EAPG 2071: MONTHLY BEHAVIORAL HEALTH CARE AND CASE MANAGEMENT SERVICES
|
Facility
|
OP
|
$36.64
|
|
Service Code
|
EAPG 02071
|
Min. Negotiated Rate |
$35.23 |
Max. Negotiated Rate |
$36.64 |
Rate for Payer: Anthem Medicaid |
$35.23
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.23
|
Rate for Payer: Dean Health Medicaid |
$35.23
|
Rate for Payer: Independent Care Health Plan Medicaid |
$35.23
|
Rate for Payer: Managed Health Services Medicaid |
$36.64
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.23
|
Rate for Payer: United Healthcare Medicaid |
$35.23
|
Rate for Payer: WMAP Medicaid |
$35.23
|
|
EAPG 2072: MONTHLY TREATMENT MANAGEMENT SERVICES
|
Facility
|
OP
|
$18.02
|
|
Service Code
|
EAPG 02072
|
Min. Negotiated Rate |
$17.33 |
Max. Negotiated Rate |
$18.02 |
Rate for Payer: Anthem Medicaid |
$17.33
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.33
|
Rate for Payer: Dean Health Medicaid |
$17.33
|
Rate for Payer: Independent Care Health Plan Medicaid |
$17.33
|
Rate for Payer: Managed Health Services Medicaid |
$18.02
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.33
|
Rate for Payer: United Healthcare Medicaid |
$17.33
|
Rate for Payer: WMAP Medicaid |
$17.33
|
|
EAPG 207: LEVEL I OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES
|
Facility
|
OP
|
$1,004.33
|
|
Service Code
|
EAPG 00207
|
Min. Negotiated Rate |
$965.70 |
Max. Negotiated Rate |
$1,004.33 |
Rate for Payer: Anthem Medicaid |
$965.70
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$965.70
|
Rate for Payer: Dean Health Medicaid |
$965.70
|
Rate for Payer: Independent Care Health Plan Medicaid |
$965.70
|
Rate for Payer: Managed Health Services Medicaid |
$1,004.33
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$965.70
|
Rate for Payer: United Healthcare Medicaid |
$965.70
|
Rate for Payer: WMAP Medicaid |
$965.70
|
|
EAPG 208: LEVEL II OTHER UTERINE AND ADNEXA GYNECOLOGICAL PROCEDURES
|
Facility
|
OP
|
$1,830.61
|
|
Service Code
|
EAPG 00208
|
Min. Negotiated Rate |
$1,760.20 |
Max. Negotiated Rate |
$1,830.61 |
Rate for Payer: Anthem Medicaid |
$1,760.20
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.20
|
Rate for Payer: Dean Health Medicaid |
$1,760.20
|
Rate for Payer: Independent Care Health Plan Medicaid |
$1,760.20
|
Rate for Payer: Managed Health Services Medicaid |
$1,830.61
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,760.20
|
Rate for Payer: United Healthcare Medicaid |
$1,760.20
|
Rate for Payer: WMAP Medicaid |
$1,760.20
|
|
EAPG 209: OTHER GYNECOLOGICAL PROCEDURES
|
Facility
|
OP
|
$229.78
|
|
Service Code
|
EAPG 00209
|
Min. Negotiated Rate |
$220.94 |
Max. Negotiated Rate |
$229.78 |
Rate for Payer: Anthem Medicaid |
$220.94
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$220.94
|
Rate for Payer: Dean Health Medicaid |
$220.94
|
Rate for Payer: Independent Care Health Plan Medicaid |
$220.94
|
Rate for Payer: Managed Health Services Medicaid |
$229.78
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$220.94
|
Rate for Payer: United Healthcare Medicaid |
$220.94
|
Rate for Payer: WMAP Medicaid |
$220.94
|
|
EAPG 20: BREAST BIOPSIES, EXCISIONS, AND OTHER RELATED PROCEDURES
|
Facility
|
OP
|
$974.22
|
|
Service Code
|
EAPG 00020
|
Min. Negotiated Rate |
$552.75 |
Max. Negotiated Rate |
$974.22 |
Rate for Payer: Anthem Medicaid |
$552.75
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$974.22
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.75
