|
EAPG 00163: LEVEL I BLADDER AND KIDNEY PROCEDURES
|
Facility
OP
|
$857.83
|
|
|
Service Code
|
EAPG 00163
|
| Min. Negotiated Rate |
$857.83 |
| Max. Negotiated Rate |
$857.83 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$857.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$857.83
|
|
|
EAPG 00164: LEVEL II BLADDER AND KIDNEY PROCEDURES
|
Facility
OP
|
$1,824.72
|
|
|
Service Code
|
EAPG 00164
|
| Min. Negotiated Rate |
$1,824.72 |
| Max. Negotiated Rate |
$1,824.72 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,824.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,824.72
|
|
|
EAPG 00165: LEVEL III BLADDER AND KIDNEY PROCEDURES
|
Facility
OP
|
$2,868.81
|
|
|
Service Code
|
EAPG 00165
|
| Min. Negotiated Rate |
$2,868.81 |
| Max. Negotiated Rate |
$2,868.81 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,868.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,868.81
|
|
|
EAPG 00169: PERITONEAL DIALYSIS
|
Facility
OP
|
$744.67
|
|
|
Service Code
|
EAPG 00169
|
| Min. Negotiated Rate |
$744.67 |
| Max. Negotiated Rate |
$744.67 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$744.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$744.67
|
|
|
EAPG 00181: CIRCUMCISION
|
Facility
OP
|
$1,184.65
|
|
|
Service Code
|
EAPG 00181
|
| Min. Negotiated Rate |
$1,184.65 |
| Max. Negotiated Rate |
$1,184.65 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,184.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.65
|
|
|
EAPG 00185: PROSTATE NEEDLE AND PUNCH BIOPSY
|
Facility
OP
|
$912.58
|
|
|
Service Code
|
EAPG 00185
|
| Min. Negotiated Rate |
$912.58 |
| Max. Negotiated Rate |
$912.58 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$912.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.58
|
|
|
EAPG 00193: TREATMENT OF INCOMPLETE ABORTION
|
Facility
OP
|
$1,194.97
|
|
|
Service Code
|
EAPG 00193
|
| Min. Negotiated Rate |
$1,194.97 |
| Max. Negotiated Rate |
$1,194.97 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,194.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.97
|
|
|
EAPG 00196: LEVEL I FEMALE REPRODUCTIVE PROCEDURES
|
Facility
OP
|
$1,019.43
|
|
|
Service Code
|
EAPG 00196
|
| Min. Negotiated Rate |
$1,019.43 |
| Max. Negotiated Rate |
$1,019.43 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,019.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,019.43
|
|
|
EAPG 00197: LEVEL II FEMALE REPRODUCTIVE PROCEDURES
|
Facility
OP
|
$2,214.84
|
|
|
Service Code
|
EAPG 00197
|
| Min. Negotiated Rate |
$2,214.84 |
| Max. Negotiated Rate |
$2,214.84 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,214.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,214.84
|
|
|
EAPG 00198: LEVEL III FEMALE REPRODUCTIVE PROCEDURES
|
Facility
OP
|
$3,117.73
|
|
|
Service Code
|
EAPG 00198
|
| Min. Negotiated Rate |
$3,117.73 |
| Max. Negotiated Rate |
$3,117.73 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,117.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.73
|
|
|
EAPG 00199: DILATION AND CURETTAGE
|
Facility
OP
|
$1,163.22
|
|
|
Service Code
|
EAPG 00199
|
| Min. Negotiated Rate |
$1,163.22 |
| Max. Negotiated Rate |
$1,163.22 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,163.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,163.22
|
|
|
EAPG 00200: HYSTEROSCOPY
|
Facility
OP
|
$1,621.24
|
|
|
Service Code
|
EAPG 00200
|
| Min. Negotiated Rate |
$1,621.24 |
| Max. Negotiated Rate |
$1,621.24 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,621.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,621.24
|
|
|
EAPG 00201: COLPOSCOPY
|
Facility
OP
|
$423.83
|
|
|
Service Code
|
EAPG 00201
|
| Min. Negotiated Rate |
$423.83 |
| Max. Negotiated Rate |
$423.83 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$423.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.83
|
|
|
EAPG 00232: LASER EYE PROCEDURES
|
Facility
OP
|
$432.73
|
|
|
Service Code
|
EAPG 00232
|
| Min. Negotiated Rate |
$432.73 |
| Max. Negotiated Rate |
$432.73 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$432.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$432.73
|
|
|
EAPG 00236: LEVEL III ANTERIOR SEGMENT EYE PROCEDURES
|
Facility
OP
|
$2,166.60
|
|
|
Service Code
|
EAPG 00236
|
| Min. Negotiated Rate |
$2,166.60 |
| Max. Negotiated Rate |
$2,166.60 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,166.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,166.60
|
|
|
EAPG 00240: LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE
|
Facility
OP
|
$479.31
|
|
|
Service Code
|
EAPG 00240
|
| Min. Negotiated Rate |
$479.31 |
| Max. Negotiated Rate |
$479.31 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$479.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$479.31
|
|
|
EAPG 00273: MANIPULATION THERAPY
|
Facility
OP
|
$36.64
|
|
|
Service Code
|
EAPG 00273
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$36.64 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.64
|
|
|
EAPG 00274: OCCUPATIONAL/PHYSICAL THERAPY, GROUP
|
Facility
OP
|
$87.13
|
|
|
Service Code
|
EAPG 00274
|
| Min. Negotiated Rate |
$87.13 |
| Max. Negotiated Rate |
$87.13 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$87.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.13
|
|
|
EAPG 00275: SPEECH THERAPY & EVALUATION, GROUP
|
Facility
OP
|
$58.32
|
|
|
Service Code
|
EAPG 00275
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$58.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.32
|
|
|
EAPG 00311: FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE
|
Facility
OP
|
$85.08
|
|
|
Service Code
|
EAPG 00311
|
| Min. Negotiated Rate |
$85.08 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.08
|
|
|
EAPG 00351: LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES
|
Facility
OP
|
$216.49
|
|
|
Service Code
|
EAPG 00351
|
| Min. Negotiated Rate |
$216.49 |
| Max. Negotiated Rate |
$216.49 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$216.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.49
|
|
|
EAPG 00370: LEVEL IV ORAL AND MAXILLOFACIAL SURGERY
|
Facility
OP
|
$625.35
|
|
|
Service Code
|
EAPG 00370
|
| Min. Negotiated Rate |
$625.35 |
| Max. Negotiated Rate |
$625.35 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$625.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.35
|
|
|
EAPG 00416: LEVEL III IMMUNIZATION
|
Facility
OP
|
$181.56
|
|
|
Service Code
|
EAPG 00416
|
| Min. Negotiated Rate |
$181.56 |
| Max. Negotiated Rate |
$181.56 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$181.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.56
|
|
|
EAPG 00421: TUBE REPLACEMENT, REVISION OR REMOVAL
|
Facility
OP
|
$165.17
|
|
|
Service Code
|
EAPG 00421
|
| Min. Negotiated Rate |
$165.17 |
| Max. Negotiated Rate |
$165.17 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$165.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.17
|
|
|
EAPG 00424: DRESSINGS AND OTHER MINOR PROCEDURES
|
Facility
OP
|
$112.28
|
|
|
Service Code
|
EAPG 00424
|
| Min. Negotiated Rate |
$112.28 |
| Max. Negotiated Rate |
$112.28 |
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$112.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.28
|
|
