRCULAR 29MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|742.29|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|742.29|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20849|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-CIRCULAR 25MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|742.26|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|742.26|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20854|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-55MM LINEAR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|439.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|439.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20859|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-CIRCULAR 33MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|744.09|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|744.09|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20860|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-75MM LINEAR CUTTER (TLC75)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|655.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21852|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-SKIN 35REG PXR35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|35.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22328|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PEANUT-ENDO 5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|73.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|73.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21572|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-LAVAGE 24FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21584|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-LAVAGE 32FR (2132)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21592|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-LAVAGE 36FR (2136)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21855|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|OSTOMY-POST OP POUCH 9764 (CTF UP TO 4") LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23968|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|OSTOMY-COLOSTOMY KIT 2 3/4" 19004|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23969|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|OSTOMY-COLOSTOMY KIT 2 1/4" 19003|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23991|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|OSTOMY-SKIN BARRIER 4"14606(BACK UP BARRIERS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22124|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LOOPS-LIGA MINI VL-201|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23099|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAP-FINGER GRASPING DEVICE (9906)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|63.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20941|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-ENDOTRACH ORAL RAE 5.5 CUFFED|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20942|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-ENDOTRACH ORAL RAE 6.0 CUFFED|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20943|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-ENDOTRACH ORAL RAE 6.5 CUFFED|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20944|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-ENDOTRACH ORAL RAE 7.0 CUFF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24165|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBE-TRACH 6.0 EXTENDED DISTAL 60XLTCD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|315.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|315.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21288|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOURNICOT-MEDIUM TCM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25030|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SET-AIRWAY ADAPTER (NOMOLINE SAMPLING LINE)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|63.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20996|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTUBATING STYLET 14FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22069|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BAG-PRESSURE INFUSOR-500CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|38.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22095|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETRIEVER-SUTURE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|200.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|200.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22155|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ELASTIC 3" STERILE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22156|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ELASTIC 4" STERILE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22157|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ELASTIC 6" STERILE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22923|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-TUOHY 18GA 6"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|778.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|778.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23563|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PAD-DUAL DISPERSIVE ELECTRODE 9165|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23976|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOWELS-STERILE 6PK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23984|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TOWELS-STERILE 2PK XRAY DETECTABLE(OR)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24222|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AIRWAY-NASOPHARYNGEAL 34FR LTX FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24664|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH LG SHORT 3634LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24887|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADHESIVE-SKIN AFFIX|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|56.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24962|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SYRINGE 5CC GLASS SLIP TIP LOSS RESISTANCE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|746.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|746.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25117|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANISTER RIGID 2000CC DISPOSABLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25118|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CANISTER RIGID 3000CC DISPOSABLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22049|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BOVIE HANDTROL (ESPB3002)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|25.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24750|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BAG-PRESSURE INFUSOR-3000CC (IN950006)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|61.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21349|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BRUSH-BRONCHOSCOPY CYTOLOGY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|67.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|67.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21393|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VALVE-BIOPSY BRONCH 52898 (MAJ-210)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|473.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|473.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21394|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|VALVE-SUCTION BRONCH 52897 (MAJ-209)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|662.01|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|662.01|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22126|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SNARE-POLYPECTOMY SD-210U-25|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22132|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SNARE-POLYPECTOMY MINILOOP SD-210U-10|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22136|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEPS-BIOPSY EGD FB-220U.A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|31.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22504|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEPS-BRONCH (DISP) FB-211D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|121.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|121.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23666|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEP-HOT BIOPSY  FD-230U|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|82.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|82.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23672|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BASKET-RETRIEVAL 3-WIRE SPIRAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|604.11|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|604.11|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24699|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PROBE-BIPOLAR HEMASTASIS SOLAR PROBE SNGL PLG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|712.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|712.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24728|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEPS-BIOPSY COLON FB222U (JUMBO BITE)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|63.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|63.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24700|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SMOKE EVACUATOR-LAPARASCOPIC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|75.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|75.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21227|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-CATHETER TROCAR 28FR 565044|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|147.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|147.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24120|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETRIEVER-NET (FOR EGD/COLON)(NEW-00711050)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|450.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|450.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24817|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FORCEP-GRASPING QUAD WIRE 00711175|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|695.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|695.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21026|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BRACE-KNEE 19" 1882-500-19|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|475.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|475.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21030|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BRACE-KNEE 24" 1882-500-24|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|550.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|550.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23853|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-POSTERIOR TIBIA/FIBULA PADDED KNEELGTH|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|330.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|330.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21118|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SPLINT-ONE STEP 5X30 (76530)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|64.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21161|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PILLOW-ABDUCTION MED M60-076-M|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|107.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|107.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21612|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BAG-URINARY LEG,MEDIUM,19OZ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21853|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ANTI-FOG SOLUTION (31142527)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22002|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP MEN MEDIUM (106725)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22114|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BONE CUBES-CANCELLOUS 15CC-5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,125.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,125.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23159|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TUBING-INSUFFLATION TM-6000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|21.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24219|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|AIRWAY-NASOPHARYNGEAL 28FR LTX FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24638|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTRODE-BLADE 6" EXTENDED INSULATION 139110|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24660|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH SMALL SHORT 3071LF|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24667|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HOSE-THIGH XLG LONG 3182|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20066|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-1/4 TUB. 242.13 3H 25MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|115.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|115.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20067|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-1/4 TUB. 242.14 4H 33MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|250.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|250.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20068|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-1/4 TUB. 242.15 5H 41MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|225.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|225.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20069|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-1/4 TUB. 242.16 6H 49MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|585.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|585.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20070|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-1/4 TUB. 242.17 7H 57MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|180.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|180.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20071|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-1/4 TUB. 242.18 8H 65MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|165.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|165.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20072|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-L MINI OBL LT 242.33 3H 2.7MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|95.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20073|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-T SMALL 242.41|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|196.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20074|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-MINI STRAIGHT 243.13 3H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|140.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|140.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20075|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-MINI STRAIGHT 243.14 4H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|142.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|142.