|
EAPG 518: BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
OP
|
$79.65
|
|
|
Service Code
|
EAPG 00518
|
| Min. Negotiated Rate |
$76.59 |
| Max. Negotiated Rate |
$79.65 |
| Rate for Payer: Anthem Medicaid |
$76.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.59
|
| Rate for Payer: Dean Health Medicaid |
$76.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$76.59
|
| Rate for Payer: Managed Health Services Medicaid |
$79.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$76.59
|
| Rate for Payer: United Healthcare Medicaid |
$76.59
|
| Rate for Payer: WMAP Medicaid |
$76.59
|
|
|
EAPG 519: NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM
|
Facility
OP
|
$56.60
|
|
|
Service Code
|
EAPG 00519
|
| Min. Negotiated Rate |
$54.42 |
| Max. Negotiated Rate |
$56.60 |
| Rate for Payer: Anthem Medicaid |
$54.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.42
|
| Rate for Payer: Dean Health Medicaid |
$54.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$54.42
|
| Rate for Payer: Managed Health Services Medicaid |
$56.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$54.42
|
| Rate for Payer: United Healthcare Medicaid |
$54.42
|
| Rate for Payer: WMAP Medicaid |
$54.42
|
|
|
EAPG 51: MUSCULOSKELETAL EXCISIONS, BIOPSIES, AND DRAINAGE PROCEDURES
|
Facility
OP
|
$773.29
|
|
|
Service Code
|
EAPG 00051
|
| Min. Negotiated Rate |
$743.55 |
| Max. Negotiated Rate |
$773.29 |
| Rate for Payer: Anthem Medicaid |
$743.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$743.55
|
| Rate for Payer: Dean Health Medicaid |
$743.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$743.55
|
| Rate for Payer: Managed Health Services Medicaid |
$773.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$743.55
|
| Rate for Payer: United Healthcare Medicaid |
$743.55
|
| Rate for Payer: WMAP Medicaid |
$743.55
|
|
|
EAPG 520: SPINAL DIAGNOSES AND INJURIES
|
Facility
OP
|
$110.86
|
|
|
Service Code
|
EAPG 00520
|
| Min. Negotiated Rate |
$66.55 |
| Max. Negotiated Rate |
$110.86 |
| Rate for Payer: Anthem Medicaid |
$66.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$110.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.55
|
| Rate for Payer: Dean Health Medicaid |
$66.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.55
|
| Rate for Payer: Managed Health Services Medicaid |
$69.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.55
|
| Rate for Payer: United Healthcare Medicaid |
$66.55
|
| Rate for Payer: WMAP Medicaid |
$66.55
|
|
|
EAPG 521: NERVOUS SYSTEM MALIGNANCY
|
Facility
OP
|
$121.18
|
|
|
Service Code
|
EAPG 00521
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Anthem Medicaid |
$59.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$121.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.50
|
| Rate for Payer: Dean Health Medicaid |
$59.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$59.50
|
| Rate for Payer: Managed Health Services Medicaid |
$61.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$59.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.50
|
| Rate for Payer: WMAP Medicaid |
$59.50
|
|
|
EAPG 522: DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS
|
Facility
OP
|
$88.75
|
|
|
Service Code
|
EAPG 00522
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$88.75 |
| Rate for Payer: Anthem Medicaid |
$55.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.07
|
| Rate for Payer: Dean Health Medicaid |
$55.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$55.07
|
| Rate for Payer: Managed Health Services Medicaid |
$57.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$55.07
|
| Rate for Payer: United Healthcare Medicaid |
$55.07
|
| Rate for Payer: WMAP Medicaid |
$55.07
|
|
|
EAPG 523: MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES
|
Facility
OP
|
$103.96
|
|
|
Service Code
|
EAPG 00523
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Anthem Medicaid |
$49.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$103.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.32
|
| Rate for Payer: Dean Health Medicaid |
$49.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$49.32
|
| Rate for Payer: Managed Health Services Medicaid |
$51.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$49.32
|
| Rate for Payer: United Healthcare Medicaid |
$49.32
|
| Rate for Payer: WMAP Medicaid |
$49.32
|
|
|
EAPG 524: OTHER CENTRAL NERVOUS SYSTEM DIAGNOSES
|
Facility
OP
|
$92.37
|
|
|
Service Code
|
EAPG 00524
|
| Min. Negotiated Rate |
$66.10 |
| Max. Negotiated Rate |
$92.37 |
| Rate for Payer: Anthem Medicaid |
$66.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$92.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.10
|
| Rate for Payer: Dean Health Medicaid |
$66.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.10
|
| Rate for Payer: Managed Health Services Medicaid |
$68.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.10
|
| Rate for Payer: United Healthcare Medicaid |
$66.10
|
| Rate for Payer: WMAP Medicaid |
$66.10
|
|
|
EAPG 526: TRANSIENT ISCHEMIA
|
Facility
OP
|
$118.40
|
|
|
Service Code
|
EAPG 00526
|
| Min. Negotiated Rate |
$102.93 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Anthem Medicaid |