|
Rate for Payer: Dean Health Medicaid |
$552.75
|
Rate for Payer: Independent Care Health Plan Medicaid |
$552.75
|
Rate for Payer: Managed Health Services Medicaid |
$574.86
|
Rate for Payer: Molina Healthcare Medicaid |
$974.22
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$552.75
|
Rate for Payer: United Healthcare Medicaid |
$552.75
|
Rate for Payer: WMAP Medicaid |
$552.75
|
|
EAPG 210: EXTENDED EEG STUDIES
|
Facility
|
OP
|
$362.43
|
|
Service Code
|
EAPG 00210
|
Min. Negotiated Rate |
$186.20 |
Max. Negotiated Rate |
$362.43 |
Rate for Payer: Anthem Medicaid |
$186.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$362.43
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.20
|
Rate for Payer: Dean Health Medicaid |
$186.20
|
Rate for Payer: Independent Care Health Plan Medicaid |
$186.20
|
Rate for Payer: Managed Health Services Medicaid |
$193.65
|
Rate for Payer: Molina Healthcare Medicaid |
$362.43
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$186.20
|
Rate for Payer: United Healthcare Medicaid |
$186.20
|
Rate for Payer: WMAP Medicaid |
$186.20
|
|
EAPG 211: ELECTROENCEPHALOGRAM
|
Facility
|
OP
|
$204.65
|
|
Service Code
|
EAPG 00211
|
Min. Negotiated Rate |
$137.69 |
Max. Negotiated Rate |
$204.65 |
Rate for Payer: Anthem Medicaid |
$137.69
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$204.65
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.69
|
Rate for Payer: Dean Health Medicaid |
$137.69
|
Rate for Payer: Independent Care Health Plan Medicaid |
$137.69
|
Rate for Payer: Managed Health Services Medicaid |
$143.20
|
Rate for Payer: Molina Healthcare Medicaid |
$204.65
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$137.69
|
Rate for Payer: United Healthcare Medicaid |
$137.69
|
Rate for Payer: WMAP Medicaid |
$137.69
|
|
EAPG 212: ELECTROCONVULSIVE THERAPY
|
Facility
|
OP
|
$383.12
|
|
Service Code
|
EAPG 00212
|
Min. Negotiated Rate |
$203.70 |
Max. Negotiated Rate |
$383.12 |
Rate for Payer: Anthem Medicaid |
$203.70
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$383.12
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.70
|
Rate for Payer: Dean Health Medicaid |
$203.70
|
Rate for Payer: Independent Care Health Plan Medicaid |
$203.70
|
Rate for Payer: Managed Health Services Medicaid |
$211.85
|
Rate for Payer: Molina Healthcare Medicaid |
$383.12
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$203.70
|
Rate for Payer: United Healthcare Medicaid |
$203.70
|
Rate for Payer: WMAP Medicaid |
$203.70
|
|
EAPG 213: NERVE AND MUSCLE TESTS
|
Facility
|
OP
|
$259.49
|
|
Service Code
|
EAPG 00213
|
Min. Negotiated Rate |
$55.08 |
Max. Negotiated Rate |
$259.49 |
Rate for Payer: Anthem Medicaid |
$55.08
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$259.49
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.08
|
Rate for Payer: Dean Health Medicaid |
$55.08
|
Rate for Payer: Independent Care Health Plan Medicaid |
$55.08
|
Rate for Payer: Managed Health Services Medicaid |
$57.28
|
Rate for Payer: Molina Healthcare Medicaid |
$259.49
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$55.08
|
Rate for Payer: United Healthcare Medicaid |
$55.08
|
Rate for Payer: WMAP Medicaid |
$55.08
|
|
EAPG 214: LEVEL I NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP
|
Facility
|
OP
|
$347.56
|
|
Service Code
|
EAPG 00214
|
Min. Negotiated Rate |
$165.75 |
Max. Negotiated Rate |
$347.56 |
Rate for Payer: Anthem Medicaid |