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20076|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-MINI STRAIGHT 243.15 5H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|337.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|337.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20077|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-L MINI OBL LT 243.33 2H 2.0MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|196.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|196.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20078|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-T MINI 243.41|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|260.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|260.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20139|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-L MINI OBL RT 243.34 2H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|95.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|95.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20140|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLATE-L MINI OBL RT 242.34 3H 2.7MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|166.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|166.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20178|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.007|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20179|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.008|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|48.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.009|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|44.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20181|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.010|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|78.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|78.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20182|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.011|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20183|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.012|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20184|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.014|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20185|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.016|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20186|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.006|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|44.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20187|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.008|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|102.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20188|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.010|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|102.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20189|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.012|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|102.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20190|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.014|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|102.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20191|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.016|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|93.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|93.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20192|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.018|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20193|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.0MM CORTEX 201.020|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20194|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.006|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20195|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.008|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|27.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20196|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.010|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|88.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20197|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.012|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|208.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20198|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.014|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|97.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20199|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.016|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|195.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|195.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20200|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.018|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|49.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20201|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.020|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|327.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|327.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20202|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.022|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|27.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20203|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 2.7MM CORTEX 202.024|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|46.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20292|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MINI 1.5MM CORTEX 200.006|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20307|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE-DRILL TIP ACUFEX 013978|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|232.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|232.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20309|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 3/32" 1625-38-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20310|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .062 9" KM172-29-62|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20313|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-CERCLAGE W/EYE 1.00MM 291.01|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|26.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20314|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-CERCLAGE COIL 1.00MM 291.05|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|110.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20317|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K-THREADED .035 KM172-29-35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20319|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-CERCLAGE W/EYE 1.25MM 291.02|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|48.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20320|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-CERCLAGE COIL 1.25MM 291.06|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|160.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|160.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20321|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K THREADED .062 KM172-29-62|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20322|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K-THREADED .054 KM172-29-54|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20323|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K-THREADED .045 KM172-29-45|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20324|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .062 4" KM172-24-62|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20325|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .054 4" KM172-24-54|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20326|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .054 9" KM172-29-54|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20327|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .045 4" KM172-24-45|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20328|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .045 9" KM172-29-45|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20329|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .035 4" KM172-24-35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20330|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .035 9" KM172-29-35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20334|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 5/64" 1617-60-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20345|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-SHOULDER PASSING 2.4MM 013972|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|233.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|233.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20346|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-PASSING 2.4MM 11" 013658**DNO**|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|439.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|439.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20357|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 3/32" KM169-29-33|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20358|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 7/64" KM169-29-76|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20359|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 1/8" KM169-29-18|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20360|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 9/64" KM169-29-96|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20361|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 5/32" KM169-29-53|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20362|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN THR 3/16" KM169-29-31|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20363|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 5/64" KM168-29-56|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20364|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 7/64" KM168-29-76|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20365|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 1/8" KM168-29-18|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20366|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 5/32" KM168-29-53|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20367|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 3/16" KM168-29-31|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|21.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20368|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN 9/64" 9" KM168-29-96|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20369|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-GUIDE AR1297L W/EYE 2.4MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|340.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|340.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20370|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-GUIDE AR1254 2MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|105.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|105.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20372|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PIN-STEINMAN SGL TROCAR 3/32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20407|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GUIDE PIN-ZIMMER HIP 1181-20|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|86.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|86.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20805|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-POLYPROPYLENE 3X6|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|602.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|602.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20869|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMOCLIP CARTRIDGE MED  523700|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|50.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20870|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP APPLIER-MULTI MED MCM20|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|255.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|255.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20871|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS X-SML SMOOTH (128691)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|933.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|933.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20874|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLIP APPLIER-MULTI LARGE MCL20|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|249.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|249.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20877|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS SM SMOOTH 128693|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|345.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20878|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS MED SMOOTH 128695|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|345.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20879|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS LRG SMOOTH (128697)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|345.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|345.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20880|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS X-SML SPIKED (128690)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|627.48|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|627.48|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20881|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS SML SPIKED (128692)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|888.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|888.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20882|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS MED SPIKED 128694|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|654.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|654.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20883|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STAPLES-RICHARDS LRG SPIKED|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|901.38|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|901.38|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22138|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG-MESH SMALL 112750|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|854.91|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|854.91|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22139|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG-MESH MEDIUM 112760|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|859.11|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|859.11|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22140|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PLUG-MESH LARGE 0112970|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|716.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|716.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22243|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-75|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|922.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|922.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22244|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-80|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|922.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|922.