$102.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$118.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.93
|
| Rate for Payer: Dean Health Medicaid |
$102.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$102.93
|
| Rate for Payer: Managed Health Services Medicaid |
$107.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$102.93
|
| Rate for Payer: United Healthcare Medicaid |
$102.93
|
| Rate for Payer: WMAP Medicaid |
$102.93
|
|
|
EAPG 527: PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DIAGNOSES
|
Facility
OP
|
$106.02
|
|
|
Service Code
|
EAPG 00527
|
| Min. Negotiated Rate |
$56.15 |
| Max. Negotiated Rate |
$106.02 |
| Rate for Payer: Anthem Medicaid |
$56.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$106.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.15
|
| Rate for Payer: Dean Health Medicaid |
$56.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$56.15
|
| Rate for Payer: Managed Health Services Medicaid |
$58.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$56.15
|
| Rate for Payer: United Healthcare Medicaid |
$56.15
|
| Rate for Payer: WMAP Medicaid |
$56.15
|
|
|
EAPG 528: ANOXIC AND OTHER SEVERE BRAIN DAMAGE OR COMA
|
Facility
OP
|
$158.95
|
|
|
Service Code
|
EAPG 00528
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Anthem Medicaid |
$86.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$158.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.45
|
| Rate for Payer: Dean Health Medicaid |
$86.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$86.45
|
| Rate for Payer: Managed Health Services Medicaid |
$89.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$86.45
|
| Rate for Payer: United Healthcare Medicaid |
$86.45
|
| Rate for Payer: WMAP Medicaid |
$86.45
|
|
|
EAPG 529: SEIZURE
|
Facility
OP
|
$118.30
|
|
|
Service Code
|
EAPG 00529
|
| Min. Negotiated Rate |
$80.65 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Anthem Medicaid |
$80.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$118.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.65
|
| Rate for Payer: Dean Health Medicaid |
$80.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$80.65
|
| Rate for Payer: Managed Health Services Medicaid |
$83.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$80.65
|
| Rate for Payer: United Healthcare Medicaid |
$80.65
|
| Rate for Payer: WMAP Medicaid |
$80.65
|
|
|
EAPG 52: LEVEL II KNEE AND LOWER LEG PROCEDURES
|
Facility
OP
|
$3,167.77
|
|
|
Service Code
|
EAPG 00052
|
| Min. Negotiated Rate |
$3,045.93 |
| Max. Negotiated Rate |
$3,167.77 |
| Rate for Payer: Anthem Medicaid |
$3,045.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,045.93
|
| Rate for Payer: Dean Health Medicaid |
$3,045.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,045.93
|
| Rate for Payer: Managed Health Services Medicaid |
$3,167.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,045.93
|
| Rate for Payer: United Healthcare Medicaid |
$3,045.93
|
| Rate for Payer: WMAP Medicaid |
$3,045.93
|
|
|
EAPG 530: HEADACHES OTHER THAN MIGRAINE
|
Facility
OP
|
$117.32
|
|
|
Service Code
|
EAPG 00530
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$117.32 |
| Rate for Payer: Anthem Medicaid |
$72.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$117.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.97
|
| Rate for Payer: Dean Health Medicaid |
$72.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$72.97
|
| Rate for Payer: Managed Health Services Medicaid |
$75.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$72.97
|
| Rate for Payer: United Healthcare Medicaid |
$72.97
|
| Rate for Payer: WMAP Medicaid |
$72.97
|
|
|
EAPG 531: MIGRAINE
|
Facility
OP
|
$125.98
|
|
|
Service Code
|
EAPG 00531
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$125.98 |
| Rate for Payer: Anthem Medicaid |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$125.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.74
|
| Rate for Payer: Dean Health Medicaid |
$53.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53.74
|
| Rate for Payer: Managed Health Services Medicaid |
$55.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$125.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$53.74
|
| Rate for Payer: United Healthcare Medicaid |
$53.74
|
| Rate for Payer: WMAP Medicaid |
$53.74
|
|
|
EAPG 532: HEAD TRAUMA WITH OR WITHOUT LOC/COMA LESS THAN 1 HR
|
Facility
OP
|
$163.36
|
|
|
Service Code
|
EAPG 00532
|
| Min. Negotiated Rate |
$97.09 |
| Max. Negotiated Rate |
$163.36 |
| Rate for Payer: Anthem Medicaid |
$97.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$163.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.09
|
| Rate for Payer: Dean Health Medicaid |
$97.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.09
|
| Rate for Payer: Managed Health Services Medicaid |
$100.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.09
|
| Rate for Payer: United Healthcare Medicaid |
$97.09
|
| Rate for Payer: WMAP Medicaid |
$97.09
|
|
|
EAPG 533: AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT
|
Facility
OP
|
$99.46
|
|
|
Service Code
|
EAPG 00533