$165.75
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$347.56
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.75
|
Rate for Payer: Dean Health Medicaid |
$165.75
|
Rate for Payer: Independent Care Health Plan Medicaid |
$165.75
|
Rate for Payer: Managed Health Services Medicaid |
$172.38
|
Rate for Payer: Molina Healthcare Medicaid |
$347.56
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$165.75
|
Rate for Payer: United Healthcare Medicaid |
$165.75
|
Rate for Payer: WMAP Medicaid |
$165.75
|
|
EAPG 217: LEVEL I PERIPHERAL NERVE PROCEDURES
|
Facility
|
OP
|
$845.60
|
|
Service Code
|
EAPG 00217
|
Min. Negotiated Rate |
$559.46 |
Max. Negotiated Rate |
$845.60 |
Rate for Payer: Anthem Medicaid |
$559.46
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$845.60
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$559.46
|
Rate for Payer: Dean Health Medicaid |
$559.46
|
Rate for Payer: Independent Care Health Plan Medicaid |
$559.46
|
Rate for Payer: Managed Health Services Medicaid |
$581.84
|
Rate for Payer: Molina Healthcare Medicaid |
$845.60
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$559.46
|
Rate for Payer: United Healthcare Medicaid |
$559.46
|
Rate for Payer: WMAP Medicaid |
$559.46
|
|
EAPG 218: LEVEL II PERIPHERAL NERVE PROCEDURES
|
Facility
|
OP
|
$3,874.98
|
|
Service Code
|
EAPG 00218
|
Min. Negotiated Rate |
$1,984.74 |
Max. Negotiated Rate |
$3,874.98 |
Rate for Payer: Anthem Medicaid |
$1,984.74
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,874.98
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,984.74
|
Rate for Payer: Dean Health Medicaid |
$1,984.74
|
Rate for Payer: Independent Care Health Plan Medicaid |
$1,984.74
|
Rate for Payer: Managed Health Services Medicaid |
$2,064.13
|
Rate for Payer: Molina Healthcare Medicaid |
$3,874.98
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,984.74
|
Rate for Payer: United Healthcare Medicaid |
$1,984.74
|
Rate for Payer: WMAP Medicaid |
$1,984.74
|
|
EAPG 21: LEVEL I MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES
|
Facility
|
OP
|
$2,230.35
|
|
Service Code
|
EAPG 00021
|
Min. Negotiated Rate |
$1,351.65 |
Max. Negotiated Rate |
$2,230.35 |
Rate for Payer: Anthem Medicaid |
$1,351.65
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,230.35
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,351.65
|
Rate for Payer: Dean Health Medicaid |
$1,351.65
|
Rate for Payer: Independent Care Health Plan Medicaid |
$1,351.65
|
Rate for Payer: Managed Health Services Medicaid |
$1,405.72
|
Rate for Payer: Molina Healthcare Medicaid |
$2,230.35
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,351.65
|
Rate for Payer: United Healthcare Medicaid |
$1,351.65
|
Rate for Payer: WMAP Medicaid |
$1,351.65
|
|
EAPG 220: LEVEL II NERVOUS SYSTEM INJECTIONS INCLUDING CRANIAL TAP
|
Facility
|
OP
|
$630.34
|
|
Service Code
|
EAPG 00220
|
Min. Negotiated Rate |
$531.68 |
Max. Negotiated Rate |
$630.34 |
Rate for Payer: Anthem Medicaid |
$531.68
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$630.34
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.68
|
Rate for Payer: Dean Health Medicaid |
$531.68
|
Rate for Payer: Independent Care Health Plan Medicaid |
$531.68
|
Rate for Payer: Managed Health Services Medicaid |
$552.95
|
Rate for Payer: Molina Healthcare Medicaid |
$630.34
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$531.68
|
Rate for Payer: United Healthcare Medicaid |