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22245|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-85|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|822.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|822.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22246|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-90|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|822.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|822.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22247|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-95|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|796.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|796.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22248|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-100|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|685.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|685.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22249|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-105|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|796.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|796.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22250|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-110|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|596.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|596.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22251|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-115|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22252|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-120|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22253|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-125|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22254|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-130|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22266|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-95-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|832.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|832.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22267|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-100-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|685.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|685.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22268|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-40-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22269|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-45-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|660.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|660.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22270|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-50-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|796.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|796.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22271|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-55-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|660.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|660.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22272|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-60-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|739.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|739.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22273|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-65-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|922.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|922.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22274|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-70-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|631.92|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|631.92|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22275|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-75-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|615.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|615.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22276|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-80-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|832.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|832.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22277|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-85-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|615.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|615.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22278|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-90-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|631.92|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|631.92|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22280|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-105-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|685.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|685.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22281|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-110-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|685.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|685.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22282|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-115-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22283|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-120-32|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|610.17|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|610.17|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22284|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-30|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|591.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|591.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22285|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|739.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|739.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22286|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-40|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|531.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|531.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22287|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-45|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|922.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|922.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22288|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-50|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|873.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|873.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22289|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-55|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|832.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|832.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22290|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-60|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|922.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|922.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22291|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-65|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|531.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|531.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22292|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SCREW-MAGNA 1146-70|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|873.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|873.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23100|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K .028 4" KM172-24-28|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23103|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-SKIN PXW35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|214.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|214.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23148|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K 0.6MM X 150MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23150|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K 1.0MM X 150MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|53.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|53.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23151|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K 1.25MM X 150MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|27.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23764|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELOADS-WHITE 45MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|615.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|615.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23765|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|RELOADS-BLUE 45MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|618.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|618.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23769|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-HEMORRHOIDAL CIRCULAR PPH03|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,192.59|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,192.59|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23859|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRIO SM OVAL (8 X12) 5950030|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,017.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,017.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23860|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRIO MEDIUM OVAL (11X14) 5950040|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,502.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,502.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23861|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRIO LG OVAL (13X17) 5950050|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,901.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,901.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23862|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRALEX LARGE CIRCLE 8.0CM 5950009|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,072.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,072.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23863|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRIO XLRG OVAL(19X25CM) 5950070|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,661.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,661.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23864|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-ONFLEX MEDIUM OVAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|615.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|615.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23865|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-ONFLEX LARGE OVAL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|735.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|735.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23866|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRALEX SM CIRCLE 4.3CM 5950007|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,044.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,044.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23867|SUP|HCPCS C1781||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MESH-VENTRALEX MED CIRCLE 6.4CM 5950008|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,257.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,257.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23956|SUP|HCPCS C1768||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GRAFT-019579P HEMASHIELD 8MM X 75MM X .3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|620.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|620.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24007|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR-5.5MM W/NEEDLE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|907.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|907.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24042|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SHUNT-CAROTID BYPASS 10F 000679|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|395.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|395.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24056|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|TUBE-PEG SYSTEM 20FR PULL TYPE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|843.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|843.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24081|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON-GASTROSTOMY 24FR 1.7CM (000285)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|655.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24082|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON-GASTROSTOMY 24FR 2.4CM (000286)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|655.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24091|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-RELOAD 30MM 2.5MM XR30V VASCULAR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|199.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|199.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24093|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-RELOAD XR30G (USE W/TX30G 24092)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|195.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|195.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24144|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BUTTON-GASTROSTOMY 28FR. 2.7CM (000262))|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|655.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|655.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24177|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-TX60B 60MM REG LINEAR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|419.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|419.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24178|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-RELOADS 60MM BLUE XR60B|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|208.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|208.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24180|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY-ALLOMATRIX INJECTABLE 1CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|918.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|918.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24185|SUP|HCPCS C1788||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PORT-POWER IMPLANTABLE MRI 8 FR 1808000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,410.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,410.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24205|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|KIT-RESORBABLE MINI BEAD (8400-0611)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,840.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,840.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24209|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|INFUSION SET-POWERLOC 19GA (0671910)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24271|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT-URETERAL KIT 6 X 28 (5556028)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|599.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|599.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24273|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT-URETERAL DBL PIGTAIL 7FR.X26CM(5607026)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|583.