|
EAPG 00007: LEVEL II SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
OP
|
$659.25
|
|
|
Service Code
|
EAPG 00007
|
| Min. Negotiated Rate |
$659.25 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$659.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$659.25
|
|
|
EAPG 00008: LEVEL III SKIN DEBRIDEMENT AND DESTRUCTION
|
Facility
OP
|
$946.29
|
|
|
Service Code
|
EAPG 00008
|
| Min. Negotiated Rate |
$946.29 |
| Max. Negotiated Rate |
$946.29 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$946.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$946.29
|
|
|
EAPG 00012: LEVEL I SKIN REPAIR
|
Facility
OP
|
$227.35
|
|
|
Service Code
|
EAPG 00012
|
| Min. Negotiated Rate |
$227.35 |
| Max. Negotiated Rate |
$227.35 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$227.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.35
|
|
|
EAPG 00013: LEVEL II SKIN REPAIR
|
Facility
OP
|
$391.59
|
|
|
Service Code
|
EAPG 00013
|
| Min. Negotiated Rate |
$391.59 |
| Max. Negotiated Rate |
$391.59 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$391.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.59
|
|
|
EAPG 00014: LEVEL III SKIN REPAIR
|
Facility
OP
|
$1,251.87
|
|
|
Service Code
|
EAPG 00014
|
| Min. Negotiated Rate |
$1,251.87 |
| Max. Negotiated Rate |
$1,251.87 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,251.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,251.87
|
|
|
EAPG 00015: LEVEL IV SKIN REPAIR
|
Facility
OP
|
$1,385.19
|
|
|
Service Code
|
EAPG 00015
|
| Min. Negotiated Rate |
$1,385.19 |
| Max. Negotiated Rate |
$1,385.19 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,385.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.19
|
|
|
EAPG 00030: GENERAL MUSCULOSKELETAL PROCEDURES
|
Facility
OP
|
$1,406.81
|
|
|
Service Code
|
EAPG 00030
|
| Min. Negotiated Rate |
$1,406.81 |
| Max. Negotiated Rate |
$1,406.81 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,406.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,406.81
|
|
|
EAPG 00065: RESPIRATORY THERAPY
|
Facility
OP
|
$191.68
|
|
|
Service Code
|
EAPG 00065
|
| Min. Negotiated Rate |
$191.68 |
| Max. Negotiated Rate |
$191.68 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$191.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.68
|
|
|
EAPG 00088: LEVEL I CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE
|
Facility
OP
|
$2,462.59
|
|
|
Service Code
|
EAPG 00088
|
| Min. Negotiated Rate |
$2,462.59 |
| Max. Negotiated Rate |
$2,462.59 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,462.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,462.59
|
|
|
EAPG 00089: LEVEL II CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE
|
Facility
OP
|
$3,146.45
|
|
|
Service Code
|
EAPG 00089
|
| Min. Negotiated Rate |
$3,146.45 |
| Max. Negotiated Rate |
$3,146.45 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,146.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.45
|
|
|
EAPG 00101: LEVEL III CARDIOTHORACIC PROCEDURES W OR W/O VASCULAR DEVICE
|
Facility
OP
|
$8,483.47
|
|
|
Service Code
|
EAPG 00101
|
| Min. Negotiated Rate |
$8,483.47 |
| Max. Negotiated Rate |
$8,483.47 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,483.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,483.47
|
|
|
EAPG 00131: ESOPHAGEAL DILATION WITHOUT ENDOSCOPY
|
Facility
OP
|
$546.19
|
|
|
Service Code
|
EAPG 00131
|
| Min. Negotiated Rate |
$546.19 |
| Max. Negotiated Rate |
$546.19 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$546.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.19
|
|
|
EAPG 00132: ANOSCOPY WITH BIOPSY AND DIAGNOSTIC PROCTOSIGMOIDOSCOPY
|
Facility
OP
|
$518.40
|
|
|
Service Code
|
EAPG 00132
|
| Min. Negotiated Rate |
$518.40 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$518.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$518.40
|
|
|
EAPG 00133: PROCTOSIGMOIDOSCOPY WITH EXCISION OR BIOPSY
|
Facility
OP
|
$628.87
|
|
|
Service Code
|
EAPG 00133
|
| Min. Negotiated Rate |
$628.87 |
| Max. Negotiated Rate |
$628.87 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$628.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.87
|
|
|
EAPG 00139: LEVEL I HERNIA REPAIR
|
Facility
OP
|
$1,843.95
|
|
|
Service Code
|
EAPG 00139
|
| Min. Negotiated Rate |
$1,843.95 |
| Max. Negotiated Rate |
$1,843.95 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,843.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.95
|
|
|
EAPG 00140: LEVEL II HERNIA REPAIR
|
Facility
OP
|
$2,215.52
|
|
|
Service Code
|
EAPG 00140
|
| Min. Negotiated Rate |
$2,215.52 |
| Max. Negotiated Rate |
$2,215.52 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,215.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,215.52
|
|
|
EAPG 00143: LEVEL I GASTROINTESTINAL PROCEDURES
|
Facility
OP
|
$1,330.49
|
|
|
Service Code
|
EAPG 00143
|
| Min. Negotiated Rate |
$1,330.49 |
| Max. Negotiated Rate |
$1,330.49 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,330.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,330.49
|
|
|
EAPG 00144: LEVEL II GASTROINTESTINAL PROCEDURES
|
Facility
OP
|
$3,602.23
|
|
|
Service Code
|
EAPG 00144
|
| Min. Negotiated Rate |
$3,602.23 |
| Max. Negotiated Rate |
$3,602.23 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,602.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,602.23
|
|
|
EAPG 00145: LEVEL I LAPAROSCOPY
|
Facility
OP
|
$2,296.35
|
|
|
Service Code
|
EAPG 00145
|
| Min. Negotiated Rate |
$2,296.35 |
| Max. Negotiated Rate |
$2,296.35 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,296.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,296.35
|
|
|
EAPG 00146: LEVEL II LAPAROSCOPY
|
Facility
OP
|
$2,916.02
|
|
|
Service Code
|
EAPG 00146
|
| Min. Negotiated Rate |
$2,916.02 |
| Max. Negotiated Rate |
$2,916.02 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,916.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,916.02
|
|
|
EAPG 00147: LEVEL III LAPAROSCOPY
|
Facility
OP
|
$3,656.34
|
|
|
Service Code
|
EAPG 00147
|
| Min. Negotiated Rate |
$3,656.34 |
| Max. Negotiated Rate |
$3,656.34 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,656.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,656.34
|
|
|
EAPG 00148: LEVEL IV LAPAROSCOPY
|
Facility
OP
|
$5,338.24
|
|
|
Service Code
|
EAPG 00148
|
| Min. Negotiated Rate |
$5,338.24 |
| Max. Negotiated Rate |
$5,338.24 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,338.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,338.24
|
|
|
EAPG 00149: SCREENING COLORECTAL SERVICES
|
Facility
OP
|
$536.35
|
|
|
Service Code
|
EAPG 00149
|
| Min. Negotiated Rate |
$536.35 |
| Max. Negotiated Rate |
$536.35 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$536.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.35
|
|
|
EAPG 00160: EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
|
Facility
OP
|
$2,035.24
|
|
|
Service Code
|
EAPG 00160
|
| Min. Negotiated Rate |
$2,035.24 |
| Max. Negotiated Rate |
$2,035.24 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,035.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,035.24
|
|
|
EAPG 00162: URINARY DILATATION
|
Facility
OP
|
$221.72
|
|
|
Service Code
|
EAPG 00162
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$221.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.72
|
|