$531.68
|
Rate for Payer: WMAP Medicaid |
$531.68
|
|
EAPG 222: SLEEP STUDIES ATTENDED
|
Facility
|
OP
|
$606.41
|
|
Service Code
|
EAPG 00222
|
Min. Negotiated Rate |
$328.43 |
Max. Negotiated Rate |
$606.41 |
Rate for Payer: Anthem Medicaid |
$328.43
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$606.41
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.43
|
Rate for Payer: Dean Health Medicaid |
$328.43
|
Rate for Payer: Independent Care Health Plan Medicaid |
$328.43
|
Rate for Payer: Managed Health Services Medicaid |
$341.57
|
Rate for Payer: Molina Healthcare Medicaid |
$606.41
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$328.43
|
Rate for Payer: United Healthcare Medicaid |
$328.43
|
Rate for Payer: WMAP Medicaid |
$328.43
|
|
EAPG 223: LEVEL I NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION
|
Facility
|
OP
|
$9,838.23
|
|
Service Code
|
EAPG 00223
|
Min. Negotiated Rate |
$2,540.67 |
Max. Negotiated Rate |
$9,838.23 |
Rate for Payer: Anthem Medicaid |
$2,540.67
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,838.23
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,540.67
|
Rate for Payer: Dean Health Medicaid |
$2,540.67
|
Rate for Payer: Independent Care Health Plan Medicaid |
$2,540.67
|
Rate for Payer: Managed Health Services Medicaid |
$2,642.30
|
Rate for Payer: Molina Healthcare Medicaid |
$9,838.23
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,540.67
|
Rate for Payer: United Healthcare Medicaid |
$2,540.67
|
Rate for Payer: WMAP Medicaid |
$2,540.67
|
|
EAPG 224: LEVEL II NEUROSTIMULATOR AND RELATED DEVICE IMPLANTATION
|
Facility
|
OP
|
$17,808.78
|
|
Service Code
|
EAPG 00224
|
Min. Negotiated Rate |
$7,840.45 |
Max. Negotiated Rate |
$17,808.78 |
Rate for Payer: Anthem Medicaid |
$7,840.45
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,808.78
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,840.45
|
Rate for Payer: Dean Health Medicaid |
$7,840.45
|
Rate for Payer: Independent Care Health Plan Medicaid |
$7,840.45
|
Rate for Payer: Managed Health Services Medicaid |
$8,154.07
|
Rate for Payer: Molina Healthcare Medicaid |
$17,808.78
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,840.45
|
Rate for Payer: United Healthcare Medicaid |
$7,840.45
|
Rate for Payer: WMAP Medicaid |
$7,840.45
|
|
EAPG 225: OTHER INTRACRANIAL NEUROSURGERY PROCEDURES
|
Facility
|
OP
|
$1,636.66
|
|
Service Code
|
EAPG 00225
|
Min. Negotiated Rate |
$1,573.71 |
Max. Negotiated Rate |
$1,636.66 |
Rate for Payer: Anthem Medicaid |
$1,573.71
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,573.71
|
Rate for Payer: Dean Health Medicaid |
$1,573.71
|
Rate for Payer: Independent Care Health Plan Medicaid |
$1,573.71
|
Rate for Payer: Managed Health Services Medicaid |
$1,636.66
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,573.71
|
Rate for Payer: United Healthcare Medicaid |
$1,573.71
|
Rate for Payer: WMAP Medicaid |
$1,573.71
|
|
EAPG 226: SLEEP STUDIES UNATTENDED
|
Facility
|
OP
|
$65.60
|
|
Service Code
|
EAPG 00226
|
Min. Negotiated Rate |
$63.08 |
Max. Negotiated Rate |
$65.60 |
Rate for Payer: Anthem Medicaid |
$63.08
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.08
|
Rate for Payer: Dean Health Medicaid |
$63.08
|
Rate for Payer: Independent Care Health Plan Medicaid |
$63.08
|
Rate for Payer: Managed Health Services Medicaid |
$65.60
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.08
|
Rate for Payer: United Healthcare Medicaid |