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|583.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24274|SUP|HCPCS C2625||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|STENT-URETERAL DBL PIGTAIL 7FR.X28CM(5607028)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|583.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|583.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24671|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER-PICC SOLO TRIPLE LUMEN 5FR 3395108Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|631.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|631.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24682|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-LINEAR GIA 030449|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,017.03|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,017.03|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24727|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-LINEAR CONTOUR SC40G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,349.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,349.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24790|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-RELOAD 45MM TAN (VAS/MED) EGIA45AVM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,309.11|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,309.11|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24791|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-RELOAD 45MM PURPLE (MED/THICK)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,360.83|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,360.83|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24901|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|BONE CUBES-CANCELLOUS 15CC (7-8MM)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,230.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,230.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24907|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY-STIMUBLAST 2.5CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,320.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,320.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24908|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUTTY-STIMBLAST 5CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24909|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|GEL-STIMUBLAST 1CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24932|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 4.75MM BI0COMPOSITE SWIVELOCK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,260.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,260.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24934|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ANCHOR 2.9MM BIOCOMPOSITE PUSHLOCK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,200.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,200.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24944|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|MONITOR-CARDIAC INSERTABLE REVEAL LINQ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|9,690.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|9,690.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25019|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSURE-SKIN SURGICAL (16)(ZIPLINE)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|425.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|425.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25022|SUP|HCPCS C1771||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|SLING-TVT GYNECARE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,338.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,338.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25038|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|ARISTA ABSORBABLE HEMOSTATIC 3GM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|881.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|881.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25131|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMOCLIP-CARTRIDGE SMALL|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25161|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|NEOTRACT UROLIFT SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|7,600.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|7,600.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25165|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|FOREFOOT IB IMPLANT SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,790.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,790.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25166|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|HEMOSTAT-SURGICEL 2X3|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|416.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|416.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25167|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|HEMOSTAT-SURGICEL 4X8|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|275.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|275.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25168|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CLOSURE-SKIN SURGICAL 24 ZIPLINE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|625.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|625.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
32152|SUP|HCPCS C1713||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|WIRE-K 1.6MM X 150MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|27.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20581|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-CHROMIC 0 802H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20601|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-CHROMIC 4-0 G121H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20605|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-CHROMIC 4-0 1637G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|26.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20607|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-CHROMIC 5-0 687G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|26.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|26.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20618|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 0 J430T|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20621|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 6-0 J492G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20628|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 3-0 J497H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20630|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 3-0 J784G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|44.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|44.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20632|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 5-0 J500H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20633|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 4-0 J494G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20652|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-SILK 3-0 CO13D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|35.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20683|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 5-0 8698G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20688|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 5-0 8321H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|40.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20689|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 0 8454H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20697|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 4-0 8557H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20700|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 4-0 8699G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20706|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHILON 5-0 698H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20708|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHILON 6-0 697H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20710|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MERSILENE CTX  RS22|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|132.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|132.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20714|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 0 X444H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20716|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 0 CX27D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20717|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 1 X518H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|10.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20718|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 2 MX69G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|66.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20724|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHILON 4-0 1667H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20725|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHILON 5-0 1666H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20744|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-POLYSORB 4-0 SL-5627-G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20756|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-POLYSORB 3-0 SL-5628|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20757|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 6-0 8695G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20777|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SPINAL 22GA 5" QUINCKE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20779|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SPINAL 22GA 7" QUINCKE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20785|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SPINAL 25GA 5" QUINCKE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20788|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SURGEONS 1/2C HEAVY PT 2167-2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20790|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SURGEONS 1826-4D TROCAR PT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20800|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SURGEONS 1/2C KELLYS INTES.|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20801|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SURGEONS KEITH ABDOMINAL ST 1827-2D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20803|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SURGEONS 1/2 C TRO MAYO CATGUT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20835|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-LIVER BIOPSY 6"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|70.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20837|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SURGEONS 1/2C TAPER PT 1859-6R|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20838|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-HUBER 19GA 1" (S02019-10)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20840|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-ILLI/STERNAL 15GA INTRAOSSEOUS DIN1515|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|47.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20841|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-PNEUMONEEDLE INSUFFLATION PN150|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|303.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|303.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20842|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-HUBER BENT 22GA 1" (S02022-10)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20843|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-ILLI/STERNAL 18GA INTRAOSSEOUS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|49.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|49.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
20906|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-BONE WAX W31G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|21.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21057|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BOWL-CEMENT MIXING 5049-11|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|36.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21177|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ELASTIC 4" X 10' STERILE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21178|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ELASTIC 6" X 10' STERILE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21181|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ESMARK 6"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21182|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BANDAGE-ESMARK 4"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21187|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-DUODERM 8X8 (187662)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|35.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21208|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAPE-ELASTOPLAST 4" *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|24.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|24.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21209|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAPE-ELASTOPLAST 2" *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21210|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAPE-ELASTOPLAST 3" *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|17.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|17.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21225|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY-PARACERVICAL/PUDENDAL BLOCK TRAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21231|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-LAPORATOMY DYNJP3040A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|64.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|64.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21232|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-CYSTOSCOPY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21238|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-ARTHROSCOPY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|205.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21241|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-HIP DYNJP8320A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|97.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21243|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-HEAD/NECK DYNJP7010A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|51.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21244|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-C SECTION DYNJ30792A**LATEX***|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|329.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|329.