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$99.46 |
| Rate for Payer: Anthem Medicaid |
$66.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$99.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.34
|
| Rate for Payer: Dean Health Medicaid |
$66.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.34
|
| Rate for Payer: Managed Health Services Medicaid |
$68.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.34
|
| Rate for Payer: United Healthcare Medicaid |
$66.34
|
| Rate for Payer: WMAP Medicaid |
$66.34
|
|
|
EAPG 534: NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION W/O INFARC
|
Facility
OP
|
$92.86
|
|
|
Service Code
|
EAPG 00534
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$92.86 |
| Rate for Payer: Anthem Medicaid |
$51.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$92.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.65
|
| Rate for Payer: Dean Health Medicaid |
$51.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$51.65
|
| Rate for Payer: Managed Health Services Medicaid |
$53.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$51.65
|
| Rate for Payer: United Healthcare Medicaid |
$51.65
|
| Rate for Payer: WMAP Medicaid |
$51.65
|
|
|
EAPG 535: CVA AND PRECEREBRAL OCCLUSION W INFARCT
|
Facility
OP
|
$109.25
|
|
|
Service Code
|
EAPG 00535
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$109.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
| Rate for Payer: WMAP Medicaid |
$97.01
|
|
|
EAPG 536: CEREBRAL PALSY
|
Facility
OP
|
$114.34
|
|
|
Service Code
|
EAPG 00536
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Anthem Medicaid |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$114.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.99
|
| Rate for Payer: Dean Health Medicaid |
$66.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.99
|
| Rate for Payer: Managed Health Services Medicaid |
$69.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.99
|
| Rate for Payer: United Healthcare Medicaid |
$66.99
|
| Rate for Payer: WMAP Medicaid |
$66.99
|
|
|
EAPG 537: MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC
|
Facility
OP
|
$87.30
|
|
|
Service Code
|
EAPG 00537
|
| Min. Negotiated Rate |
$83.94 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Anthem Medicaid |
$83.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.94
|
| Rate for Payer: Dean Health Medicaid |
$83.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83.94
|
| Rate for Payer: Managed Health Services Medicaid |
$87.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$83.94
|
| Rate for Payer: United Healthcare Medicaid |
$83.94
|
| Rate for Payer: WMAP Medicaid |
$83.94
|
|
|
EAPG 538: HEAD TRAUMA WITH LOC/COMA MORE THAN 1 HR
|
Facility
OP
|
$235.90
|
|
|
Service Code
|
EAPG 00538
|
| Min. Negotiated Rate |
$226.83 |
| Max. Negotiated Rate |
$235.90 |
| Rate for Payer: Anthem Medicaid |
$226.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.83
|
| Rate for Payer: Dean Health Medicaid |
$226.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$226.83
|
| Rate for Payer: Managed Health Services Medicaid |
$235.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$226.83
|
| Rate for Payer: United Healthcare Medicaid |
$226.83
|
| Rate for Payer: WMAP Medicaid |
$226.83
|
|
|
EAPG 539: INTRACRANIAL HEMORRHAGE
|
Facility
OP
|
$130.25
|
|
|
Service Code
|
EAPG 00539
|
| Min. Negotiated Rate |
$125.24 |
| Max. Negotiated Rate |
$130.25 |
| Rate for Payer: Anthem Medicaid |
$125.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.24
|
| Rate for Payer: Dean Health Medicaid |
$125.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$125.24
|
| Rate for Payer: Managed Health Services Medicaid |
$130.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$125.24
|
| Rate for Payer: United Healthcare Medicaid |
$125.24
|
| Rate for Payer: WMAP Medicaid |
$125.24
|
|
|
EAPG 53: SPINE INJECTIONS AND OTHER RELATED PROCEDURES
|
Facility
OP
|
$330.11
|
|
|
Service Code
|
EAPG 00053
|
| Min. Negotiated Rate |
$317.41 |
| Max. Negotiated Rate |
$330.11 |
| Rate for Payer: Anthem Medicaid |
$317.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$317.41
|
| Rate for Payer: Dean Health Medicaid |
$317.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$317.41
|
| Rate for Payer: Managed Health Services Medicaid |
$330.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$317.41
|
| Rate for Payer: United Healthcare Medicaid |
$317.41
|
| Rate for Payer: WMAP Medicaid |
$317.41
|
|
|
EAPG 545: PERIPHERAL, CRANIAL, AND AUTONOMIC NERVE INJURIES
|
Facility
OP
|
$78.10
|
|
|
Service Code
|
EAPG 00545
|
| Min. Negotiated Rate |
$75.10 |
| Max. Negotiated Rate |
$78.10 |
| Rate for Payer: Anthem Medicaid |
$75.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.10
|
| Rate for Payer: Dean Health Medicaid |
$75.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$75.10
|
| Rate for Payer: Managed Health Services Medicaid |
$78.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$75.10
|
| Rate for Payer: United Healthcare Medicaid |
$75.10
|
| Rate for Payer: WMAP Medicaid |
$75.10
|
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