$63.08
|
Rate for Payer: WMAP Medicaid |
$63.08
|
|
EAPG 227: LEVEL I CRANIOFACIAL BONE PROCEDURES
|
Facility
|
OP
|
$1,129.75
|
|
Service Code
|
EAPG 00227
|
Min. Negotiated Rate |
$1,086.30 |
Max. Negotiated Rate |
$1,129.75 |
Rate for Payer: Anthem Medicaid |
$1,086.30
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,086.30
|
Rate for Payer: Dean Health Medicaid |
$1,086.30
|
Rate for Payer: Independent Care Health Plan Medicaid |
$1,086.30
|
Rate for Payer: Managed Health Services Medicaid |
$1,129.75
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,086.30
|
Rate for Payer: United Healthcare Medicaid |
$1,086.30
|
Rate for Payer: WMAP Medicaid |
$1,086.30
|
|
EAPG 228: LEVEL II CRANIOFACIAL BONE PROCEDURES
|
Facility
|
OP
|
$2,154.76
|
|
Service Code
|
EAPG 00228
|
Min. Negotiated Rate |
$2,071.88 |
Max. Negotiated Rate |
$2,154.76 |
Rate for Payer: Anthem Medicaid |
$2,071.88
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,071.88
|
Rate for Payer: Dean Health Medicaid |
$2,071.88
|
Rate for Payer: Independent Care Health Plan Medicaid |
$2,071.88
|
Rate for Payer: Managed Health Services Medicaid |
$2,154.76
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,071.88
|
Rate for Payer: United Healthcare Medicaid |
$2,071.88
|
Rate for Payer: WMAP Medicaid |
$2,071.88
|
|
EAPG 229: MINOR AUDIOMETRY TESTS AND AUDIOLOGY SCREENING SERVICES
|
Facility
|
OP
|
$13.20
|
|
Service Code
|
EAPG 00229
|
Min. Negotiated Rate |
$12.69 |
Max. Negotiated Rate |
$13.20 |
Rate for Payer: Anthem Medicaid |
$12.69
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.69
|
Rate for Payer: Dean Health Medicaid |
$12.69
|
Rate for Payer: Independent Care Health Plan Medicaid |
$12.69
|
Rate for Payer: Managed Health Services Medicaid |
$13.20
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.69
|
Rate for Payer: United Healthcare Medicaid |
$12.69
|
Rate for Payer: WMAP Medicaid |
$12.69
|
|
EAPG 22: LEVEL II MASTECTOMY AND RECONSTRUCTIVE BREAST PROCEDURES
|
Facility
|
OP
|
$4,107.32
|
|
Service Code
|
EAPG 00022
|
Min. Negotiated Rate |
$3,001.19 |
Max. Negotiated Rate |
$4,107.32 |
Rate for Payer: Anthem Medicaid |
$3,001.19
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,107.32
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,001.19
|
Rate for Payer: Dean Health Medicaid |
$3,001.19
|
Rate for Payer: Independent Care Health Plan Medicaid |
$3,001.19
|
Rate for Payer: Managed Health Services Medicaid |
$3,121.24
|
Rate for Payer: Molina Healthcare Medicaid |
$4,107.32
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,001.19
|
Rate for Payer: United Healthcare Medicaid |
$3,001.19
|
Rate for Payer: WMAP Medicaid |
$3,001.19
|
|
EAPG 230: MINOR OPHTHALMOLOGICAL PROCEDURES AND DIAGNOSTIC SERVICES
|
Facility
|
OP
|
$277.99
|
|
Service Code
|
EAPG 00230
|
Min. Negotiated Rate |
$120.05 |
Max. Negotiated Rate |
$277.99 |
Rate for Payer: Anthem Medicaid |
$120.05
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$277.99
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.05
|
Rate for Payer: Dean Health Medicaid |
$120.05
|
Rate for Payer: Independent Care Health Plan Medicaid |
$120.05
|
Rate for Payer: Managed Health Services Medicaid |
$124.85
|
Rate for Payer: Molina Healthcare Medicaid |
$277.99
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$120.05
|
Rate for Payer: United Healthcare Medicaid |
$120.05
|
Rate for Payer: WMAP Medicaid |
$120.05
|
|