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21247|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-LITHOTOMY DYNJP9020A|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21256|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-PLAIN .25 X 5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21257|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-PLAIN 1"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21258|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-IODOFORM .5X5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21259|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-IODOFORM .25"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21261|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-PLAIN .5|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21262|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-PLAIN 2"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|21.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21263|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-IODOFORM 1"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21264|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACKING-IODOFORM 2"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|18.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|18.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21287|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|WRAP-COBAN 4" SELF ADHERENT 2084S|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|10.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21299|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLIP APPLIER-ENDO CLIP (ER320)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|420.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|420.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21304|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CAUTERY-HIGH TEMP FINE TIP AA01|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21355|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE-J ARROW 04235|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|47.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21468|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-COUDE FOLEY 16FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|47.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21471|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY PEDI 8FR SILICONE 100%|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21473|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY 12FR 5CC BALLOON *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21480|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-HEYMAN 4FR OLIVE TIP (136904)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|152.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|152.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21487|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER-UMBILICAL 3.5FR (160333)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21491|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-FOLEY 3-WAY 22FR 30CC BALLOON*LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|41.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|41.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21493|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-URETERAL 5FR OLIVE TIP (136505)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|65.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|65.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21494|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-EMBOLECTOMY 5FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|255.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|255.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21496|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY COUNCILL 16FR *LATEX*5CC 2WAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21498|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-PACING SWAN-GANZ 5FR BIPO *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|290.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|290.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21501|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-THORACIC 32FR (8032)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21505|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER-UMBILICAL 5FR (8888160341)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|61.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|61.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21506|SUP|HCPCS C1751||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER-UMBILICAL 8FR (160234)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|98.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|98.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21508|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY KIT 14FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|22.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|22.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21520|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-COUDE FOLEY 18FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|47.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21521|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-COUDE FOLEY 20FR *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|47.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|47.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21524|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-FOLEY 3-WAY 20FR 30CC BALLOON *LATEX|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21525|SUP|HCPCS C1726||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-FOLEY 3-WAY 24FR 30CC BALLOON *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|60.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|60.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21548|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY SILICONE 16FR 5CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21554|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY 10FR PEDI SILICONE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|40.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|40.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21556|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-RADIAL ARTERY 20GA RA-04020|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21621|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAIN-SUCTION JACKSON-PRATT (SU130-1309)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|21.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21627|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|EVACUATOR-THREE SPRING 400ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|36.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21629|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAIN-PVC MED 1/8" W/TROCAR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|35.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|35.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21630|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAIN-PVC SML 3/32" W/TROCAR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|38.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21633|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY-FOLEY CATH 16FR W/BAG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21634|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY-FOLEY CATH 18FR W/BAG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|70.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|70.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21657|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RESERVOIR-JACKSON PRATT SU130-1305 100ML|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21659|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 5 B499T|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21666|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-IOBAN LG 6651EZ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|48.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|48.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21667|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-IOBAN SM 6650EZ|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21670|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-STERI U|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21672|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-EZ ISOLATION BAG D1003|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|27.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21675|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-UNIVERSAL X-RAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21676|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-IOBAN 2 HIP 6617|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|87.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|87.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21678|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-STERI #1050|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21684|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LEGGING LITHOTOMY 8420|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|10.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21880|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE HOOK LATERAL RELEASE 9730BA|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|203.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|203.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21901|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-AIR DERMATOME 880-000-10|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|184.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|184.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21902|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-GIGLI SAW 12" 2808-01|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|88.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|88.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21918|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-MICRO OSCIL 2296-31-172 STRYKER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|487.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|487.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
21999|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHOE-POST OP LADIES MEDIUM (111025)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22165|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MONOCRYL 0 Y340H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22183|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PDSII 0 Z990G CTX LOOP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22188|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MM CLEAR 4-0 PDS II Z662H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22189|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 2-0 GREEN BRAIDED 30IN 75CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22236|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 2 J649G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|62.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|62.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22294|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-TRIANGLE 3054|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|595.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|595.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22340|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ADHESION BARRIER-INTERCEED 3X4 4350|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|949.77|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|949.77|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22365|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-LAPAROSCOPY 29604|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|51.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22372|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-CHOLANGIO. PERCU 4.5FR 20018-M55|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|436.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|436.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22411|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STENT-URETERAL KIT 6 X 26|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|565.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|565.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22413|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STENT-URETERAL KIT 4.5 X 26 (5604526)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|583.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|583.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22426|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLIPS-FILSHIE AVM 851|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|633.33|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|633.33|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22462|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-TUOHY 17GA 5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|34.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|34.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22506|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-EXTREMITY DYNJ30793|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|79.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|79.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22822|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-BRONCHO LFT 32FR CPAP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|251.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|251.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22890|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-MINI 6600 C ARM E9100AB|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|32.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|32.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22891|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-C-ARMOR (5523)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|205.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|205.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22912|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAP-2.0MM 311.19|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|630.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|630.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22913|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAP-2.7MM 311.26|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|690.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|690.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22920|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAP-4.5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|432.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|432.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22927|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-1.1MM 310.11|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|277.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|277.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22928|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-1.5MM 310.15|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|482.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|482.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22929|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-2.0MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|336.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|336.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22930|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-2.5MM 310.25/4806-110-25|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|336.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|336.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22931|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-2.7MM 310.26|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|465.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|465.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22932|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-3.5MM 310.35/4806-110-35|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|389.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|389.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22933|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-3.2MM DIAM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|358.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|358.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22935|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRILL BIT-4.5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|389.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|389.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22981|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-MED 4.0 EGG 5120-15-40|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|498.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|498.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22982|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-MED 5.0 EGG 5120-15-50|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|498.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|498.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22983|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-MED 2.5 RD 5120-10-25|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|450.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|450.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22984|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-MED 4.0 RD 5120-10-40|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|472.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|472.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22987|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-LONG MED KM-33-1111|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22988|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-MED AGGRESSIVE KM3-511|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22990|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-LONG MED AGGRESSIVE KM3-525|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22991|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-MED NARROW 2296-33-114|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22992|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-LONG NARROW 2296-33-115|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
22993|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RASP-LONG TEAR CROSS CUT 5100-37-114|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|658.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|658.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23051|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 3-0 X-963H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23068|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|KIT-ARTERIAL RADIAL AK04020C|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|97.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23070|SUP|Custom 27800001||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|CATHETER-FEMORAL 4 1/4" FA04018|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|66.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|66.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23074|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 4-0 J422H UNDYED|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23087|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY 18FR W/30CC SILICONE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|31.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23091|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-SORBAVIEW LG 41/2" SQUARE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23094|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 0 8418H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23095|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 2-0 J105T|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|31.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|31.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23097|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-ENDOSCOPY INJECTION NM200U-0425|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|114.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|114.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23105|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 7-0 8800H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|36.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|36.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23117|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TAP-1.5MM 311.15|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|575.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|575.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23195|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER-DEVICE 3LUM. AVA3XI|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|568.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|568.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23196|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-CENTRAL VENUS 3 LUMEN 7.0FR.|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|394.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|394.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23197|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-SWAN-GANZ 7.5FR. *LATEX*|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|959.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|959.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23225|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BASIN SET-MAJOR DYNJ30789|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|102.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|102.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23227|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BASIN SET-MINOR  DYNJ30791|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|69.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|69.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23568|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|STAPLER-PROTACK 5MM ENDOSCOPIC (PTACK30)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,056.08|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,056.08|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23570|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-MEDIUM NARROW 2296-33-412|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23594|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND 1 X538H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23602|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BOOT-4" UNNA GEL CAST|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|20.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|20.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23632|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SHEET-BILATERAL LIMB 29416|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23682|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAIN-BLAKE ROUND HUBLESS (2228)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|57.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|57.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23689|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|FOLEY-16FR 5CC 2000ML URINE METER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|77.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|77.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23692|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MONOCRYL 4-0 Y494G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23697|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY-FOLEY CATH 14FR W/BAG|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23713|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PIN-PASSING DRILL TIP MITEK CRUCIATE LIGAMENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|852.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|852.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23773|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BALLOON-KIDNEY SHAPE  (OMSPDBS2)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,085.76|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,085.76|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23774|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-BLUNT TIP OMS-T12BT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|918.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|918.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23805|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 0 ENDOLOOP EJ10G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|184.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|184.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23809|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CUTTER-FLEX 45 ATS45(MUST ADD STAPLES)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|667.26|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|667.26|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23820|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 0 J727D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23840|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ESSURE SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|3,700.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|3,700.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23841|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 0 J740D CT-1 W/TRAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23848|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 1 J741D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|46.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23870|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-NUROLON 2-0 C526D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|46.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|46.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23872|SUP|HCPCS C1758||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-URETERAL OPEN ENDED TIP 5FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|81.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|81.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23880|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-PNEUMONEEDLE INSUFFLATION PN120|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|272.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|272.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23886|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL #1 J765D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|45.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|45.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23887|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-VICRYL 2-0 J775D|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23889|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-NOVAFIL 2-0 4459-51|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|51.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|51.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23890|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-NOVAFIL 0 4455-61|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23893|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-HIP W/POUCH & ARMBOARD|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|71.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|71.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23898|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-STIM INSULATED 21GAX2 W/EXT TUBING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|39.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23899|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-STIM 22GA X 1 3/8" W/EXT TUBING|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|43.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|43.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23923|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHILON 3-0 1669H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23924|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-SOLOSITE 4"X4" (PT)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|998.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|998.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23926|SUP|HCPCS C1733||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-ABLATION NOVASURE NS2000US|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|2,060.36|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|2,060.36|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23943|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-HUBER 22GA 3/4" (S02022-75)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|37.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23944|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-STIM 21G X 4"INSULATED W/EXT SET|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|56.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23946|SUP|HCPCS C1757||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-EMBOLECTOMY 6FR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|255.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|255.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23949|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 6-0 8726H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|37.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23950|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MONOCRYL 3-0 Y936|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23953|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-WARMER IRRIGATION SOLUTION (ORS-300)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|380.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|380.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23977|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-SAGITAL 25X90 (BR1-2590-35)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|130.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|130.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23979|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-SAGITAL 25X1 (BR4125-127-100)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|120.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23980|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-SAGITAL 11X1.27X90 (4111-127-090)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|120.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23981|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-SAGITAL 18X1.27X100 (4118-127-100)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|120.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|120.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
23988|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 2-0 SH 8523H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24006|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-FIBERWIRE #2|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|110.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24019|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MONOCRYL 4-0 Y823G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|21.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|21.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24050|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR PACK-FLEXIPATH 15MM (FPK02)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|688.11|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|688.11|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24059|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PROLENE 5-0 8325H (24")|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|39.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|39.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24066|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-KALTOSTAT 2GRM ROPE-CALCIUM ALGINATE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24068|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRAPE-IOBAN LARGE 6619|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|101.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|101.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24069|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CLOSURE DEVICE TROCARS (CTI-512N)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|675.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|675.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24084|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLOVES-CUT RESISTANT SZ XL (HAMAN)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|285.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|285.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24104|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-LINGEMAN PROCEDURE 3-N-1 PACK|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|331.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|331.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24108|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-FOLEY 18FR 5CC 2WAY (SILVER COAT)SILICON|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24109|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATH-FOLEY 20FR 5CC 2WAY (SILVER COAT)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24122|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-ASPIRATION TRANSBRONCHIAL ENDOSCOPY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|266.65|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|266.65|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24125|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-SILK 0 590H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|15.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|15.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24134|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-12MM BLUNT TIP|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24135|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-12MM BLADED (BALLOON)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24136|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-5MMX100MM OPTICAL ACCESS CFR03|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24137|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-12MM OPTICAL COR29|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24140|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-12MM THREADED 12X150MM C0661|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24148|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETRIEVAL BAG-10MM MONARCH CD001|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|229.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|229.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24160|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-MICRO SAW KM33-410|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|42.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|42.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24161|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-GENERAL ENDOSCOPY DYNJP3100S|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|100.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|100.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24162|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-5MM THREADED CTS02|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|38.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24164|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-10/11 HANDLED BLADELESS C0150|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24199|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-C-ARM (E9100AH)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|108.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|108.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24210|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-SPINAL WHITACRE 22G X 3 1/2" (405010)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|25.10|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|25.10|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24235|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-INTRAOSSEOUS AD 25MM:15GA (PTS 40KG+)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|625.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|625.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24236|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-INTRAOSSEOUS PD 15MM:15GA (PTS 3-39KG)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|625.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|625.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24257|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-4.0 RESECTOR 375-542-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|263.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|263.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24258|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-TOMCAT 4.0MM 375-545-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|263.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|263.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24259|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-5.5 RESECTOR 375-562-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|266.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|266.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24260|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-AGGRESSIVE 3.5 375-638-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|266.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|266.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24261|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-RESECTOR 3.5MM 375-532-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|240.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|240.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24263|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-CUTTER 4.0 375-747-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|263.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|263.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24265|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-BARREL 4.0MM 6-FLUTED 375-941-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|278.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|278.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24268|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-BRONCHO 39FR LFT 125139|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|251.20|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|251.20|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24275|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-AGGRESSIVE 2.5MM (375-628-000)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|285.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|285.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24276|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-ROUND 4.0MM 6 FLUTED 375-940-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|278.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|278.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24280|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BUR-BARREL 5.5MM 6-FLUTE 375-951-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|278.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|278.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24284|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ELECTROLUBE EL101|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|125.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|125.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24316|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-SLOTTED WHISKER 4.0MM 375-548-000|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|263.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|263.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24321|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PACK-SHOULDER CUSTOM DYNJ37891|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|260.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|260.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24324|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SLEEVE-TROCAR 5MMX100 SMOOTH CFS02|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|38.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|38.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24594|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-STIMUPLEX ULTRASOUND 21G X 2"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|56.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24622|SUP|HCPCS C1769||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GUIDEWIRE-STIFF WIRE .038X145CM PTFE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|104.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|104.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24635|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MONOCRYL 3-0 Y427H PS2 27"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|19.60|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|19.60|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24675|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|PERI-STRIPS DRY 60 UNIV. REINFOREMENT|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|979.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|979.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24684|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-RADIAL ARTERY 20G RA-40220(SHORT)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|59.40|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|59.40|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24687|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PDO 0 (POLYDIOXADONE)RA-1029Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|97.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|97.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24689|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-PDO 2 (POLYDIOXANONE) RA-1065Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|111.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|111.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24690|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-MONODERM 2-0 YA-1015Q|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|81.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|81.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24704|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHILON 2-0 593H|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|13.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|13.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24705|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-FIBERWIRE #4 AR-7230-02|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|110.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|110.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24726|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-FIBERWIRE #5 AR-7211|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|200.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|200.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24731|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DISPOSABLE BLADE ASSEMBLY 81010|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|645.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|645.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24732|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-MINI BEAVER ST DOUBLE BEVEL 6900|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|27.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|27.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24733|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-CLIPPER UNIVERSAL DYND70850|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|12.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|12.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24734|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-CLIPPER,UNIVERSAL,GRAY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|10.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|10.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24757|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-CLIPPER NARROW MEDICLIP DYND70860|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|16.30|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|16.30|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24759|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-5MM X150MM BLADED C0Q53|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24761|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-RECIPROCATING BLADE 277-96-275|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|56.85|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|56.85|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24778|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|RETRACTOR-O LARGE ALEXIS (C8403)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|375.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|375.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24813|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ETHIBOND EXCELL 5 MB66G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|68.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|68.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24816|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INCISION-SINGLE GELPOINT SYSTEM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,387.14|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,387.14|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24825|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-FOLEY SILICONE 14FR 5CC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24835|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-5X100KII BLADED Z-THREADED CTB03|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24836|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-11X100 KII BLADED Z-THREADED CTB33|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24837|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-12X100 KII BLADED Z-THREADED CTB73|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24867|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|BLADE-CLIPPER COARSE HAIR DYND70845|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|11.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|11.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24870|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-ENDOLOOP PDS 0 EZ10G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|184.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|184.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24877|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-CHOLANGIOGRAM LAPAROSCOPIC 9100|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|610.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|610.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24878|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|INTRODUCER-MICROINTRODUCER 4.0 FR 21G/7CM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|242.80|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|242.80|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24885|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ENDOCLIP-5MM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|711.35|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|711.35|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24895|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-8MM BLADED THREADED KII|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24903|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-CHG PATCH 1" DISK W/4MM CENTER|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|28.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|28.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24920|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-TROCAR 36FR THORACIC 8888570564|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|37.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|37.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24928|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-WOUND GRANUFOAM MEDIUM|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|244.45|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|244.45|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24929|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-WOUND GRANUFOAM LARGE|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|288.75|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|288.75|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24953|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|ENDO FASCIAL CLOSURE SYSTEM (EFX)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|504.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|504.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24954|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GLOVES-SURGICAL 7 POWDER FREE RADIATION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|159.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|159.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24956|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|GRASPER-MINI GRIP ALLIGATOR|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|825.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|825.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24957|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR 5X100MM OPTICAL Z-THREADED (CTR03)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|76.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|76.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24960|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-FLEX CYSTO INJECTION (MAJ-656)|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|248.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|248.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24963|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|CATHETER-EPIDURAL POLYAMIDE PERFIX 20G|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|844.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|844.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24964|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-TUOHY 20G 3 1/2" 332168|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|500.55|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|500.55|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24965|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-TUOHY 17G 3 1/2"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|539.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|539.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24966|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-TUOHY 17G 4 1/2"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|862.90|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|862.90|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24967|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|LAPARSCOPIC INST PORT - TRIPORT OLYMPUS|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,088.64|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,088.64|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
24968|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-TUOHY 18G 3.5"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|526.25|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|526.25|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25014|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TROCAR-12MMX100MM BLUNT FIRST ENTRY|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|127.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|127.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25033|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DEVICE-SUTURE CAPTURING CAPIO|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,386.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,386.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25034|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|SUTURE-CAPIO 0 833-124|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|170.50|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|170.50|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25040|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080275|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25041|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079886|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25042|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080048|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25043|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2076768|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25044|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080017|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25045|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2007343|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25046|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2075605|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25047|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079205|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25048|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096279|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25049|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096284|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25050|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2092132|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25051|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096621|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25052|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096498|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25053|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096203|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25054|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096245|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25055|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096607|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25056|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096573|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25057|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2093743|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25058|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096210|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25059|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080201|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25060|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096202|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25061|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2093576|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25062|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079184|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25063|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2076618|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25064|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096211|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25065|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080571|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25066|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080552|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25067|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2068973|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25068|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079967|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25069|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2002539|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25070|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2000801|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25071|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079946|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25072|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096133|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25073|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2093772|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25074|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096115|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25075|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080659|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25076|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080924|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25077|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2077424|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25078|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080200|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25079|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2094453|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25080|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2074295|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25081|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080191|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25082|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096111|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25083|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080644|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25084|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080879|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25085|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080792|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25086|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096701|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25087|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2096163|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25088|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080574|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25089|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2066162|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25090|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079213|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25091|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2067260|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25092|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2072812|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25093|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2076494|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25094|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079517|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25095|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2048073|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25096|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2064921|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25097|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2072091|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25098|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2075130|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25099|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2035662|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25100|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080437|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25101|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2048047|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25102|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079906|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25103|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2067275|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25104|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2069945|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25105|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079365|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25106|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2007247|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25107|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2063156|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25108|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2068653|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25109|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080784|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25110|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080631|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25111|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080809|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25112|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2080811|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25113|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2079109|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25114|SUP|HCPCS C1772||0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT|PUMP-SPECTRUM 2068391|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|0.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|0.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25116|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|NEEDLE-STIM 20G 6"|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|1,088.01|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|1,088.01|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25120|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-OPTIFOAM 4X4|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|14.15|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|14.15|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25121|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-OPTIFOAM 6X6|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|23.95|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|23.95|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25122|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-OPTIFOAM SACRUM 7X7|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|50.00|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|50.00|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25164|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|TRAY-CHEST TUBE INSERTION|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|128.05|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|128.05|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported
25169|SUP|Custom 27200001||0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY|DRESSING-QUIKCLOT HEMOSTATIC|1|CARESOURCE [20200]|VAN HB MEDICAID MGD CARE (BUCKEYE, CARESOURCE, MOLINA, UHC MEDICAID COMMUNITY PLAN INCLUDED) [180]|CARESOURCE [202001]|293.70|Inv Loc: 4006001; OR Loc: 4006001||Not reimbursed separately|293.70|Inv Loc: 4006001; OR Loc: 4006001||External grouping not supported